Electric Handpieces in a Post COVID World

July 10, 2020 blog01

Dr. Paschal explains why he switched from air to electric handpieces and how his office eliminated the production of extraoral aerosol.

By: James “Jep” Paschal, DMD, MS

Paschal.jpgI have been in private practice as an orthodontist for 15 years. Before that, I was a private practicing Prosthodontist. Like many of you, generating an aerosol with a high-speed handpiece (HP) is a way of life. Until recently, I considered the aerosol as merely a byproduct of utilizing the dental world’s version of a negative paintbrush. Our handpieces, combined with burs of all shapes, administer the most comfortable and expeditious means of reshaping enamel and removing dental materials from our patient’s teeth. As of this writing, there is no other methodology that meets both the needs of dental professionals and our patients when operating on the dentition.

Unfortunately, when utilizing our traditional air-driven turbines, it is challenging to avoid generating an aerosol. You can’t take a bur inserted into a handpiece, rotate it at approximately 425,000 RPMs with an air pressure of 45-60 psi, spray the working end of the bur with a stream of water and avoid generating an aerosol. Or can you?

As orthodontists, we use the handpiece very differently than a general dentist. Unlike our colleagues, orthodontists do not typically utilize rotary instruments to remove decayed or broken down enamel to make way for restorations. In an orthodontist’s hands, the handpiece is primarily used to remove cured composite resin off the surface, or esthetically or functionally offending enamel. Most of the time, this is performed without the utilization of a water spray. Since we are merely removing composite or enamel from the surface of the teeth, very little heat is generated, and the use of water as a coolant can be safely avoided. This alone will reduce the amount of aqueous aerosol that is generated.

It is with these considerations in mind that I wish to tell you about my story of transitioning from air to electric handpieces. That is, from an $18, imported, disposable, air-driven handpiece, to a state-of-the-art, Tesla of the dental arsenal, electric handpiece (EHP).

About 20 years ago, while still practicing as a prosthodontist, I began hearing about the EHP. The discussions focused on the incredible torque that could be generated at the bur-tooth interface and the subsequent efficiencies that were enjoyed by the clinician. The problems were the head size and weight of the handpiece.

Then, around ten years ago, I started getting tired of hearing the high-pitched sound that the air turbine in the high-speed handpiece generated. The high-pitched squeal that insights fear in our patients the moment they walk into our offices. In an effort to seek greater psychological comfort for the patient I began researching EHP’s again. However, I was deterred once again. But this time by the price. Yes, I am a solo practitioner, and like you, running a business. Everything comes down to cost versus value. I could not justify the expense to equip all of my units in two offices with electric engines and handpieces. To make the value differential even worse, I had discovered the $18 HP’s available on eBay. For less than $200, I could get 10 HP’s that would last about 1-2 years. This significantly tilted the scales against pursuing the EHP’s.

However, just as I continue to dream of owning a Tesla, I would find myself underwhelmed by my handpieces and begin to imagine life with EHP’s again. Then, a few years ago, I was introduced to Komet USA, a premier rotary instrument company. I was hooked from day one. Between the quality of the instruments they produce and the support that we are given, Komet USA supplies me with instruments that improve my abilities as an artist and a clinician. Their Q-Finishers revolutionize the way that we remove composite and finish all of our orthodontic cases. From full bracket debonds to aligner attachment removal, the Q-finishers have become our primary tool.

I was happy. Improved efficiency, and my personal time spent chairside was cut in half due to only having to utilize one Q-finisher to remove all the composite and polish the teeth. What more could I want? Reduced sound! Yes, I still had that squealing chalkboard sound of dentistry ringing throughout the office every time I spun up my handpiece. Striking fear into the hearts and minds of our unsuspecting patients. Once again, Komet USA came to the rescue. They started carrying the Bien-Air handpieces and kindly sent one out for me to evaluate. I immediately fell in love. The handpiece had decreased sound, vastly increased torque, and incredible cutting efficiency. I was in heaven, but I couldn’t justify the price. So, yet again, I held off from purchasing.

Then COVID-19 hit, and it changed everything. Seemingly overnight, we were having discussions around the generation of aerosol and how our team members and other patients were at risk. Colleagues talked about respirators, office airflow, dedicated high volume suction units, oral rinses, etc. All to reduce contaminated aerosols.

We already reduced aerosol generation by not using water spray during composite removal or surface enamel modifications, but I wanted to do more. One evening, I was deliberating on how we could further reduce aerosol dispersion when I remembered my time spent with the Bien-Air EHP from Komet USA. A seemingly unimportant observation was the significant reduction in the air coming out of the head of the EHP and the subsequent decrease in aerosol dispersion. I got on the phone with my friend at Komet USA the next day and had them send another unit for evaluation. This time specifically to evaluate aerosol generation.Bien Air_EVO15_Anti-Retractive Valve

With the Q-Finisher burs at 200,000 RPM’s, there is significantly less visible aerosol generated than what is produced with our air driven turbines. And when we reduced the speed down to 100,000 RPM’s, we saw even less aerosol dispersed extraorally without a significant loss in cutting efficiency. Add a well-placed high-volume evaluator (HVE), and we found we could effectively eliminate the production of extraoral aerosol. And the noise? When the speed is decreased to 100,000 RPM’s, the sound becomes negligible when compared to air turbines.

With reduced aerosol and sound, and increased torque and efficiency, the time was right to purchase. Now there was a sufficient value proposition to push me over the edge and buy EHP’s for every dental unit.

Over the past few weeks, I have come to truly enjoy all the positive benefits of equipping our offices with electric handpieces, and our patients have taken note. All air-driven handpieces have been removed, and even the staff utilize the same EHP at slow speed when they need a rotary instrument.

Thankfully, COVID-19 has been less substantial than was once predicted. However, it is a significant infection for a specific cohort of our patients. It has reminded us that we need to be mindful of the aerosol that we generate in our offices. Through the utilization of EHP’s, HVE, and no water spray, we are now effectively eliminating the extraoral dispersion of aerosol in our orthodontic office.


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