by Joseph A. Blaes, DDS, Editor
I am one of those dentists who can still remember practicing dentistry with a belt-driven handpiece. When I started out on the clinic floor in dental school, only a few of our stand-up, pump-up chairs in the crown and bridge department were equipped with air-driven handpieces; everything else was belt-driven. We had to carry our “triple-section arm” to each chair, and connect the belt and handpiece to the electric motor mounted on the unit right above the cuspidor.
As I recall, our maximum speed (if the motor was in good shape) was about 20,000 RPM. Cutting through enamel was a real challenge. The biggest problem was not to push too hard because the carbide bur would heat up and turn bright red because of the friction. Diamonds were reserved for crown preps. I visited a number of dental offices during my junior and senior years. The more progressive offices had the newest in high speed - the Paige-Chayes system. Its motor turned at a higher RPM and was connected to an improved belt system. This gave the dentist speeds up to 90,000 RPM. The only problem was that it screamed like a banshee and you better not be in the way when the belt broke because it usually went flying.
Upon graduation, I joined the United States Navy and was stationed at Camp Lejeune, N.C. Luckily, the clinics had just been retrofitted with the brand new “Borden air rotors.” High speed at its finest! In those days, we did a lot of experimentation because nobody had much experience with these new handpieces. They didn’t have a lot of torque, so we learned to use a feather touch. And although they were really loud, we didn’t burn up any more carbide burs.
Fast-forward to the late 1980s when I first experienced an electric handpiece. A salesman for a German equipment company stopped by the office to show me a brand new handpiece driven by an electric motor. For a change, I outtalked him and convinced him to leave a demo for me to try. Fate stepped in there because the salesman changed jobs and the company did not know I had the electric handpiece. I used it for eight months before it broke down and needed service. The company picked up the handpiece and demo unit. The company only sold the electric handpiece attached to a specific operatory unit. You had to buy the whole package to get the handpiece. So I did. That was one of the dumbest things I ever did because I found out the unit worked OK but the handpiece had constant service problems. I think it spent more time in the mail than it did in my office. After about 18 months, I junked the handpiece and the unit. That was an expensive lesson. But I really missed my electric handpiece!
I went back to my air-driven handpiece with average bur speeds of 400,000 to 420,000 RPM, which gave me 14 to 18 watts of cutting power at the bur. This is a technical way of saying what you all already know - the bur will slow down and eventually stop with applied pressure. We adapted by using a “feather” prep. The noise level in the office went up again with the whine of air-driven handpieces. How often have you heard a patient say, “If you could just get rid of the noise, this wouldn’t be too bad”? Most air-driven handpieces have ball bearings in the head, which are susceptible to wear. As they wear, the bur becomes less concentric and begins to wobble, creating “chatter.” And we wonder why patients complain about vibration! On the plus side, air-driven handpieces are lightweight and some have very small heads. Nevertheless, we all still have hand and wrist fatigue.
About 10 years ago, I found another electric handpiece company. Their handpiece would easily retrofit to my existing unit, so I was back in business again. This time, the handpiece did not need service as long as it was properly maintained. Now I have bur speeds that are variable from 84 to 200,000 RPM, which translates to up to 60 watts of cutting power at the bur. With this power, you will experience - for the first time - a constant torque that will not slow down when you apply pressure. Even at lower speeds, you still have ample torque to make precise margins. So, the only thing you have to learn is how to retrain yourself to forget the “feather prep!”
With an electric motor driving the handpiece, you simply put the bur on the tooth and cut it with an ease that you have never experienced before. I found that I was able to cut teeth faster, with less stress both physically and mentally. But, this is not just about speed! I always thought my tooth preparations were great, but now they are even better. Constant torque gives me more control over the bur. I suddenly noticed that my preparations were more precise, and my dentistry had reached a level that I never thought possible. Even my lab noticed the difference. David Block, owner of Aesthetic Porcelain Studios - (800) 544-9605 - called to ask what I was doing differently. David had always told me I had the best preps he had ever seen, but now I was on a new level. The only thing I was doing differently was using the electric handpiece.
I have not even mentioned the advantages for the patient. First off, if I am doing better preps, they are getting better dentistry! But they will notice other things first, such as less of that irritating whine. It isn’t totally eliminated, but noise is reduced by about 65 percent. They will notice no vibration because unlike air rotors, electric handpieces use a gear-driven head design that consistently maintains 90 degrees between the bearings and shaft. This design makes the bur concentric. Patients notice their time in the chair is reduced because I am able to be more efficient. I have yet to have a patient complain about spending less time in the chair. Gosh, if you are more efficient, maybe you could produce more in less time and free up some extra time for more production or perhaps more time for yourself and your family.
I have painted a very rosy picture. Are there disadvantages to the electric handpiece? Probably the first one the naysayers will mention is price. Yes, there is an increased acquisition cost. The electric is more expensive than the air-driven. There is a slight learning curve, which is mainly an appreciation of greater torque and cutting power. The contra angle attaches to the electric motor, making the handpiece longer and heavier than you may be accustomed to. You will learn to balance the handpiece in your hand to dissipate the weight. Women dentists generally have smaller hands so they will need to search more to find lighter and shorter electric systems. Each one of us has to make a buying decision based on our own circumstances. Appreciating the benefits of improved productivity, greater precision, and less physical and mental fatigue can help to make that decision.
How do you proceed if you want to explore the world of electric handpieces? If you are just starting, this is a great time of the year because most of the major dental shows are in the winter and spring. Get out on the exhibit floor and look at the electric handpieces. Almost every major handpiece company now has an electric model. Go to a booth and pick up their handpiece. The first thing you will notice is weight. Ask the sales people to help you balance the handpiece. Then pick up the bone or tooth they’ll have available and start cutting. Give it a real test. I usually drop the diamond into the material about a quarter inch and then proceed to write my name as fast as I can without stopping. In other words, try to stall it. This will give you a real idea about the torque. Then get all the details, ask all of your questions, and move to the next booth.
Don’t buy yet! If you did, you would be buying on the hype. The only way to make an informed decision instead of an emotional one is to use the electric handpiece in your office. So, get with your sales rep and map out a plan to try the handpieces that impressed you. Try two or three brands for comparison. First, set up the demos in your favorite treatment room (it takes less than five minutes to hook one up). Be sure to have some good cases scheduled to try the handpiece on. It is best to arrange your demos close together so you can remember the feel of each one. Then, make your buying decision.
By this time, I think you know I am sold on the electric handpiece. I don’t even have any air-driven handpieces in my ops anymore except for hygiene. I cannot remember anything that has affected my practice as positively as the electric handpiece. No other piece of equipment has given me a greater return on investment. If my electric handpiece were to break down, I'd cancel the day and go home. I could possibly work without an assistant, but not without my electric handpiece.
The rest of this article will summarize the points that I have made about the electric handpiece without all the stories. As Joe Friday would say, “Just the facts.” Is it time to invest in electric?
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What are the technical differences between air-driven and electric handpieces?
Air-driven
Bur speed avg. 400K-420K RPMs = 14-18 watts of cutting power
Bur will slow down and stop with applied pressure resulting in the need to “feather” prep
Air turbines allow for less bur concentricity
Susceptible to “chatter” during procedure
They are loud and create unpleasant high-pitched noise
Lightweight (however hand and wrist fatigue exist with use)
Electric
Bur speed is variable from 84-200,000 RPM = up to 60 watts of cutting power
Bur will not slow down and stop with applied pressure; it maintains constant torque
Greater speed range creates opportunity to use attachments designed for specific parts of a procedure such as endo or implants
Electric handpieces offer greater concentricity at the bur
Little opportunity for “chatter” = cleaner and more precise cut
Electric handpieces offer smoother and quieter operation
Overall noise is reduced, but not silent
Electric handpieces and motor are heavier than air-driven
Advantages and benefits of electric handpieces versus air-driven
No need to “feather” prep. More torque = more cutting power
Less opportunity for pulp damage. Faster cutting = less heat build-up at prep
Precise margins because of greater control in cutting prep
Cleaner, smoother margins. Smoother running = “milling versus chopping”
For patient and doctor, less noise and motion trauma, and less hand fatigue. Less vibration = quieter operation. No “ditching.” Better concentricity eliminates “chatter”
Improved preps and outcomes. Precise applications, more attachment choices, greater speed ranges
Disadvantages of electric
Increased acquisition cost. More expensive than air-driven
Slight learning curve - must modify approach to cutting; no need to “feather.” Get accustomed to greater torque and cutting power. More attachment choices - must choose the right contra-angle for the technique/application
Understanding the costs
Acquisition cost and long-term costs
Is it really a good deal?
Are there additional costs after the initial sale?
Cost of ownership - what it costs to repair and maintain over set timeframe
How much will it cost to use over three to five years?
How often will the attachments need to be sent in for reconditioning? How much will this cost you?
How long is the warranty? What is covered? What isn’t?
Personal costs - What are trade-offs versus air?
What technique changes?
How much will you have to modify your approach?
Change of habits
Using more than one attachment
Appreciate the benefits
Improved productivity
See more patients or have more free time
Greater precision = better preps
Improved margins = improved outcomes
Less physical fatigue
Noticeably reduced hand and wrist fatigue
Less noise pollution
Reduced overall stress
Tips and “how tos” with making your buying decision for electric handpieces
Be committed to buy and use daily
Don’t “kick the tires”
Don’t waste time
Your comfort level will grow with repeated use
Try at least two or three brands
Know what is out there; many good brands are available
Do your homework
Arrange demos one after another
Rely on a fresh memory
Don’t let too much time pass between demos and buying decision
Don’t stick with the brand name you know best for comfort's sake
Electric technology Is different than air. Just because you like the air-driven version doesn’t mean you should go with that brand (be sure you know who made the handpiece - you may be surprised)
Find the best “ergonomic” fit
Electric handpieces are heavier than air-driven
What fits best in your hand? You will use it daily; find what feels as natural as possible
Which brand has best overall comfort for you?
What is easiest for you to use?
Look for the applications and attachments that fit your dentistry
What procedures do you do most?
What features will you need on the control box?
What type of attachments will you need?
How many of each attachment will you need?
When do you sterilize?
How many patients will you see between sterilizations?
Don’t buy “bells and whistles” if you won’t use them. If the unit is full of features you won’t use, they will only get in your way
Look for intuitive, easy-to-use controls
The easier, the better
Understand how to use the entire product
Don’t buy on price (acquisition cost) alone
Look for best warranty and service commitments possible
Know your cost of ownership over time
Keep the overall economic benefits In mind
How easy is the product to clean and maintain?
Most electric systems are just as easy to maintain as air-driven
Look for cleaner and lube combined - one spray can versus two
Make sure your staff will comply
Use common sense and follow the manufacturer’s recommendations
I have some biased (I love my electric handpieces) closing remarks. My best advice to you is to make an informed decision, not an emotional one. Switching to an electric handpiece requires a commitment to use it daily. Don’t let it sit in your treatment room and gather dust (what a waste)! When I got my second electric, I installed it in my favorite treatment room. We all have one of these even if we don’t like to admit it. It’s the room where we and our clinical assistants feel most comfortable. My point is that you don’t need to equip all your rooms at once. You will use it most in your favorite room. Before long you will be so happy with your purchase that you will eventually equip all of your treatment rooms. But most of all, get one because of the enjoyment it will add to your dentistry. Cutting teeth is fun again with an electric handpiece!
