The magnitude of cutting forces at high speed

Evaluation of diamond rotary instruments marketed for removing zirconia restorations

STATEMENT OF PROBLEM

The high strength of zirconia makes the removal of zirconia restorations challenging and time consuming. Whether diamond rotary instruments marketed for removing zirconia restorations are more efficient is unclear.

PURPOSE

The purpose of this in vitro study was to compare the efficiency of diamond rotary instruments specifically marketed to cut zirconia with the efficiency of a conventional diamond rotary instrument.

MATERIAL AND METHODS

Two diamond rotary instruments marketed to cut zirconia (JOTA Zirkon Cut Z838L [JOT] and Intensiv ZirconCut Zr02/10 [IZC]) and a conventional diamond rotary instrument (Intensiv FG 334/6 [IFG]) were tested on 2 zirconia materials: 3Y-TZP (IPS ZirCAD LT) and a multilayered 4Y-TZP (IPS ZirCAD MT Multi). Zirconia specimens (2 mm) were cut under water cooling using a force of 2 N or 6 N. Cutting times and maximum temperatures at the tip of the diamond rotary instruments were recorded. The surface roughness before and after use was measured, and the elemental composition was analyzed.

RESULTS

Overall, cutting times were shorter for IFG (85 seconds) and IZC (100 seconds) than for the JOT (182 seconds). Cutting times were shorter for MT zirconia than for LT zirconia. Higher temperatures (2 N: 24.6 °C, 6 N: 36.7 °C) and lower surface roughness occurred with higher cutting loads. Impurities of diamond particles were seen for JOT. The diamond particle embedding materials were either nickel alloys (IFG and JOT) or a resin material (IZC).

CONCLUSIONS

Diamond rotary instruments marketed for cutting zirconia did not perform better or generate less heat compared with a conventional diamond rotary instrument. A load of 2 N with sufficient water cooling is recommended for cutting zirconia to avoid an extensive temperature increase.

Retrieval of cement-retained zirconia implant-supported crowns with an Er,Cr:YSGG laser

STATEMENT OF PROBLEM

Cement-retained implant-supported crowns can be challenging to retrieve from the abutment once technical or biological issues arise. Removal traditionally requires sectioning the crown with rotary instruments, which causes irreversible damage to the crown and potential damage to the periodontal apparatus stabilizing the implant.

PURPOSE

The purpose of this in vitro study was to evaluate an erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser as a minimally invasive alternative for the retrieval of zirconia implant-supported crowns from titanium abutments. Time, temperature, and structural changes to the crown after retrieval were assessed. Appropriate laser parameters were established for this method of crown retrieval.

MATERIAL AND METHODS

Twenty zirconia crowns were milled for a maxillary left second premolar based on a CAD-CAM implant analog cast. Ten of these crowns were cemented with a noneugenol zinc oxide dental cement (group Temp) (n=10). The remaining 10 were cemented with a self-adhesive universal resin cement (group Resin) (n=10). Er,Cr:YSGG laser irradiation was performed with the Waterlase iPlus for 1-minute cycles. An attempt was made to remove the crown with a mechanical instrument after each cycle. A type K thermocouple continuously recorded temperature at the level of the abutment. For statistical comparison of decementation time and temperature, the Mann-Whitney test was used (α=.05). Scanning electron microscopy of the nonirradiated and the irradiated crowns was used for analysis of structural and dimensional changes.

RESULTS

A significant difference (P<.001) was found in the time ±standard deviation required to retrieve the crowns between group Temp (02:40 ±00:18 minutes:seconds) and group Resin (05:26 ±00:36 minutes:seconds). A significant difference (P<.001) was found in the mean ±standard deviation temperature recorded between group Temp (24.0 ±1.19 °C) and group Resin (25.7 ±0.66 °C). No structural changes to crowns were observed after irradiation.

CONCLUSIONS

Retrieval of cement-retained zirconia implant-supported crowns with an Er,Cr:YSGG laser is safe and efficient. Crowns luted with zinc oxide dental cement were retrieved significantly faster while maintaining a significantly lower average temperature than those luted with resin cement. Laser irradiation for decementation did not cause structural changes to zirconia implant-supported crowns.

The Effect of Water Coolant and Bur Type on Pulp Temperature When Removing Tooth Structure and Restorative Dental Materials

OBJECTIVE

The aim was to compare intrapulp temperature (IPT) changes when flat-fissure diamond burs and pear-shaped tungsten carbide burs were used to cut tooth structure, amalgam, and composite resin with and without water coolant.

METHODS

Thermocouples were inserted into the pulp chamber of extracted intact mandibular molars. The thermocouples were connected to an electronic thermometer that detects temperature every second to an accuracy of 0.1°C. IPT changes were recorded while using a high-speed handpiece during MOD cavity preparations (n=40), composite resin removal (n=40), and amalgam removal (n=40). A two-way ANOVA was used for each procedure to test for the effect of bur (pear-shaped tungsten carbide vs flat-fissured diamond) and water coolant (on vs off), with significant main effects (α=0.05) further analyzed using Tukey's multiple comparison test.

RESULTS

During MOD cavity preparation, water coolant reduced changes in IPT (0.03±0.27°C) compared to no water coolant (1.27±0.29°C) when tungsten carbide burs were used (p<0.05) but not when diamond burs were used. During composite resin removal, tungsten carbide burs had less changes in IPT (0.55±0.18°C) compared to diamond burs (1.66±0.50°C) with no water coolant (p<0.05). Water coolant also reduced changes in IPT (0.09±0.14°C) compared to no water coolant (1.66±0.50°C) when diamond burs were used (p<0.01). Water coolant did not significantly affect IPT when tungsten carbide burs were used. During amalgam removal, tungsten carbide burs had lower changes in IPT (0.56±0.15°C) compared to diamond burs (1.88±0.43°C) with no water coolant (p<0.05). Water coolant also significantly reduced changes in IPT (0.71±0.2°C) compared to no water coolant (1.88±0.43°C) when diamond burs were used (p<0.05) but not when tungsten carbide burs were used.

CONCLUSIONS

Water coolant reduced IPT changes when drilling tooth structure with tungsten carbide burs, but not when removing amalgam or composite. Conversely, water coolant reduced IPT changes when drilling with flat fissure diamond burs to remove amalgam and composite, but not when removing tooth structure. When amalgam and composite were removed without water coolant, the tungsten carbide burs resulted in lower IPT changes than when flat fissure diamond burs were used in the same way.

Bur choice when removing zirconia restorations

PURPOSE

Removal of zirconia restorations can be challenging and time consuming, requiring dental burs with optimal cutting efficiency to minimize iatrogenic complications. Yet, there are very few burs marketed for this purpose and little evidence of their comparative benefit. This study evaluated one specialized bur and compared its cutting efficiency with three general-purpose burs (one single use and two multiple use) MATERIALS AND METHODS: This study was designed to assess the cutting efficiency of four burs on a high strength zirconia substrate. One of these burs is a multiple use bur marketed for high strength ceramics (Komet 4ZR), another is a single use general-purpose bur (Piranha 837.012 coarse), and two are multiple use general-purpose burs (Brassler 6837.31.012C coarse and Komet 6837.314.012 coarse). The cutting efficiency of each bur was determined by measuring the time taken to perform serial 2 mm cuts into a block of zirconia. Ten burs in each group were tested with repeated cuts until the time taken for a 2 mm cut was twice that of the first 2 mm cut (50% loss of efficiency). This study was performed under reproducible conditions using a custom designed and fabricated rig assembly.

RESULTS

The results demonstrated a statistically significant difference in the cutting efficiency between bur types. The single use general-purpose bur (Piranha 837.012) was the most efficient for all cut numbers p <2.2 × 10^-16 . The performance of all burs decreased with each cut, with cutting efficiency dependent on time point/cut number (p = 0.02). The rate of deterioration varied between burs, but this difference was not sufficient to be statistically significant.

CONCLUSIONS

This study demonstrated that a single use bur is more efficient than 3 multiple use burs. The cutting efficiency of a single use general-purpose bur (Piranha 837.012 coarse) on Cerec Zirconia Mono L was statistically superior to that of multiple patient use burs in this study, including one marketed for use on high strength ceramics. Because single use burs are comparatively inexpensive and require no sterilization, they should be strongly considered for the removal of zirconia restorations. This article is protected by copyright. All rights reserved.

Ultrasound device as a minimally invasive approach for caries dentin removal

Abstract The aim of this study was to evaluate the efficacy of an ultrasound device and the dentin surface morphology after removal of the caries dentin lesions by removal rate and scanning electron microscopy (SEM). The Knoop hardness test on the bovine dentin blocks (n = 20, 4x4x2mm) was performed to standardize the samples and only those with 38 ± 2 KHN were included. The dentin blocks were submitted to induction of artificial caries lesions, using the bacterial model. Strains of Streptococcus mutans and Lactobacillus acidophilus were used for 7 days. The caries dentin lesion was removed for 1 min, according to two methods: G1 - carbide bur under low-speed rotation (control group) and G2 - ultrasound device under refrigeration. For the removal rate, the samples were weighed 3 times: T0 (before induction), T1 (after induction) and T2 (after removal). Morphology evaluation of the residual dentin surface was performed by SEM. Data normality was verified by Shapiro-Wilk test (p ≥ 0.240). T-test for independent samples was applied to evaluate the removal rate. A significance level of 5% was adopted. G2 provided lower removal rate than G1 (G1: 3.68 mg and G2 = 2.26 mg). SEM images showed different morphological characteristics between the groups. G2 showed absent of smear layer, while G1 showed a visible smear layer over the surface. We concluded that ultrasound device provides minimally invasive removal with residual dentin exhibiting open dentin tubules and no smear layer formation and no bacteria, which infer the removal of the infected tissue.

Quantifying machining outputs of pristine human teeth relevant to dental preparation procedures

Minimally-assisted tooth repair (MaTR) systems are envisioned to be capable of substituting for the skill of a dentist. If successfully developed, MaTR systems could enable lower-skilled dental technicians to provide dental care at a fraction of the overall medical cost. This paper explores a key initial step towards the development of such systems by quantifying the machining responses of pristine human teeth relevant to dental preparation procedures. The working hypothesis of the study is that such findings will enable the benchmarking of key process planning and control metrics relevant for the future development of MaTR systems. To this end, pristine human cadaver teeth were cut using a computer-controlled motion platform and dental hand-piece. Relevant cutting responses, such as cutting forces, in-process rotational speed of the dental bur, teeth morphology, and bur wear were captured. The trends in cutting forces show the potential for implementing region-specific process parameters for cutting the enamel and dentin regions of the tooth. A feed-per-tooth value of 0.1 µm at rotational speeds of 8 krpm and 50 krpm is seen to cut both the enamel and dentin regions at cutting forces lower than patient discomfort thresholds identified in literature. Cutting force signals were also successfully mapped against the CT-scan data of the tooth. This mapping indicates a clear identification of the enamel/dentin regions, and a transition region that is dependent on cutting parameters, tooth/tool geometry and tool pose. The trends in the in-process rotational speed of the dental bur indicate that stalling of the dental bur occurs at feed per tooth values greater than 0.25 µm. The evidence of stalling can be detected by both a drop in the cutting force signal and by surface morphology changes on the cut surface of the tooth. MaTR systems should be designed to avoid bur stalling regions by either operating at feed per tooth values ≤ 0.25 µm or by the use of dental spindles with higher torque capacity. Lastly, the type of fit present on the shank of the bur is seen to result in differences in the cutting force signals and wear of the cutting edges (flutes) of the dental bur. In general, a right-angle (RA) fit on the shank of the dental bur results in a larger tool runout leading to uneven loads on the flutes and increased tool wear. The friction grip (FG) fit avoids these problems and may be more suited for MaTR systems.

Multivariate evaluation of the cutting performance of rotary instruments with electric and air-turbine handpieces

STATEMENT OF PROBLEM

Laboratory studies of tooth preparation often involve single values for all variables other than the one being tested. In contrast, in clinical settings, not all variables can be adequately controlled. For example, a new dental rotary cutting instrument may be tested in the laboratory by making a specific cut with a fixed force, but, in clinical practice, the instrument must make different cuts with individual dentists applying different forces. Therefore, the broad applicability of laboratory results to diverse clinical conditions is uncertain and the comparison of effects across studies difficult.

PURPOSE

The purpose of this in vitro study was to examine the effects of 9 process variables on the dental cutting of rotary cutting instruments used with an electric handpiece and compare them with those of a previous study that used an air-turbine handpiece.

MATERIAL AND METHODS

The effects of 9 key process variables on the efficiency of a simulated dental cutting operation were measured. A fractional factorial experiment was conducted by using an electric handpiece in a computer-controlled, dedicated testing apparatus to simulate dental cutting procedures with Macor blocks as the cutting substrate. Analysis of variance (ANOVA) was used to assess the statistical significance (α=.05).

RESULTS

Four variables (targeted applied load, cut length, diamond grit size, and cut type) consistently produced large, statistically significant effects, whereas 5 variables (rotation per minute, number of cooling ports, rotary cutting instrument diameter, disposability, and water flow rate) produced relatively small, statistically insignificant effects. These results are generally similar to those previously found for an air-turbine handpiece.

CONCLUSIONS

Regardless of whether an electric or air-turbine handpiece was used, the control exerted by the dentist, simulated in this study by targeting a specific level of applied force, was the single most important factor affecting cutting efficiency. Cutting efficiency was also significantly affected by factors simulating patient/clinical circumstances and hardware choices. These results highlight the greater importance of local clinical conditions (procedure, dentist) in understanding dental cutting as opposed to other hardware-related factors.

Designed experiment evaluation of key variables affecting the cutting performance of rotary instruments

STATEMENT OF PROBLEM

Laboratory studies of tooth preparation are often performed under a limited range of conditions involving single values for all variables other than the 1 being tested. In contrast, in clinical settings not all variables can be tightly controlled. For example, a new dental rotary cutting instrument may be tested in the laboratory by making a specific cut with a fixed force, but in clinical practice, the instrument must make different cuts with individual dentists applying a range of different forces. Therefore, the broad applicability of laboratory results to diverse clinical conditions is uncertain and the comparison of effects across studies is difficult.

PURPOSE

The purpose of this study was to examine the effect of 9 process variables on dental cutting in a single experiment, allowing each variable to be robustly tested over a range of values for the other 8 and permitting a direct comparison of the relative importance of each on the cutting process.

MATERIAL AND METHODS

The effects of 9 key process variables on the efficiency of a simulated dental cutting operation were measured. A fractional factorial experiment was conducted by using a computer-controlled, dedicated testing apparatus to simulate dental cutting procedures and Macor blocks as the cutting substrate. Analysis of Variance (ANOVA) was used to judge the statistical significance (α=.05).

RESULTS

Five variables consistently produced large, statistically significant effects (target applied load, cut length, starting rpm, diamond grit size, and cut type), while 4 variables produced relatively small, statistically insignificant effects (number of cooling ports, rotary cutting instrument diameter, disposability, and water flow rate).

CONCLUSIONS

The control exerted by the dentist, simulated in this study by targeting a specific level of applied force, was the single most important factor affecting cutting efficiency. Cutting efficiency was also significantly affected by factors simulating patient/clinical circumstances as well as hardware choices. These results highlight the importance of local clinical conditions (procedure, dentist) in understanding dental cutting procedures and in designing adequate experimental methodologies for future studies.

Evaluation and prevention of enamel surface damage during dental restorative procedures

BACKGROUND

This study examined the effect of operator experience, dominance, tooth position and access, on frequency and extent of iatrogenic damage to approximal tooth surfaces during conventional Class II cavity preparations. The effectiveness of protective devices in minimizing damage was also explored.

METHODS

10 students and 10 experienced dentists each prepared 24 Class II cavity preparations in typodont teeth without protection; 10 utilizing stainless steel matrix bands and 10 utilizing protective wedges. The frequency and extent of damage were analysed with respect to the above variables. Subsequently, 20 natural and 20 typodont teeth were utilized to establish the relationship in depth of damage caused by a high-speed diamond bur on typodont versus natural teeth.

RESULTS

Dentists caused iatrogenic damage on 74% of approximal surfaces without protection, which fell to 50% and 46% respectively when matrix bands and wedges were used as guards. The corresponding rates of damage for students were 94%, 80% and 44%. There was no difference in depth of damage caused on the two types of teeth when bur was in contact with teeth for a very short time.

CONCLUSIONS

Greater operator experience and the use of guards reduces iatrogenic damage to proximal surfaces during preparation with high-speed rotary instruments.

Changes in the cutting efficiency of different types of dental diamond rotary instrument with repeated cuts and disinfection

STATEMENT OF PROBLEM

Cutting efficiency is one of the most important factors to consider when a specific dental diamond rotary instrument is selected. However, the selection of a dental diamond rotary instrument is based on clinical experience rather than any scientific evidence.

PURPOSE

The purpose of this study was to identify how the cutting efficiency of different types of dental diamond rotary instrument changed with repeated cuts and disinfection.

MATERIAL AND METHODS

Four types of diamond rotary instrument from 2 dental manufacturers (Shofu, Jin Dental) were investigated with a high-speed air-turbine handpiece. The groups were as follows: S cham group (n=10): chamfer design from Shofu; J cham group (n=10): chamfer design from Jin Dental; S thin group (n=10): thin tapered design from Shofu; J thin group (n=10): thin tapered design from Jin Dental. Changes in the cutting efficiency of diamond rotary instruments on glass ceramic blocks were measured after repeated cuts. Changes in cutting efficiency also were measured for 30 diamond rotary instruments, the same type as those used in group J cham after disinfection with ethylene oxide gas, immersion in solution, or autoclaving. One-way ANOVA, 2-way ANOVA, and repeated-measures ANOVA were used to identify differences in cutting efficiency, in total cutting efficiency, and change trend in cutting efficiency (α=.05). The Tukey honestly significant difference method was used for the post hoc tests. The principal metal components of the diamond rotary instruments were detected with x-ray spectrometry.

RESULTS

The mean (standard deviation [SD]) total cutting efficiency after 10 cuts in the 4 groups was in the following order: J cham group (0.210 ± 0.064 g/min) > S cham group (0.170 ± 0.064 g/min) > J thin group (0.130 ± 0.042 g/min) > S thin group (0.010 ± 0.040 g/min) (P<.05).The decrease in the cutting efficiency was greatest after the first cut. The cutting efficiency was not influenced by repeated disinfection.

CONCLUSION

The cutting efficiencies of diamond rotary instruments with different designs and particle sizes showed a decreasing trend after repeated cuts but did not show any change after various disinfecting procedures.

Factors Affecting Dental Air-Turbine Handpiece Bearing Failure

Objectives

To investigate the influence of various factors on air-turbine handpiece bearing failure through developing standard protocols for testing the bearing longevity.

Methods

Groups of four air-turbine assemblies (Synea TA-98, W&H, Dentalwerk, Bürmoos, Austria) were subjected repeatedly to a full binary combinatorial set of operating conditions: with and without lubrication, simulated clinical loading, and corrosion protection, all with autoclaving, to the point of failure. A control set was lubricated only. Lubrication (Assistina, W&H), autoclaving (ST-Im30b, Eschmann Bros & Walsh, West Sussex, England), simulated clinical loading (0.56 N at 45° to the turbine axis, after autoclaving), and corrosion protection during autoclaving (magnesium sacrificial anode) were used as required. Free-running speed (Hz) and bearing resistance (μNm) were determined (Darvell-Dyson testing machine) at baseline and after every 10 cycles until turbine failure. Three-way analysis of variance (lubrication × loading × corrosion protection) of log(cycles to failure), with α = 0.05, was used.

Results

All autoclaved turbines had failed by 560 cycles, while the controls failed at 960-1000 cycles. All three main effects were significant: loading (p&lt;10−6), lubrication (p&lt;0.0002), and corrosion protection (p&lt;0.02), as was the interaction lubrication × loading (p&lt;10−6). No other interaction attained significance.

Conclusions

Running under load was the most important factor affecting bearing longevity. While autoclaving clearly has a detrimental effect, lubrication effectively increases longevity. A sacrificial anode may be economically worthwhile to extend life further, but low-load usage patterns, as generally instructed, are confirmed as beneficial.

Students' satisfaction with electrical handpieces in an educational setting

OBJECTIVE

This article presents the evaluation and outcome of improvements carried out at Case Western Reserve School of Dental Medicine (CWRU) based on feedback provided by students during implementation of electrical handpieces technology in the school.

METHODOLOGY

Students were surveyed in February 2010 (first survey) regarding their satisfaction with the existing clinical set-up for electrical handpieces. Following a change in clinical setting and integration of the control box into the dental unit in November 2010, students were administered the same survey as in February 2010 (second survey).

RESULTS

There was an increased level of satisfaction with electric handpieces in the new clinical setting; these levels were significant regarding the ergonomics of the handpiece and clinical setting, operation of the handpiece, and technical maintenance. There was a significant shift from those who were categorically against using electrical handpieces after graduation towards those were 'not sure' regarding the adoption of electric technology in their practice.

CONCLUSIONS

Specifically improving the clinical setting of a control box for electrical handpieces can influence overall student perception regarding the quality of handpieces and their operation.