The development of the dental high-speed air turbine handpiece. Part 2

Biofouling of surgical power tools during routine use

Surgical power tools (SPTs) are frequently used in many surgical specialties such as dentistry, orthopaedics, ophthalmology, neurology, and podiatry. They have complex designs that may restrict access to cleaning and sterilization agents and frequently become contaminated with microbial and tissue residues following use. Due to these challenges, surgical power tools can be considered the weak link in the decontamination cycle and present a potential for iatrogenic transmission of infection. We aimed to review the existing literature on the decontamination of surgical power tools and associated iatrogenic transmission of infection. A search of the medical literature was performed using Ovid online using the following databases: Ovid Medline 1950-2014, Embase 1980-2014, and EBM Reviews Full Text--Cochrane DSR, ACP Journal Club, and Dare. Despite challenges to decontamination processes, reported episodes of iatrogenic infection directly linked to SPTs appear rare. This may reflect a true picture but more likely represents incomplete reporting, failure to investigate power tools, or lack of surveillance linking surgical site infections (SSIs) to power tools. Healthcare professionals should be aware of the complexities associated with the decontamination of different SPTs, and should review manufacturers' reprocessing instructions prior to purchase. More clarity is required in the manufacturers' validation of these reprocessing instructions. This particularly applies to the emerging surgical robot systems that present extreme challenges to decontamination between uses. Investigation of cross-infection incidents or SSI surveillance should include an element of assessment of SPT decontamination to further elucidate the contribution of SPTs to skin and soft tissue infections.

Synthetic optimization of air turbine for dental handpieces

A synthetic optimization of Pelton air turbine in dental handpieces concerning the power output, compressed air consumption and rotation speed in the mean time is implemented by employing a standard design procedure and variable limitation from practical dentistry. The Pareto optimal solution sets acquired by using the Normalized Normal Constraint method are mainly comprised of two piecewise continuous parts. On the Pareto frontier, the supply air stagnation pressure stalls at the lower boundary of the design space, the rotation speed is a constant value within the recommended range from literature, the blade tip clearance insensitive to while the nozzle radius increases with power output and mass flow rate of compressed air to which the residual geometric dimensions are showing an opposite trend within their respective "pieces" compared to the nozzle radius.

Failure analysis of the ball bearings of dental air turbine handpieces

BACKGROUND

The aim of this study was to identify the nature and causes of deterioration and failure in dental handpiece ball bearings and thus provide guidance for clinical handling for service longevity.

METHODS

The bearings of 36 turbine assemblies were dismantled for visual inspection, documented using a digital camera, and examined using scanning electron microscopy, as appropriate.

RESULTS

For the metal parts of the ball bearing assembly, defects observed were mainly wear arising from the running load and corrosion. This was in the form of scratches and discoloured circumferential bands on the balls, and dull or worn surfaces extending around the circumference of the raceways. Cage damage including cracking, fracture, surface rubbing and distortion occurred, in varying degrees, in every failed turbine.

CONCLUSIONS

Dental ball bearing failure modes have been identified. Cumulative effects of damage from corrosion and mechanical factors lead to handpiece deterioration. The cage was found to be very vulnerable to damage, and this may be the key limitation on bearing lifetime. Autoclaving may contribute to that, as it does to corrosion in the absence of adequate lubrication, but this seems to be minor in comparison to the effects of abuse. There is no justification for failing to observe usage and sterilization instructions.

Dental handpiece contamination: a proteomics and surface analysis approach

Dental handpieces (DHPs) become biofouled internally with patient derived material that is difficult to access for removal and inactivation. This study undertook a quantitative and qualitative investigation of protein contamination of internal components from three different types of DHP: the turbine, slow speed contra-angle and surgical. Eluates from the high speed turbine, low speed spray channels and surgical gear were assayed for protein using an orthophthaldehyde assay. Eluates concentrated by Amicon ultrafiltration were also analysed by SDS-PAGE, mass spectroscopy, Western blotting and ELISA. The surfaces of handpiece components were also investigated by SEM, EFSCAN and EDAX microscopy. Surgical gears contained highest levels of protein (403 μg), followed by low speed spray channels (17.7 μg) and the high speed turbine (<5 μg). Mass spectroscopy of surgical gears demonstrated mostly serum derived proteins. Decontamination of the DHPs using an automated washer disinfector and handpiece irrigator showed a significant reduction in residual protein levels.

Are friends electric?: A review of the electric handpiece in clinical dental practice

Contemporary restorative procedures demand precise detail in tooth preparation to achieve optimal results. Inadequate tooth preparation is a frequent cause of failure. This review considers the electric high-speed, high-torque handpiece and how it may assist clinicians in achieving greater accuracy in tooth preparation.

CLINICAL RELEVANCE

The electric handpiece provides a satisfactory alternative to the air-turbine and may be considered by clinicians who wish greater control with operative procedures.

Vibration characteristics of dental high-speed turbines and speed-increasing handpieces

OBJECTIVES

Vibrations of dental handpieces may contribute to symptoms of hand-arm vibration syndrome in dental personnel and iatrogenic enamel cracking in teeth. However, methods for measuring dental handpiece vibrations have previously been limited and information about vibration characteristics is sparse. This preliminary study aimed to use a novel approach to assess the vibrations of unloaded high-speed handpieces in vitro.

METHODS

Maximum vibration displacement amplitudes of five air turbines and two speed-increasing handpieces were recorded whilst they were operated with and without a rotary cutting instrument (RCI) using a scanning laser vibrometer (SLV).

RESULTS

RCI rotation speeds, calculated from frequency peaks, were consistent with expected values. ANOVA statistical analysis indicated significant differences in vibrations between handpiece models (p<0.01), although post hoc tests revealed that differences between most individual models were not significant (p>0.11). Operating handpieces with a RCI resulted in greater vibrations than with no RCI (p<0.01). Points on the head of the handpiece showed greater vibration displacement amplitudes than points along the body (p<0.01).

CONCLUSIONS

Although no single measurement exceeded 4 microm for the handpieces in the current test setup (implying that these vibrations may be unlikely to cause adverse effects), this study has formed the basis for future work which will include handpiece vibration measurements whilst cutting under clinically representative loads.

Flow and free running speed characterization of dental air turbine handpieces

OBJECTIVES

Dental air turbine handpieces have been widely used in clinical dentistry for over 30 years, yet little work has been reported on their performance. A few studies have been concerned with measurement of speed (i.e. rotation rate), torque and power performance of these devices, but neither investigations of functional relationships between controlling variables nor theory dealing specifically with this class of turbine have been reported. This has hindered the development of satisfactory methods of handpiece specification and of testing dental rotary cutting tools. It was the intention of the present work to remedy that deficiency.

METHODS

Measurements of pressure, temperature, gas flow rate and rotation rate were made with improved accuracy and precision for 14 ball bearing turbine handpieces on several gases. Functional relationships between gas properties, supply pressure, flow rate, turbine design factors and free running speed were identified and equations describing these aspects of behaviour of this class of turbine developed.

RESULTS

The rotor radius, through peripheral Mach number, was found to be a major determinant of speed performance. In addition, gas flow was found to be an important limiting factor through the effect of choke.

CONCLUSIONS

Each dental handpiece can be treated as a simple orifice of a characteristic cross-sectional area. Free running speed can be explained in terms of gas properties and pressure, with allowance for a design-specific performance coefficient.

Performance of high-speed dental handpieces subjected to simulated clinical use and sterilization

BACKGROUND

The authors investigated the performance of nine commercially available high-speed air-turbine dental handpieces subjected to 1,000 simulated clinical uses and sterilizations.

METHODS

Six new handpieces from each of nine different models were subjected to simulated clinical use with a custom-made handpiece wear tester and then autoclaved. Ten parameters related to clinical performance (longevity, power, turbine speed, fiberoptic transmission, eccentricity, noise, chuck performance, visibility angle, interocclusal clearance and water coolant spray pattern) were measured at baseline and after 250, 500, 750 and 1,000 use/sterilization cycles.

RESULTS

Power, turbine speed, eccentricity and noise performance were statistically analyzed using one-way analysis of variance and Turkey post hoc pairwise comparison tests at the .05 significance level. At baseline, significant differences were found between models for all of these parameters. In general, from baseline to 1,000 cycles, the handpieces exhibited greater eccentricity and reduced fiberoptic performance. Longevity data analyzed by using Gehan's generalized Wilcoxon test for comparison of survival distributions (alpha = .05) revealed significant differences between the handpiece models.

CONCLUSIONS

The results of this study indicate that no handpiece model is superior to the others in all parameters evaluated. All models evaluated can be expected to perform for at least 500 clinical use/sterilizations, or approximately one year, if properly maintained.

CLINICAL IMPLICATIONS

Clinicians need to be able to identify handpieces that can withstand repeated heat sterilization without loss of performance or longevity. The results of this study will aid clinicians in selecting handpiece models that meet their needs.

Dental air turbine handpiece performance testing

Air turbine handpieces are expected to continue to be widely used as the main means of carrying out dental cutting work and scope exists for further design improvements. An understanding of the theoretical principles governing the performance of these devices seems essential for the systematic development of better handpiece designs and methods of specification. Furthermore, for experimental work on cutting behaviour with air turbine equipment, this knowledge is required for appropriate characterization of the performance of the particular handpiece used with respect to actual rates of energy disposition. The literature relating to air turbine handpiece performance is critically reviewed to assess currently available methods of measuring important variables such as speed, torque, and power. In this, consideration is given to the current state of knowledge of the influence on these variables of air pressure, flow and turbine design features. It is apparent that, although various measurement methods have been described and data for individual handpieces published, no attempt has yet been made to explore the functional relationships that exist between the variables. It is concluded that there is a need to identify the factors influencing turbine performance, to develop measurement systems which would provide adequate accuracy and precision and then to investigate the functional relationships between these relevant variables.

Aspects of the design of modern dental air turbine handpieces

Air turbine handpieces are manufactured with a wide range of alternative design features which may influence their suitability for particular clinical procedures. In this article a general account of these features is presented and their advantages and disadvantages are discussed. Some deficiencies in current methods of stating equipment specifications are reported and suggested improvements are given. Where appropriate, general recommendations are made regarding handpiece selection for clinical practice.