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.

[Monitoring steam sterilisation processes in the dental office]. / Het monitoren van stoomsterilisatieprocessen in de mondzorgpraktijk.

In dental offices, steam sterilisation is used to sterilise instruments and in that way to prevent the cross-contamination of patients and the dental team. In order to ensure that the sterilisation process has been executed successfully, every sterilisation process has to be monitored. The monitoring of every load in the steam steriliser is necessary and often even required, either directly (by legislation) or indirectly (by harmonised standards). The complete monitoring protocol consists of controls of the installation, the exposure, the loading, the packaging and, finally, the 'track and trace' of the instruments. For examining the installation, a steam penetration test, such as the Bowie and Dick test, can be carried out.

Performance of single-use and multiuse diamond rotary cutting instruments with turbine and electric handpieces.

STATEMENT OF PROBLEM: As single-use rotary cutting instruments and electric handpieces become more available, the performance of these instruments with electric as compared to turbine handpieces requires evaluation. In addition, if rotary cutting instruments marketed as single-use instruments are used for multiple patients, the effects on their performance of cleaning, sterilization, and repeated use are of interest to the clinician. PURPOSE: The purpose of the study was to evaluate how the cleaning, autoclaving, and repeated use of single-use and multiuse rotary cutting instruments, with either a turbine or electric handpiece, affected their performance. MATERIAL AND METHODS: The effects on cutting performance of 2 handpieces (turbine and electric), 2 cleaning and sterilization conditions (cleaned and autoclaved versus noncleaned and nonautoclaved), and 6 different diamond rotary cutting instruments (4 single-use and 2 multiuse) during simulated tooth preparations were evaluated by using a 24-treatment condition full-factorial experimental design. A computer-controlled dedicated testing apparatus was used to simulate the cutting procedures, and machinable glass ceramic blocks were used as the cutting substrate for tangential cuts. In addition, for each treatment condition, 8 consecutive cuts, for a total of 192 cuts, were measured to assess the durability of the rotary cutting instruments. A linear mixed model was used to study the effect of instrument type, handpiece, cleaning, and sterilization, as well as the status and number of cuts on the outcome variables. The Tukey honestly significant difference test was used for the post hoc pairwise comparisons (α=.05). RESULTS: Performance, as measured by the rate of advancement, decreased with the repeated use of rotary cutting instruments (P<.001), while cleaning and sterilization procedures improved the average performance of the 8 cuts (P=.002). The electric handpiece showed a greater load than the turbine (P<.001) and a lower rate/load metric, but no differences in the rate of advancement. Significant differences were also detected among the different rotary cutting instruments tested with the Two Striper, which showed the highest cumulative performance of all groups. CONCLUSIONS: The repeated use of both single-use and multiuse rotary cutting instruments decreased cutting performance. The use of a cleaning and sterilization procedure between cuts improved the average cutting performance. During a tangential cutting process, although the ease of advancement (rate/load) was greater for the turbine, the electric handpiece did not produce a statistically different cutting rate.

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.

Coolant effectiveness in dental cutting with air-turbine handpieces.

OBJECTIVE: To establish a strategy for evaluating coolant effectiveness and to compare typical cooling conditions used in dental cutting. MATERIALS AND METHODS: A test system comprising a resistive heat source and an array of four type K thermocouples was used to compare the cooling effectiveness of air alone, water stream alone, and an air-water spray, as delivered by representative air-turbine handpieces. Mean temperature change at the four sites was recorded for a range of water flow rates in the range 10 to 90 mL min(-1), with and without air, and with and without the turbine running. The thermal resistance of the system, R, was calculated as the temperature change per watt (KW(-1)). RESULTS: For wet cooling (water stream and air-water spray), R was 5.1 to 11.5 KW(-1), whereas for air coolant alone the range was 18.5 to 30.7 KW(-1). R for air-water spray was lower than for water stream cooling at the same flow rate. CONCLUSIONS: The thermal resistivity approach is a viable means of comparative testing of cooling efficacy in simulated dental cutting. It may provide a reliable means of testing handpiece nozzle design, thus enabling the development of more efficient cooling.

Water jet as a novel technique for enamel drilling ex vivo.

To investigate the usage of a water jet for enamel drilling ex vivo, 210 individual extracted molars without lesions or fillings were collected. Then, the specimens were drilled by a water jet or a high-speed dental drill. The cavities of 50 teeth were reconstructed digitally by micro-computed tomography (micro-CT) to measure the height and width. The cavities of 10 teeth were longitudinally incised and their surfaces were observed by scanning electronic microscopy (SEM). After the cavities were filled, 50 fillings were vertically incised. The bonding interface between tooth and filling was observed by SEM. 50 teeth with fillings were stained in 0.1% rhodamine B solution, and then the dye penetration between tooth and filling was observed under the stereomicroscope and confocal laser scanning microscopy (CLSM). The bonding strength between enamel and filling of 50 teeth was simulated and predicted with finite element analysis (FEA). At 140-150 MPa and for 2-3 s, cavities were made with a depth of approximately 764 µm in each tooth. SEM showed the cavity surface in the water jet group had a more irregular concave and convex structure than that in the high-speed dental drill group. There was a trend that the microleakage and bonding width was smaller in the water jet group than in the high-speed dental drill group. FEA indicated that the stress on the resin surface was greater than on the enamel surface in the water jet group. Compared with the tooth drilled by a high-speed dental drill, the tooth drilled by a water jet gained better retention of the filling material and suffered less bonding strength on the enamel surface. Water jet drilling is effective for enamel drilling.

Comparison of cutting efficiencies between electric and air-turbine dental handpieces.

STATEMENT OF PROBLEM: Dentistry is gravitating toward the increased use of electric handpieces. The dental professional should have sufficient evidence to validate the switch from an air-turbine handpiece to an electric handpiece. However, there is little research quantifying the cutting efficiency of electric and air-turbine handpieces. Studies that do quantify cutting efficiency typically do so with only a single material. PURPOSE: The purpose of this study was to compare the cutting efficiency of an electric handpiece and an air-turbine handpiece, using various materials commonly used in dentistry. MATERIAL AND METHODS: Seven materials: Macor (machinable glass ceramic), silver amalgam, aluminum oxide, zirconium oxide, high noble metal alloy, noble metal alloy, and base metal alloy, were each cut with a bur 220 times; 110 times with an electric handpiece, and 110 times with an air-turbine handpiece. The weight difference of the material was calculated by subtracting the weight of the material after a cut from the weight of the material before the cut. The cutting efficiency was calculated by dividing the weight difference by the duration of the cut (g/s). Data were analyzed by a 2-way analysis of variance followed by Tukey's Honestly Significant Difference (HSD) test (alpha=.05). RESULTS: The electric handpiece cut more efficiently than the air-turbine handpiece (F=3098.9, P<.001). In particular, the high noble metal alloy, silver amalgam, and Macor were cut more efficiently with the electric handpiece (0.0383 +/-0.0002 g/s, 0.0260 +/-0.0002 g/s, and 0.0122 +/-0.0002 g/s, respectively) than with the air-turbine handpiece (0.0125 +/-0.0002 g/s, 0.0142 +/-0.0002 g/s, and 0.008 +/-0.0002 g/s, respectively). CONCLUSIONS: The electric handpiece is more efficient at cutting various materials used in dentistry, especially machinable glass ceramic, silver amalgam, and high noble alloy, than the air-turbine handpiece.

In vitro comparison of the cutting efficiency and temperature production of 10 different rotary cutting instruments. Part I: Turbine.

STATEMENT OF PROBLEM: Standards to test the cutting efficiency of dental rotary cutting instruments are either nonexistent or inappropriate, and knowledge of the factors that affect their cutting performance is limited. Therefore, rotary cutting instruments for crown preparation are generally marketed with weak or unsupported claims of superior performance. PURPOSE: The purpose of this study was to examine the cutting behavior of a wide selection of rotary cutting instruments under carefully controlled and reproducible conditions with an air-turbine handpiece. MATERIAL AND METHODS: Ten groups of rotary cutting instruments (n=30) designed for tooth preparation were selected: 9 diamond rotary cutting instruments (7 multi-use, 2 disposable) and 1 carbide bur. One bur per group was imaged with a scanning electron microscope (SEM) at different magnifications. Macor blocks (n=75) were used as a substrate, and 4 cuts were made on each specimen, using a new rotary cutting instrument each time, for a total of 300 cuts. The cuts were performed with an air-turbine handpiece (Midwest Quiet Air). A computer-controlled, custom-made testing apparatus was used to monitor all sensors and control the cutting action. The data were analyzed to compare the correlation of rotary cutting instrument type, grit, amount of pressure, cutting rate, revolutions per minute (rpm), temperature, and type of handpiece, using 1-way ANOVA and Tukey's Studentized Range test (alpha=.05). RESULTS: Compared to the baseline temperature, all rotary cutting instruments showed a reduction of temperature in the simulated pulp chamber. The Great White Ultra (carbide bur) showed a significantly higher rate of advancement (0.15 mm/s) and lower applied load (106.46 g) and rpm (304,375.97). CONCLUSIONS: Tooth preparation with an adequate water flow does not cause harmful temperature changes in the pulp chamber, regardless of rotary cutting instrument type. The tested carbide bur showed greater cutting efficiency than all diamond rotary cutting instruments.

Influence of number of dental autoclave treatment cycles on rotational performance of commercially available air-turbine handpieces.

The influence of number of autoclave treatment cycles (N) on rotational speed and total indicated run-out of commercially available air-turbine handpieces from five manufacturers was investigated at N=0, 50, 100, 150, 200, 250 and 300 cycles, and the significance in the test results was assessed by Dunnett's multiple comparison test. Some air-turbine handpieces showed the significant differences in rotational speed at N=300 cycles, however, the decreases of the rotational speeds were only 1 to 3.5 percent. Some air-turbine handpieces showed the significant differences in total indicated run-out, however, the respective values were smaller than that at N=0 cycle. Accordingly, it can be considered that the ball bearing in the air-turbine handpieces is not affected significantly by autoclave. To further evaluate rotational performance, this study focused on the rotational vibration of the ball bearing components of the air-turbine, as measured by Fast Fourier Transform (FFT) analysis; the power spectra of frequency of the ball's revolution, frequency of the cage's rotation and frequency of the ball's rotation were comparatively investigated at N=0, 150 and 300 cycles, and the influence of autoclave was evaluated qualitatively. No abnormalities in the ball bearings were recognized.

Accuracy of the TCM Endo III torque-control motor for nickel-titanium rotary instruments.

The purpose of this study was to determine the torque output and examine the accuracy of five TCM Endo III torque control motors. A handpiece was attached to the motor and gripped with a vise. A 0.07 taper Orifice Shaper, size 50, was inserted in the handpiece. The instrument tip was clamped in a chuck connected to a torque sensor. Four torque settings were evaluated at 350 rpm. Ten tests were performed at each torque setting. A new instrument was used for each test. The means of the torque values generated by the motors at the different torque levels were analyzed using analysis of variance and post-hoc pairwise comparisons with the Bonferroni test. The actual torque values were significantly higher than the torque preset on the motor (p < 0.0001) and did not differ significantly among the motors (p > 0.05). The actual torque deviated from the preset torque. The usefulness of these motors is questionable.

Performance of engine-driven rotary endodontic instruments with a superimposed bending deflection: V. Gates Glidden and Peeso drills.

A laboratory study was performed on Gates Glidden and Peeso drills to determine the incidence of shaft fracture when a bending deflection was superimposed on the rotating drills. Samples of sizes #1 to #6 stainless steel Gates Glidden drills, sizes #1 to #6 stainless steel and carbon steel-type P Peeso drills, and sizes #009 to #023 carbon steel-type B-1 Peeso drills from each of two manufacturers were evaluated with a unique apparatus that applied a 2-mm bending deflection while rotating the instruments. The apparatus did not restrict movement of the bur head during rotation. The test drills were rotated at 2500, 4000, and 7000 revolutions per minute, and the number of revolutions at failure was recorded. Scanning electron microscopic observations established that the stainless steel Gates Glidden and Peeso drills failed by ductile fracture, whereas the carbon steel Peeso drills failed by brittle fracture. Instrument fracture was always near the handpiece shank with this test, and the length of the fractured drills was measured from the working tip. It is recommended that this additional test be adopted to determine fatigue properties of engine-driven rotary endodontic instruments in establishing international performance standards.

Torque, power and efficiency characterization of dental air turbine handpieces.

OBJECTIVES: In a previous paper the flow and free running speed characteristics of dental air turbine handpieces were discussed. The present work was to continue the analysis and characterization of these handpieces by addressing the issues of torque, power generation, efficiency and the specification of figures of merit to aid comparative testing and selection. METHODS: Using the principle of the rope brake, torque was determined from stall to free running at a variety of supply pressures for fourteen models of handpiece. Using previous results for air flow rate and free running speed, power and efficiency were calculated. RESULTS: Stall torque was demonstrated to depend on rotor position. Dynamic torque was found to closely approach the expected linear relationship over the range from stall to free running. Several figures of merit (performance indices) were identified which might be used for routine rating and specification of handpieces. CONCLUSIONS: Standardized testing can now be performed and effective figures of merit derived to characterize the behaviour of dental air turbine handpieces.

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.

The performance of autoclaved high-speed dental handpieces.

High-speed dental handpieces, which are used so extensively in modern dental practice, may be a source of cross-contamination between patients. A standard autoclave procedure of 121 C for 15 minutes will sterilize the handpieces evaluated in this report. The performance in a standardized laboratory trial showed deterioration of speed in the simulated three-month period. Clinical evaluations for three months showed some minor mechanical problems. These dental handpieces should be used in conjunction with a formal daily and three-month maintenance program.

The effect of handpiece spray patterns on cutting efficiency.

BACKGROUND: High-speed handpieces' spray ports direct coolant at the cutting interface. The authors evaluated the effect of the number of ports and their positions on cutting rates, or CRs. METHODS: The authors performed cutting studies on a machinable ceramic block using an established testing regimen. One-port, three-port and four-port handpieces from one manufacturer were operated at maximum torque and rotation speed under a water flow of 25 milliliters per minute. The authors made 6-millimeter long edge and groove cuts in 13-mm cross-section blocks using six medium-grit diamond burs for each handpiece. Each bur cut a total of 78 mm. The authors determined CR as the time to transect the block and analyzed the data by two-way analysis of variance with post hoc Scheffé tests. RESULTS: CRs varied by the type of cut and the number of spray ports. No differences were found in CRs for the three handpieces during edge cutting. The one-port handpiece cut significantly slower (P < .001) than did the three- and four-port handpieces during groove cutting. CONCLUSION: The data indicate that the number of handpiece spray ports, and their positioning relative to the bur affect water supply to the cutting interface and, consequently, the CR under these study conditions. CLINICAL IMPLICATIONS: Optimal cutting efficiency requires good coolant access, especially within restricted areas. A multiple-port handpiece may be advantageous when preparing the interproximal region for a crown or a proximal box, owing to the better water spray pattern. Dentists should consider the influence of the number of spray ports when selecting handpieces for cutting procedures.

An in vitro study of various instruments for root planing.

Rotating instruments are becoming increasingly significant in the scaling and planing of the root surface. The objective of this in vitro study was to test various root-planing instruments on extracted teeth and then to compare the treated surfaces using scanning electron microscopy. Two manual instruments (scaler and curette) and five mechanically rotating instruments (Desmo-Clean; Perio-Set; Viking-Set; and 40-microns and 15-microns diamond finishers) were investigated. From a total of 42 teeth, six root surfaces were treated with each instrument. The results confirm the clear superiority of the manual instruments (especially the curette). The manual instruments permit good root planing with minimum ablation from the root surface and only a thin smear layer (a compound of grinding dust, dentinal fluid, and water). The best planing results by rotating instruments were achieved with the Desmo-Clean and the 15-microns diamond finisher, whose performance was almost equal to that of the manual instruments. The rotating instruments, however, were associated with higher ablation and a marked smear layer. Manual instruments remain the media of choice on easily accessible root surfaces; however, rotating instruments are of advantage in inaccessible areas (eg, furcations) because of their handling properties.

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.

The present status of dental rotary cutting performance tests.

Appropriate methods of assessing the cutting ability of handpiece and rotary cutting instrument combinations are needed for research into the processes involved in dental cutting. They are also required for the development of improved devices and recommendations on operation as well as for equipment specification and standards testing. In reviewing the literature on dental rotary cutting performance testing to evaluate available methods, the factors which may influence clinical cutting behaviour are identified as those related to characteristics of the operator, handpiece, rotary cutting instrument, coolant/lubricant used and workpiece material. Existing industrial cutting theory is of limited help in understanding dental cutting in view of the differences between the control of relevant variables in the two cases. Consideration is given to the ways in which the important variables have (or have not) been controlled in past studies of dental cutting and thus the clinical relevance of available methods evaluated. Serious problems such as the lack of suitable test workpiece materials, as well as deficiencies in current knowledge of operator behaviour, handpiece characteristics and effects of coolant/lubricant application are noted. It is concluded that before improved, clinically relevant tests can be developed, further fundamental research in these areas is essential and that until this is done, further work under arbitrary experimental conditions would be of little value.

Handpiece degradation associated with performance testing of diamond rotary cutting instruments.

Reliable standardized testing of dental rotary cutting instruments remains a problem because of the many significant parameters that require identifying and quantifying. In a previous study, handpiece wear or degradation was identified as a potentially significant confounding variable leading to the suggestion that the use of industrial handpieces might be necessary. Therefore, the objective of this investigation was to measure and compare industrial and dental air rotor degradation during a simulated diamond rotary cutting instrument test. Two dental and two industrial products were tested in a random sequence using three replicate samples of each air rotor. The simulated test consisted of 10 diamond instruments each making 90 passes through a float glass substrate. The testing apparatus comprised a computer-interfaced device that controlled the contact force between the cutting diamond and the substrate. Air rotor performance was based on the time required to cut a standardized path through the substrate. The performance change that occurred from diamond instrument to instrument during the simulated test was attributed to air rotor degradation. Multiple regression analyses showed significant differences between replicate samples of the same type and between regression intercepts for different air rotor types. Surprisingly, four air rotors exhibited improving performance during the simulated test. Changing air rotor performance must be considered to achieve reliability for the testing of diamond rotary cutting instruments.

Effect of the spray pattern, water flow rate, and cutting position on the cutting efficiency of high-speed dental handpieces.

The aim of this study was to evaluate the effect of the spray pattern, water flow rate, and cutting position on the cutting efficiency of high-speed dental handpieces. One- and three-port high-speed handpieces were selected. Cutting efficiency (mm/s) in different cutting positions was evaluated in vitro on machinable ceramic underwater flow rates of 15, 25, and 35 mL/min. Statistical analysis revealed significant differences in cutting efficiency for the various cutting positions and flow rates. The authors recommend multiport handpieces with a flow rate greater than 30 mL/min for use in clinical practice, especially during groove cutting.