The Latest on Electric and Air-Driven Handpieces

You're listening to the Phil Klein Dental Podcast Thanks for joining us. I'm Dr. Phil Klein. Today, we'll be discussing some important improvements and modifications in both electric and air-driven handpieces. Additionally, we'll address some really important tips on how to extend the life of handpieces. Our guest is Dr. Mark Geissberger. who practices in Greenbrae, California, and was a full professor, department chair, and educator at the University of the Pacific for 30 years. He has published on Restorative Dentistry for the past two decades and teaches many hands-on programs and lectures all over the world. Dr. Geissberger, it's a pleasure to have you on the show. I'm thrilled to be here. Thanks for having me. The handpiece is certainly the workhorse of every dental practice. So any information we can get on it that helps us is certainly appreciated. So to begin, what are the greatest improvements in handpieces over the last two decades? Well, I think the greatest improvement with handpieces is really one of efficiency. You and I are old enough to have used some older handpieces that didn't provide a lot of torque or speed. And as such. were pretty inefficient. It would take us a long time to do a simple preparation. With the advent of higher wattage air-driven handpieces or even electric handpieces with higher torque, the efficiency has just gotten so much better. Smoother preparations, faster preparations, far more effortless and less straining to the dentist. Yeah, when you talk about straining, what about ergonomics? How has the actual handpiece been designed to improve the lifespan of a doctor practicing so that they don't have any problems with ergonomics? Yeah, you know what's changed quite a bit is the weight of handpieces. When the first electrics came out, quite frankly, if you had a smaller hand, they were actually quite cumbersome to work with. And if you were doing a larger case, you know, above four or five units, you would literally get fatigued from holding such a heavy handpiece. So companies have really worked hard to keep that electric motor to a minimum, bring down the weight, change the balance of the handpiece. And even with air driven, we've seen the weight go down substantially. Not only that, the head angles have changed to allow us to keep our elbows closer to our sides. which really adds some great benefits ergonomically for dentists. So when it comes to comparing electric handpieces to air-driven, we hear a lot about that. And for a period of time, and maybe it's still going on now, Dr. Geissberger, the buzz and publicity and marketing has been very highly focused on electric handpieces. So the question is, With the industry heavily focused on electric handpieces, what role, if any, do air-driven handpieces play in dentistry? Yeah, that's a really interesting question. So you're right. Electric handpieces have really become dominated in the marketplace. And that's because there really haven't been much improvements in air-driven handpieces in the last 15 years, while electrics have made huge advances. One of the greatest benefits to an electric handpiece is that high torque. That high torque allows us to do complicated procedures like cutting off zirconia crowns or even an old PFM very efficiently because of the high torque. Keep in mind that electric handpieces are actually moving far slower than a standard air-driven handpiece, but they provide a lot more torque. I always equate electric handpieces to my old cars, and I'm an old car guy, so they're like a Model A. They're not really fast, but they're really torquey, and they do the job. They've got a lot of power. Now, air-drivens have always had high RPMs, but very low torque until real recently. And in fact, NSK, one of the leaders in producing handpieces, is about to launch a new handpiece. The Z990 and Z890, that has double the power of an original air-driven handpiece, which brings it up to about the power of an electric. Now, one of the greatest benefits to that is air-driven are far lighter. So I always found when I first moved to electrics that refining a prep was a bit challenging because you didn't get as much tactile feedback from the handpiece because of the weight. But with an air-driven, because it was lighter, you'd almost feel the prep. You could feel the tooth. So I'm really excited about these new changes with air-driven that we haven't seen in 15 to 20 years. They've been virtually unchanged. Right. So basically what happened is the huge advancements with handpieces were focused on electric. And electric was the big buzz, no pun intended. And then we had these... handpieces, these air-driven handpieces kind of sitting around the office, they're the same handpieces that we got when we were in dental school, when we first was given our dental school kit. So now air-driven is catching up, you're saying. So the technology and the research and development has been funneled more into the air-driven because essentially dentists prefer air-driven, right? I mean, isn't that just the way it is? They do. If they could cut off crowns more efficiently, most dentists would tell you, especially ones with smaller hands, um will tell you you know the electrics are a pretty pretty cumbersome um compared to an air driven but they're not as efficient so what i think nsk focused on is getting those hand pieces to be um equally efficient with higher torque higher wattage um still still the same speed um but higher torque and higher wattage which is hugely beneficial. Right. And also considering half of the dental school class that's graduating now are females. And that's going to be even more so towards the female side as time goes on, as far as the projections go. I know University of Pennsylvania, my alma mater, they're basically putting out more than 50% females. in the graduating class. And usually females have smaller hands than men, right? I mean, that's just the way it is anatomically. So I'm sure that that demographic would be something that these companies thought about that are manufacturing these handpieces. So what can we say about the extension of the life of the handpiece? What does a practitioner do to extend the life of their air-driven handpiece? Okay, so I'll say a few things that are probably universally true for both air-driven and electric. First of all, when you buy your handpiece, it's just like buying a car. There's a certain amount of maintenance you have to do to keep that car's life expectancy up, to keep your handpiece life expectancy up. So regular cleaning, regular lubrication on a cycle. will extend the life of your handpiece. You know, a can of these oils and lubricants are very inexpensive compared to a new handpiece. But what a lot of offices do, they don't have a real good protocol for maintaining the handpieces. That's number one. Number two is to not continually use old burrs that won't cut. We've all had the clinical situation where we're sitting down to a prep and we're starting to prep. And as soon as we lean on the tooth, It won't cut. It's not the handpiece. It's the burr. And we've got a decision to make. Do we ask our assistant to get us a new burr or do we hog through the procedure? Well, sometimes dentists are penny wise pound. foolish, they hog through the procedure. What that does to the turbine is destroy it real quickly. And what that means in your office is you're down a handpiece. You've got to send that in for repair. Now, one of the neat thing about the new NSK Z-990 is they've designed the handpiece should a turbine go out. In about two minutes, you switch it in your practice. You don't have to send the handpiece back in for repair. And it's easy to do, which is a real neat feature. But the way to prevent that, I think, is moving more towards disposable burrs, especially for longer procedures. Because having that brand new sharp instrument will extend the life of your handpieces considerably. Right. Now, are all disposable burrs? similar or, you know, because there's Premier, there's Microcopy, there's a lot of burr companies out there. Is it important to discern between the manufacturers or when it comes to disposable, they're pretty similar? They're fairly similar, given the fact that they're designed to be used as a single session. I have my personal favorites. I really do like the Premier burrs. They work extremely well. and are very efficient. They have a long history with their autoclavable two-striper, but their solo burrs designed for single use, for me, cut beautifully. And I can really be efficient clinically, and I know that I'm not destroying the internal mechanisms of my handpieces. This new handpiece from NSK, is that available or is that coming out soon? I believe it launches in a couple of weeks. I've had it in my office for two months just during the evaluation period. And it's smaller, it's lighter, and it's very efficient. I'm like, wow. My assistant's like, you're not using your electric anymore. I'm like, you know, this thing rocks. It is really a game changer. How does it do with zirconia with a new burr? Oh, it tears to it. It literally tears through it. The other thing that I really like is with the handpiece, and this is something that's very interesting. NSK has engineered a very unique thing internally in the handpiece. So you're pushing on the handpiece, and usually when you lift your foot off the handpiece, the handpiece comes to a very slow stop. It's not a quick stop. Well, they've got a clutching mechanism inside. But as soon as you lift your foot off the rheostat, the burr stops, which is nice because I saw dental students when I was teaching not realize that the burr continued to spin even though their foot was off the rheostat. So they've got this built-in clutching mechanism that stops that. Not only that, they've built in some unique features, and this is new to handpieces, where there's no longer suck back of oral fluids after you turn off the handpiece. So it's kind of a self-purging and prevents internal contamination of the handpiece. So I think it's a really neat addition to something that, in my opinion, hasn't changed in 15 to 20 years, honestly. Yeah. Now, as far as the handpiece goes, access to difficult parts of the mouth posteriorly, where you have a patient that loves not to open their mouth very wide. We love those patients, don't we? Working on tooth number two. Yeah, exactly. A DO. I mean, I was an endodontist for 14 years before I switched into a different profession, running Viva Learning. But I did hit a lot of these kind of patients where they just, with a rubber dam on, the opening was just impossibly narrow and difficult to get back there to do anything. Yeah. Not yet do a root canal, which was very difficult for even an endodontist. So how does that handpiece ergonomically fit into those tight areas? Yeah, so one of the interesting things about air-driven in general is they are a shorter height. So doctors who even use electrics exclusively or almost exclusively will usually have an air -driven standing by because there are clinical situations where you simply cannot get the handpiece in the mouth. With that said, the new 990 from NSK is even shorter profile than a conventional air -driven handpiece. So it really affords you maximum amount of room to get back to those situations. I've had clinical cases where I can't get my electric. And, you know, sometimes it's behind a second molar. I'm trying to prep a crown margin and it's just the patient can't open. And as an endodontist, it must have been brutally hard when you're trying to drill through the occlusal because that's the tallest part of the tooth. Practically made me retire from that profession. Yeah, it was a rough, rough morning when those things happened. Actually, it wasn't always the morning. They often happened, you know, Thursday evening, my last day of the week. I tried not to work on Fridays, but yeah. So let me ask you this last question as we wrap up. What do you say to a dentist who says, well, you know, I buy hand pieces on price? I need a stack of them in the office. We have four operatories running all the time. We can't afford, you know, very expensive hand, or we can afford it, but we just would prefer to buy just a whole handful of these hand pieces. And they're not, they're no name hand pieces. What's your thought on that? Well, honestly, I think that again is being somewhat myopic. I think if you have a really well engineered design hand piece, you shouldn't need as many in your office. especially now that you could switch out a turbine in two minutes if you needed to, if one handpiece went down. So I think that's a huge feature. My observation with these handpieces is they don't spin as concentrically as a well-engineered handpiece like the NSK or even a CAVO is a well-engineered handpiece. And as such, they create a lot of vibration on the teeth, quite frankly. So I think that's one area. We probably shouldn't skimp in dentistry. The most important tool we're using. It is literally the most important tool. Without a doubt, I totally agree. I just wanted to throw that in there for some of our listeners. Last question, sound. How loud is this new advanced handpiece as far as that cacophonus? So it is actually quieter than a standard. It's quieter than a standard air-driven handpiece. It still has that higher pitch compared to an electric, but it's not as high a pitch or as loud as a standard air-driven. So it is quieter. I don't know how many decibels quieter, but I've noticed a big difference. So in closing, when shopping for a handpiece, when a dentist is looking either to replace one that's not functioning well or they need more or they're opening up a new practice and they need to equip their operatories with handpieces, what is the most important consideration? when purchasing handpieces, what's the best way to do it? I think the best way to go about doing that is with some of the more reputable companies, the NSKs, the CAVO. If you're looking to outfit your office with handpieces, most of these companies will give you a loaner handpiece for a couple of weeks. And I think I wouldn't even consider buying from a company that didn't. They let you basically test drive it. Because ultimately, they want to make you a sale, right? So if you try it out, you like it, you like the ergonomics, you like how it feels, I think that's the best way to go about it. I wouldn't go to a trade show and just start buying handpieces unless you bought a bunch and you intended to return them. But that's not really, I don't think, all that fair to the companies. Dr. Geissberger, thank you. much for your time. It's been very enlightening to learn about your experience with handpieces and what you are expecting to hit the market soon from NSK, which is interesting to hear. You certainly have a lot of experience as a teacher, so you know what... hurdles are and the challenges that dental students face and everything else that goes along in private practice, because you've done that for 30 years. So I could see why you were asked to evaluate this new handpiece from NSK. And I'm sure there are other handpieces out there that are also excellent, but it's great to hear your perspective on this new one that's coming out soon. Thank you very much for your time. Really appreciate it. Dr. Klein, thank you for having me. It's been a pleasure and we'll talk again soon, I hope. Be well. If you've been enjoying our podcast, we'd love to hear your thoughts and feedback by leaving a review on your favorite podcast platform, whether it's Spotify, Apple, Google or any other platform you listen on. Leaving a review is a fantastic way to support us and help others discover our show. Thanks for listening. See you next time.