Electric vs. Air Driven Handpieces: The Great Debate

You're listening to the Phil Klein Dental Podcast So what are the advantages, disadvantages, myths, and facts about air-driven handpieces versus electric handpieces? To help us put this all in perspective and give us his expert recommendations on this topic, we'll be speaking with Dr. Foroud Hakim. Dr. Hakim holds a full-time position in the Department of Preventive and Restorative Dentistry at the University of the Pacific. He has maintained a private practice for over 30 years where his deep ties with the dental industry allow for beta testing and consulting for new product evaluation and development. Dr. Hakim, it's a pleasure to have you on the show. It's great to be here, Phil. Always nice talking to you. So over the past 10 years or so, how has the dental handpiece evolved regarding design and power source? That's a great question, and I'll take a step back. I'll start with this. You know, being in practice for a lot of years now and working with a lot of colleagues, I've noticed that doctors kind of mail in or ignore two really important components of their technology. That's curing lights and handpieces. We're very picky about, hey, what's the latest adhesive or composite that we use? What's the latest ceramic? A lot of people relegate themselves to using whatever light or whatever handpiece they kind of inherited when they bought their office or has been there in place forever. And I think that's a big mistake because we're really limiting ourselves. So along the line of handpieces, honestly, handpieces come in two categories, either air -driven or electric. And while electric has lagged behind in the U.S., it's mainly because most folks, when they went to dental school, they were used to being trained with air-driven handpieces. And then they graduate to an office who always has a compressor readily available and typically was already loaded with air-driven handpieces. And so that adoption of electric has lagged behind in the U.S. That said, Europe's quite a bit ahead and there's quite a bit of electric handpiece market share in Europe. I think the U.S. is going to follow because since that time, The dental schools have really started to adopt electric. If they haven't already switched, most of them will be switching. So the new users, the new graduates coming into the practice marketplace will essentially only know electrics. And so I think we're going to see this shift happening. I can go back to my start. And in 1991, when I graduated, I was only trained under air driven. I went to an office, bought the office. They only had air driven. It wasn't even the brand or the type that I was trained under. So it took me a little bit just to adopt to that. But with loans and the costs of the office and all the overhead, it was really hard to say, hey, I'm going to go spend another 5, 10, 15K and renovate the hand pieces. I just learned to live with what I had, which was not great probably in retrospect, but it's what a lot of people are faced with. Tell us about the transition process from air driven to electric. How did you go about exploring electric hand pieces where you found that this is what you want? I had the feeling and I just didn't want to admit it. So my first experience with electrics was probably a few years into graduation, maybe late 90s, early 2000. I would go like a lot of doctors. I was at a trade show. Who knows? Maybe the CDA or the ADA. And you go to the booths and some of the manufacturers had electrics and they pull you in and say, try this. My first experience with the electrics was a non-clinical setting. You're standing at a booth. They give you a piece of bone or some synthetic block, give you this big, heavy electric handpiece, and they step on the rheostat and cut away. And I hated it. I very foolishly said, oh, I'll never go electric. This is silly. And that was very premature of me to make that kind of declaration. I later found out that, yeah, that wasn't really realistic. I wasn't getting the tactile feedback that I thought I wanted. It was heavy. It's not what my hands were used to. I went and looked at it a second time and a third time, and eventually I kind of came around. Yeah, so that initial experience you had, they were big, they were heavy, difficult to get into restricted access areas in the mouth, and they had a whole different feel to them, right, with the rheostat. Certainly, certainly. What have you seen lately as far as design and power regarding air and electric? Because what I'm hearing from other KOLs is that air-driven handpieces, as we know, Many dental practitioners prefer them just for the reasons you mentioned and other reasons that they're smaller, they're lighter, they're what they're used to learning on in dental school, they're what they inherited in the practices they form associates with or they purchase. So they stick with them. And electric hand pieces have, of course, huge advantages in certain areas of torque and power. But is the gap not closing to some extent? It definitely is. And to kind of understand that better, it's good to know. kind of the core competencies of each kind of design. With air-driven handpieces, the ones that are working at the optimal speed, they can go up to 400,000 RPMs. That's a breathtaking number. In fact, when I have patients in my chair that maybe have home shops or do woodworking or in the construction business, I'll sometimes just for fun ask them, how fast do you think this is spinning? And they'll say, I know this is going way faster than my power drill or my Dremel. you're probably doing it 20,000 RPM. And when I tell them it's 400,000 RPM, their jaw drops. So that's a scary number. And it's amazing. It's a credit to dental technology. And in that tiny little head, something can be spinning that fast and it's just not melting down and exploding in the mouth. So that is interesting. But the difference is when you have air driven, the doctors that have trained on that have kind of learned that magic dance. where once it comes across a hard substrate, you're cutting through enamel or non-precious metal or something, it starts to want to stall out. So we've all learned that sketching technique where you sketch out the prep. You dance on and off the tooth. You feather it. You use higher speed when you're prepping. You stall out and do refinement speeds. And so that's that perfect dance that we learned that we were so used to because it was what's comfortable for us. they had to adopt an entire new learning curve with electrics because the electrics now have unlimited torque. You don't really stall out. And that's very empowering in that you can prep or essentially mill rather than jumping off the tooth. You can mill very robotically the preparation that you want, but you have to be careful not to over push and not to have the handpiece get away from you or the burr get away from you. That's really the learning curve between the two. And when somebody figures out that learning curve, they're able to use both technologies pretty efficiently. So in your practice, Dr. Hakim, do you use both air-driven and electric? And if you do, how do you approach the clinical application for each of those hand pieces? Yeah, I absolutely do. And I don't know if that's by design or by accident, because when I built our new office, which is not new anymore, 20 years ago, I came to that office with my old air -driven, but I knew that I was going to go to electric. So I put in lines for both. And eventually, as soon as we put the first electric in the first operatory, I realized, wow, me or my associates are always fighting for that operatory. So next thing you know, we're putting electrics in all of them. But there will always be times, whether it was a small, limited opening, where I'm just working on natural teeth, a pedo situation, things where I really like that light feather touch of the air driven. And so I would pick and choose my battles. And sometimes it comes down to how many units you have and what's in the sterilizer. I can still do dentistry with both, but I have my preferences based on procedure. What about going through a zirconia crown? What do you prefer? Obviously, probably electric. Yeah, electric wins every time. And that's not any different than people that have been doing crown and bridge forever. When we had to cut through really hard, non-precious metals, you know. crowns and bridges that we'd have to take off, rexilium, the torque of the electric helped. Same thing now, the high-strength ceramics, bonded Emax zirconia, the electrics with the right burr definitely give you an advantage. You know, if you're trying to go in there with a weaker, lower watt, air-driven handpiece, you're basically bringing a knife to a gunfight. You're not going to win. So most of the dentists that prefer air-driven, their typical logic behind their preference of air-driven is, What? The handpiece is too large. It's a little bit too heavy. Again, half of our dentists out there are women. They have smaller hands. Have we made advancements in electric where that argument may not hold up because of the new advancements? Yeah, we're definitely shrinking the gap. So I'll address those points plus some of the other points. We know that patients don't love necessarily being in the chair. They all associate that dental drill sound. Well, the air-driven has that higher pitch and more vibration. And so patients will report more comfort or less anxiety when somebody's working on them with an electrocampus. It doesn't have quite the same vibration or chatter. The burrs are more concentric. They come up more smoothly. So while it's still not a day at the spa, it tends to be a more comfortable experience for the patient. Never mind that if the operator can get the preparation done faster, then everybody's the winner there. both for efficiency and productivity and patient in chair time. And then finally, like you said, they've really dialed in the size. They've got tremendous power and torque out of electrics. They have much smaller heads. And more importantly, they've figured out the right counterbalance. So while the handpieces have the right size, a big part of ergonomics and hand fatigue has to do with the weight of either side of the handpiece, the part that's on your fingers and the parts that are over your wrist. If that counterbalance weight is correct, barely feel hand fatigue at that point. And that's where my NSK handpieces are wonderful. I've really had a good time working on patients, not experiencing that hand fatigue, having patients comment the difference between the handpieces. They'll know that, hey, I'm using something different than I used on them the time before. So what would you say to a dentist who's looking to get into the electric handpiece world and they want to make that transition in their practice? Yeah, so this is where I would encourage doctors. If somebody's looking to build a new office or renovate their handpiece armamentarium, I'd say don't go based on your old biases or talk to a colleague that tried something five or six years ago. Find a good company, a good partner. And mine, like I said, is NSK. I think they're wonderful everywhere from warranty to service. They'll be more than happy to come into the office and let you try both. They'll leave loaners if you need for a few weeks. because they've shrunk that gap or difference. If somebody is still very much a creature of habit and addicted to using their air-driven handpieces, they now have the Z2 line where the wattage or power, which is how electric handpieces are measured, is at 44, where traditional air-driven handpieces are between 20 and 30. So now suddenly you have a lot more torque. It may not quite be the same as the electric, but you're shrinking that gap. So if somebody's addicted to the feel of air-driven, Well, we have really good air-driven handpieces that you can choose. And if somebody is ready to make the switch to electric, then their Z95L series is amazing. And then you wind up having the opportunity to buy endodontic heads, implant-type heads, all these specialty handpieces in addition to your basic high and slow speeds. So let's talk about cost and return on investment. What would you tell a dentist who currently has compressors in their office, they're all set up for air, and they want to make the move to electric? Cost and return on investment. What are your thoughts? Historically, it was a lower barrier to entry with new air -driven handpieces because everybody already has a compressor in their office. They're buying a few handpieces, they connect it, maybe they just need a new tubing or connection, but it's ready to go. With electric, realize that you do need a motor in each room. in addition to the new hand pieces. So the initial cost entry is a little bit higher, but you recoup that because turbine change and repairs tend to go down. And that's kind of just the tip of the iceberg. The big part of the iceberg we don't see is how much more efficiently you're going to get your procedures done. And that's what a lot of doctors forget because we're creatures that have it. The average dollar cost per minute of running an office overhead is $7 a minute. So you think about that. If you're getting through your preps five, 10 minutes faster, every procedure you're saving $20, $30. And so that adds up very quickly. So I would tell people not to be kind of penny wise and dollar foolish. Realize that when productivity and ROI go up, you're definitely a winner. So really choose the best product that helps you practice the most comfortably. A good hand piece is going to reduce hand fatigue, make you more profitable, make your patients more comfortable. And one last thing is when you have the right output of sound, we all know that there's a growing awareness of marginal hearing loss with practitioners where we have these very high-pitched frequency handpieces from yesteryear working. So a modern handpiece is going to lead to operator safety as well. Yeah. So would you say that this is one of the most critical things to consider purchasing in your office as far as dental equipment? Absolutely. Absolutely. And remember my first quote, I said, I'll never do these electrics. Then as soon as I got an electric, I said, I'll never go back to air. And now I've realized always and never statements don't belong in dentistry. You have to type in the one that works the best for you and find a company that's a good ally that has product lines that are great in both technologies. Yeah, the word never doesn't belong in a lot of things in life, not just dentistry. But that is true. Coming from a true dentist, Dr. Hakim, I hear your perspective. All right. Thank you so much for your feedback. You're always wonderful to interview on this show. We love you. Well, hopefully we'll have you on another podcast and webinar on Viva Learning soon. Thanks for all your contributions on Viva Learning. Have a great rest of your week. Thank you so much. It was a pleasure, Phil. Always fun talking to you. If you're enjoying this podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.