Implant Success Starts Here: Picking the Right Motor and Handpiece

Most of the basic motors have a range up to 15 Newton centimeters. Now, the advanced ones and the ones that are a little bit more technically better suited for implant placement, they can go up to 80 Newtons, for example. And that is going to be a very important factor when you're placing some of those newer type of implants which are self-threading. They are preparing the site. as well as going into the bar at the same time. Welcome to the Phil Klein Dental Podcast. Today we'll be addressing an important decision for any dentist placing implants, choosing the right implant motor and handpiece. So what exactly should you be looking for when making this investment? What specifications matter most for efficiency, precision, and long-term reliability? And are there any game-changing features worth considering? To help us break it all down, we're joined by Dr. Krikor Derbabian, a prosthodontist with over 25 years of implant experience. Dr. Derbabianserved as clinical associate professor at USC's dental school. In his practice in Southern California, he's currently placing around eight implants per week and has used a wide range of implant motors and handpieces. He knows what works, what doesn't, and what features truly make a difference in making life easier and implant placement more enjoyable and predictable. And by the way, he will be recommending his favorite system later on in this episode. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Dr. Derbabian, so nice to have you on the show and nice to meet you. Well, nice to meet you. You're certainly the expert to ask here as a prosthodontist who does lots of implants. You know, with more and more dentists placing implants these days, especially general dentists, many of us are in the market for either a new or replacement implant motor and handpiece. And there are many options out there. So what advice can you give our listeners regarding making the right purchase decision on this equipment? Yes, absolutely. In general, an implant motor and handpiece from a major manufacturer is going to be adequate for most users. And then when you get into the depth of the situations and you want to look into more advanced features, you have to look at some features that are absolutely necessary. And then there are some features that are nice to have, but are luxurious. Yeah, it sounds like the car dealership. You can say that. Yeah, I mean, when I was younger and I had minimal money, I would buy the base model, but I would buy it from a good dealership and I'd buy it from a good brand, but I would give up the leather seats, the heated seats, you know, the whole tech system at that time. That's a great analogy, actually. You need the basics. You need to have a unit that is going to do the job, but it has to come from a manufacturer that is reliable. The motor has to be tested. It's an intricate meticulous procedure when we're placing implants. So there are certain criteria that are absolutely necessary. Yeah, so I'm going to ask you what those criteria are. But first, I want to ask you something else. If you're a dentist who's toying with the idea of doing implants, and then you get some training, you do a couple of basic implants, single tooth, is it something where... The decision that you're about to make on buying the implant motor and the handpiece, should it be something where you make that decision and say, okay, I need to buy something super high quality, of course, with all the bells and whistles because I don't want to buy another one, another motor and handpiece later when I decide, hey, I'm getting good at these implants and I'm putting more and more in. This way I make one purchase and I could grow into it. Or what about the mindset where a dentist says, I'm not really sure I'm going to be doing a lot of these. I'll stick to the simple cases. I don't need all the bells and whistles. Tell me about that mindset. How should we be thinking here? That is actually a very important decision that you're going to make. And if you are starting to place implants, some of the units that have advanced features are going to make your life so much easier that maybe that is the preferable way, even though the initial expense may be slightly higher. But it's going to reduce your stress when you're placing your initial case implants. And it's going to help you. And absolutely, you're going to save money in the long run by not buying an upgrade later on. Yeah. So and that's true with even CBCT, with the field of view and all sorts of things that I'm sure you're getting. Yeah. And for someone that does a lot of implants like yourself, I'm sure you're very familiar with all of that. So tell us what the essential features are. In other words. Let's come in from the mindset where I don't need all the bells and whistles. I'm going back to my days when I bought the base model of every car because I wanted a good car, but I didn't want to spend the money for all the extras. But as far as implant motors, let's address that first. What are the essential features? Let's take a GP, for example, should look for in an implant motor. Yes. when placing implants there are certain criteria and there are certain procedures that you are going to follow and the implant manufacturer is going to assist you with those they will give you the protocols for their systems one of the most important things that you have to take into consideration is the speed control of the motor because if you exceed the speed recommendation recommended for the drills you may overheat the drills and also subsequently you may overheat the bone which can be a problem with the osseointegration procedures. So that is one of the basic functions of the motor is to be able to control the speed and that has to be an accurate speed. And then you also have to be able to control the torque. Because when you're placing an implant, especially some of the newer implants, when the implant itself is preparing the osteotomy as you place it into the bone, you need to be able to have the higher torques that is necessary to be able to place that implant into the osteotomy. Getting back to torque, what's the range you're talking about? And that's in Newton centimeters? That's in Newton centimeters. It's measured in Newton centimeters. Right. So what are we talking about in the range that... I should be looking at if I'm looking to buy a basic implant motor? Most of the basic motors have a range up to 15 Newton centimeters. Now, the advanced ones and the ones that are a little bit more technically better suited for implant placement, they can go up to 80 Newtons, for example. And that is going to be a very important factor when you're placing some of those newer type of implants which are self-threading. They are preparing the site as well as going into the bone at the same time. So that's an example of growing out of something. If you decide to go into that modern day implant or the newest implants where you're describing, you will not be able to do that if you're limited to 80 Newton centimeters. yes i'm sorry i'm sorry 50 50 newton centimeters yes if you are limited to 50 newton centimeters the procedure basically is going to be to give up the motor and the handpiece go to a hand torque device switch that place it in the mouth torque it to the adequate torque and then go back to the handpiece so it's it becomes a little bit cumbersome it's not impossible but it you know if you have a motor that is capable of doing up to 70 or 80 meters centimeters this the is going to be so much more, basically it's going to be much, much better, much easier for you. So you talked about the speed that the implant motor is capable of, but aren't all implant motors pretty much the same when it comes to adjusting the speed based on implant manufacturer's recommendations? The motor speed actually is recommended. The manufacturer will tell you for each drill, they have recommended speeds. the speed is not the issue most motors will be adequate however the accuracy is important because as the drill size is gets bigger and bigger the rotational the rotation of that drill becomes a little bit more important. So if you are overheating the bone or the drill, you are going to damage the bone and you're not going to have proper oscillation integration. Okay, so what you're saying, and you said that earlier, is that you want the preciseness of the motor to follow the instructions based on the implant manufacturer saying, yeah, in order to do this correctly, follow. And they give you the torque also, right? They give you that recommendation as well. Absolutely, yes. So both of those measurements, torque and speed have to be transferred from the recommendations of the implant manufacturer into the output of the equipment. And if the equipment can't output precisely what those measurements dictate, then you're risking the prognosis of your case. Absolutely. So what other essential features are we looking at when it comes to the motor? Well, one of the other essential features is that the motor has to be able to deliver a coolant to the handpiece. And you have to be able to control the coolant. The coolant is also important because it's going to minimize the overheating of the drills and the boning again. The other feature that I would say is, it's not absolutely necessary, but it's very desirable, is programmability. You have to be able to program different cycles because the procedure of placing an implant requires different procedures for each step. so you're talking about are you talking about presets presets exactly yeah so would you consider preset an essential feature or a luxury item because i think that's essential i think nowadays it's essential because even if you're placing one type of implant there are Different sequences that you're going to follow. If you are not able to program the sequences, it's going to be very cumbersome going back and forth to the motor and inputting every step as you go. What are the things about the motor? Maintenance, warranty, price. Those are factors too. Of course, price is always a factor. Right. But when you're purchasing a motor from a reliable company, absolutely the warranty is very important maintenance is very important repairability is very important those are those become very very important features when placing an implant you don't want to be in the middle of a procedure and then all of a sudden your motor is not working so reliability becomes crucial Any other essential features that we didn't cover when it comes to the implant motor? I think we covered all the essential features that the motor is required to have for proper implantation. Yeah, it sounds like to me, before we get into the luxury items that are nice to have, it's very critical, as you mentioned earlier in this episode, is to understand the manufacturer that's behind the equipment. Just imagine if the motor failed, I guess you... you would have a backup i would assume every office has a backup but you just don't want that to happen because it disrupts the procedure it's stressful it doesn't look good in front of the patient and the staff for that matter so have you ever had that happen where a motor failed during a procedure i have but fortunately i always have a backup it's always nice to have a backup but i've been placing implants for a long time so the initial motors that i started working with they were not as reliable as today's equipment do you think it's important we're going to talk about the handpiece now to purchase a handpiece from the same manufacturer that makes the motor i think so i think it is very important because one of the luxury items features that i'm going to discuss later on is you need to be able to to accurately calibrate the torque of the machine because as you use the handpiece for example there are there's wear and tear inside the handpiece itself which in turn is going to determine the torque of the the motor so you need to be able to use a handpiece that is you can use to calibrate the motor and if the same manufacturer is providing both equipment that is ideal yeah and i assume it's also good for troubleshooting Right. Because if you contact the company and say, hey, this is the issue I'm having, then they'll say, well, what handpiece are you using? Well, that's. Yes, absolutely. And they'll blame it on the handpiece. Then you call the handpiece company up and of course they're going to blame it on the motor. By the way, which which implant motor do you actually like before we get into the handpiece? Well, I actually love the new NSK Sergic Pro 2. I've had NSK handpieces and motors for a long time. But the new one, which is not very new, it's been in the market for the last couple of years, has so many advanced features that makes implant placement so much more pleasurable and it's so much fun to use. When you say advanced features, are you talking about the motor, the handpiece? The motor, mostly, yes. Mostly the motor. And what are some of those advanced features? Well, one of the features that some other equipment might have also, but it's the ability to program different for different implants not overly different steps but you can have if you're placing different types of implants for example you can program all of those in the same motor and you don't have to go back and forth and reprogram it every time you want to use it now another feature is that it has a wireless foot controller this may be a luxury but actually when you're trying to place the implant and you have already the motor with the cord, having a cordless foot controller is very nice and makes the procedure so much more manageable. In addition, the foot controller also controls the motor itself. You don't have to use your hands. It's basically a hands-free operation. You can go from one program to the next by only using the foot controller. So those are really nice features to have. Another feature that I love is that it has a very large LCD screen and you can see very easily all the parameters that you have programmed. That's another feature. And I think we already mentioned the high torque. Most motors the maximum torque that they generate is 15 newton centimeters the nsk sergic pro 2 goes up to 80 newton centimeters and there are a lot of manufacturers that recommend up to 70 newton centimeters for placing their implants so that is a very nice feature to have yeah and if implant manufacturers are recommending 70 newton centimeters you don't want to have the system go up to 70. it's nice to have it to go to 80 so you have some buffer in there exactly yes you always like to have a little bit more just again going back to the car analogy doctor we you know it shows 140 miles an hour on my subaru but i don't take it that fast but it's nice to know it's up there Right. OK, so let me ask you this. Let's talk about the handpiece itself. Now, you're one that believes in sticking with the same company. And it certainly makes sense to me. I mean, we hear that a lot from key opinion leaders, even with materials. They're using adhesives. They're using composites. Then they're using bulk fill. And they stick with the same manufacturer. They just like it to have one system. And they could troubleshoot things, obviously, that way. You're using an NSK handpiece with that motor with the Surgic Pro 2. Tell us about what we should be looking for in a handpiece first, the essentials. Well, the essentials are basically, it has to be very precise. Also, it has to have an irrigation feature. You have to be able to irrigate some saline as a coolant. So those are absolutely minimum requirements. It has to be very precise. It has to be able to irrigate. and then there are some additional features that are nice to have it has a fiber optic for example light or led light in this case is very nice to have it makes the surgical area so much better illuminated and you can work much more precisely and then there are some headpieces that are oversized and so heavy and so large that is very difficult to use well i've used those for a long time but the newer ones from nsk for example they are much more compact and the center of gravity is so much more comfortable to use the whole procedure will be much easier and much more effective yeah they seem to have really mastered the ergonomics of their hand pieces across the board not only implant hand pieces their timex yeah they have they have an air-driven handpiece that has the power of electric i don't want to sound like a commercial but the feedback that i'm hearing from the key opinion leaders that use it is that it's extremely ergonomic the lightness of it the size of it and they have different sizes they have one air driven handpiece that's extremely small for areas that are just impossible to get back in the in the in the back of the mouth so is it a difficult decision for someone new getting into implants to make this purchase because of all the options they have out there are there are there tons of options regarding implant motors and hand pieces and again the choice needs to be made on features quality reliability like we talked about and of course there's price so there's a lot to look at before making that purchase decision it is absolutely difficult especially if you don't know what you are looking for So the basics are important, obviously, but the luxuries, especially if you are a beginner implant placing dentist, the luxuries and the additional items that you are looking for in the motor and the handpiece are going to make things easier for you. And they're going to make things much, much more enjoyable. And I do want to touch on the illumination, the optic part of the motor. of the surgic pro 2 there's something about that we talked offline that the control of that light is is quite unique and uh very useful actually the one of the features that the motor has it can control different uh light intensities so sometimes if it's too bright it's not good either and the light on these nsk hand pieces are color leds not regular leds so it does make a difference it's again it's a luxury thing but it does make a difference and sometimes you want a little bit less light than more you can oh it's all controllable to the handpiece to the model sorry right so you're a prosthodontist do you do implants every week how many implants are you doing in a month Just so I get, you know, so the reason why I'm asking is because it's important to get recommendations from a doctor who does the stuff. You know what I mean? You're doing the thing, but you're also experiencing equipment and you're trying some equipment and discarding some and sticking with others. And you've been doing this for, tell us how long you've been doing it, how many you do, and how many implant systems as far as equipment did you have to go through to find the NSK as the holy grail? Those are all the nice questions. I've been restoring implants for over 25 years, but I've been placing implants in the last 15 years and I place implants regularly, almost about eight to 10 implants a week. So there is a large number for me as a restorative dentist. I'm placing about eight to 10 implants per week. Now I have gone through many motors and hand thesis. Some of the earliest ones were extremely difficult to use. There was no programmability. It was very difficult. The irrigation systems were very poor. But the newer motors are much more reliable again. But the NSK, the Surgipro 2, it's a huge difference between most of the motors out there and this one. It is a huge difference. The small items that are, the small luxuries that it provides. the foot control that is cordless, the different programmabilities. Those are very nice features to have. It does make placing implants much more straightforward. Now, if someone's getting started on implants, as we wrap up this podcast, I want to ask you this. You have a backup in case something goes bad with the motor or the handpiece. Now, I don't know what these things cost. I'm not an implant guy. I don't do implants. I'm a retired endodontist doing podcasts. When you're purchasing this equipment, what do you say to a dentist who's on a budget? They're careful about what they're spending. Is the NSK Surgic Pro 2 that much more money than a competitor that has way less features? Actually, I don't think so. I think they are very comparable. There may be a few hundred dollars difference, but it's not excessively more expensive. The features, in my opinion, are worth it. But again, if somebody is thinking of a backup, I don't think the motor is the important aspect. Most of the time when I had failures in the past, it was the handpiece. So a backup handpiece may be okay to have. if you're placing a lot of implants. For me, it's absolutely a necessity to have a backup, for example. But for somebody who is starting new and they're placing a few implants per week or per month, I don't think with going with the NSK, it is a reliable motor. It is a reliable handpiece. And if they take good care of it, I don't think it's going to be a problem. That's good. And there would be, I assume, some symptoms of a motor giving you... notice that something's going to be coming down the road as far as a failure. It doesn't just stop working without any symptoms, right? Exactly. That's correct. That's correct. Yeah. Really good stuff. Interesting conversation. And I appreciate your time, Dr. Derbabian. And it's nice to hear from someone who's, like I mentioned, doing the thing quite often in the office to talk about equipment. You know, it's like a baseball player talking about the right glove to... catch with, if he's a catcher and the right equipment to use behind the plate. Anybody who's doing it all the time, they're the ones you want to talk to. And it's certainly worth listening to someone who's in the trenches doing these implants all the time to hear about the equipment they're using for successful cases. That was the purpose of this episode. Before we wrap it up, any final thoughts, doctor? It was a pleasure talking to you, Dr. Klein, about implant mortals and handpieces. I think if a dentist is going to start placing implants, they have to make everything as easy as... possible for them and one of the decisions that i have to make is buying a good equivalent yes absolutely have a great night thank you so much for your time thank you so much