Surgical Advancements in Dental Handpieces: A Clinician's Perspective

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing surgical advancements by way of new handpiece technology from a clinician's perspective. Our guest and clinician is Dr. Sam Shamardi. He practices full-time while teaching part-time at the Harvard Division of Periodontics. He lectures nationally and internationally on topics within periodontics and hearing loss in dentistry. and has published multiple articles in a variety of dental publications. Dr. Shamardi, it's a pleasure to have you on Dental Talk. Thanks so much, Phil. I'm thrilled to be back with you. Yeah, you're a pretty busy guy. You're teaching at Harvard, practicing dentistry, speaking a lot for Viva Learning, as a matter of fact, which we appreciate. It's good to stay relevant. Well, that's when you know things are going well. Yeah, that's right. Hey, listen, it's good to be busy. Okay, so when comparing traditional air-driven versus electric handpieces, what do you see as the main clinical advantages? Yeah, I think the trend certainly has gone more towards the electric direction. I've made use of, you know, more traditional ones as well. But I think there's a couple of things with the electric that can provide some advantages. One thing that I'm sure you know I speak so much on is about hearing loss. So one of the big things with the electric ones is the difference in noise output, which, you know, a lot of times from a clinician standpoint, practically on teeth. And I think electric has advantages with that anyways. But just from the noise standpoint alone, the amount of sound it's emitting is so much less than the traditional air -driven that I think that's one significant advantage to it. And I think just the technology and what's been developing, there's a couple I've gotten experience with. I've been fortunate enough to look at this new Z series. that NSK has been taken out. And it's really something pretty interesting because one quality they have, they have a little notch there on the inside of the handpiece that you can literally twist it. And just by twisting that dual switch that it has, you can switch from a traditional water jet to an actual spray. So that could be really helpful depending where in the mouth you're working in. One of them is just a surgical drill. So for me, using it for extractions and maybe being concerned about getting into spaces. and visibility, you know, to be able to just literally at the switch of a little, you know, button go from a mist to a traditional jet. That's just, you know, one example of some of the advancements that I see with the electric that, you know, we just don't have that with our more traditional hand pieces. Now, when it comes to surgery, how important is that additional torque that you're getting with the electric hand piece? It helps quite a bit. And really, it comes into use for a lot of different applications. I mean, there's the surgical aspect of it just from, you know, working, trying to get teeth out and extractions. That definitely comes into play. You know, a lot of times for extractions, we're sectioning teeth. And some of these teeth have crowns on them. And obviously, depending on the type of crown, the material, sometimes those aren't so easy to just section through and take off. Having the added torque and the extra, you know, power you get definitely makes a difference. And, you know, another big thing of it for us as dental professionals is just the amount of time, not just from the noise, but from the actual stress our hands take from drilling so much and the cumulative effect that makes on us. So having something that can help us do our job more efficiently, quicker, cleaner, not be as loud, all these things over time really add up. The whole concept of the noise is something that's really kind of been ignored by a lot of practitioners. Now you got into this and actually developed a product called EarAid, which this podcast is not about, but I do want to mention that. Is that an available product for our audience to look into through down? It is. Or who sells that? Yeah, right now, a company called Forward Science, they're out of Texas. They're known for more oral diagnosis stuff that people know them for. Yeah, it's called Ear Aid. I guess they could just look it up on Google and find more information. Okay, so that's really important for a clinician to be aware of, especially a young person who's got many years ahead of them. Because it is cumulative, right? Hearing loss is a cumulative. That's correct. It's cumulative based on the length of our career and the job that we do. We're in the eye of the storm. And these issues are starting at earlier and earlier ages because we've got so much new tech we have in our ears now. iPods, ear pods, everything. So it's just gotten, the problem's just getting worse. So getting back to the surgical topic that we're talking about today. As a clinician who does a lot of surgery, from your perspective, what stands out about this device called Surgipro? Well, it's a motor. I assume NSK makes that motor, and we like not to focus on any one product, but we talked offline you like Surgipro, although you've used other motors for implants and so forth. But what do you think about Surgipro versus other systems you've used in your surgery cases? Yeah, it's a great question. And, you know, it's been about 15 years that I've been using different implant motors for implants, extractions, et cetera. And there are definitely some great ones. You know, when I finished my residency, I purchased a W&H, which I still have as a backup motor in case, you know, something happens at work. And it's been great. You know, it's been with me from day one, and it's really been very effective. I've used, I believe their company is called BN, BN Pro. I've used that motor before. been comfortable with it, seen a lot of good things. I think the reason the Surgipro really caught my eye is that having used the W&H and even the BN for these past 12 to 15 years, and then seeing the differences with Surgipro, it kind of stood out. to me a little bit more on a couple levels. One thing that really stood out to me is it's a really smooth motor. When you use it, again, we keep talking about this noise, but number one, it's very quiet and it's just smooth as you use it and you switch through modes and you're actively doing the drilling, let's say it's an implant preparation and you're preparing your osteotomy. Just the feeling that you get as you use it, it just really gives you a lot more confidence. It just works very comfortably. It's very smooth. torques all the way up to 80 newton centimeters which is pretty unique it's definitely something my other motors weren't doing now you know am i planning to go up to 80 newton centimeters on implant placements regularly obviously not but especially in cases where you know maybe an implant torques out having that extra power to be able to reverse and really dense bone and there's there's all sorts of situations that are unforeseen that you never know and come up. So having that extra torque available to me is also really important. And even just the workability and cleansability. I mean, I don't know how they designed it, but they've made an implant motor that's actually autoclavable. So, you know, you can do that, which is very unique. And just as a whole, I just have found that the motor is just very smooth and just very easy to work with. And I've just really noticed that change compared to the ones I've had before. How's the interface as far as the information that's relayed to the clinician while they're using it, the display and so forth? Tell us about that. Pretty straightforward. It's a very clear screen LED. So, you know, it's very easy to read. They've got some not just on the screen, but they've got some straightforward buttons for speed, for torque. The other thing that's unique, they have up to eight different programs that you can actually set your own customized settings. So if there's a certain setting you want to have for the drilling versus the placement versus different torque, you can kind of have that set. almost kind of like in your car where you preset, you know, the seating position that you're comfortable with. So it provides you with that very easy either by, you know, by hand or by the foot pedal to switch modes, switch the amount of water you want coming out. So between the display and the LED and just kind of the ease of use, it's a very intuitive, very straightforward thing. Obviously, when I got the motor and use it for the very first day, I mean, I had never touched it and never used it before. And it really, you know. it took hardly any time to adapt. We've been talking about the motor. Tell us about the handpiece itself that goes with that and the technology that's so new and why you feel that this technology is actually making a noticeable impact in dentistry as a whole. Yeah, I think just when it comes to unique handpieces, they've really kind of, in my opinion, just kind of raised the bar in terms of options that you have. So, you know, with the implant handpiece itself, I mentioned, you know, just ease of use, really smooth, quiet. You have these different settings that you can not just for torque, but for speed, kind of customize things for yourself, which I think can really come into play. Obviously, we see what they've done with the electrics and kind of what's unique with that. Another thing that I think for clinicians is really worth noting, and this could be just for your everyday. It doesn't even have to be for surgical. This could be for restorative. They've actually come out with a nano series of handpiece, and by nano, it's referring to the actual size of the handpiece itself. And I can't tell you for me how big this is because the only thing more frustrating than having to do a crown lengthening or an extraction up on a distal of a number two or number 31, the procedure is hard enough. But obviously, a lot of our patients, they either have TMJ, they have a small jaw, they just physically aren't able to open as much as we would like them to. And then, you know, our hands are literally getting jammed and we're getting stuck. And so it's making our job considerably more difficult. We're having to come in at all sorts of, you know, different angles that aren't good for us. So to be able to make use of a handpiece that's significantly smaller and lighter, now, even if you've got that patient with the bite block or with the TMJ or whatever it might be, suddenly, you know, instead of having to struggle to access, you know, really apically, for me, at least from a periosurgery standpoint, or even just from a restorative standpoint, you're able to get in there very comfortably and no longer have that be an issue. I think, you know, just between that, the motor, the electric, I've gotten the sense from what I've seen with what they're doing. They really have kind of just raised that bar and just the advancements that they have are really kind of user-friendly and really kind of, you know, give us a different advantage that we just haven't had before. Yeah. Now, when you talk about the size of the handpiece, that nano product line, what's the ergonomics like for something small? There's certainly a difference in the way they designed it to get it that small. So how does that affect the ergonomics? Yeah, it's a great question. So not only again, length shorter, the weight is considerably less, of course. And of course, you know, you put something smaller, shorter and lighter in your hand, how that balances in our hand also is going to be slightly different. So kind of the weighted point, as we would call it in terms of where we're kind of feeling it is going to be in a slightly different position than what we're used to with our more traditional hand pieces. So certainly, I think, you know, using it off the bat, it's going to. It feels slightly different, and it should because it's something shorter and smaller. So there'll probably be an initial kind of getting used to the balance and kind of how it feels. But they've designed the weighted point in a way where they obviously know this is something smaller and shorter, and the way we're going to hold it is going to slightly feel different in our hands. So they've optimized where that weighted point is. So it's still not going to affect our ability to prep or drill, whatever it is we're doing. not going to feel like it's some completely different ergonomic standpoint. It's actually, I think, going to do the opposite because of the lighter weight. I think it's going to help preserve, again, a lot of our hand pain and stress that we have because of having to try and force in a bigger handpiece at a much worse angle. If a dentist wants to transition their existing equipment into some of these NSK products, how involved is it? based on the equipment that's already in an office that's different in other words how compatible are the components of these nsk products Yeah, that's a great question. And honestly, when I first wanted to start making, you know, trying these out, that was my biggest concern. Working as a specialist in a couple of different practices, obviously each practice has a completely different setup. And so my concern is, well, how are we going to make a switch? And fortunately, what I've found is their components are extremely compatible. So they have a lot of different coupler options, for example. send the local rep a picture of what your setup is, and they can find the coupler that would be the proper match and help you transition to what they have going on. And then even if you are going with the electrics, for example, and you're trying to see kind of how that fits, their electric motor, not only is it extremely compact, and again, it's the lightest that I've seen, and I believe it's the lightest that's out there, but it also comes with a very flexible mounting platform. So again, And depending on how your setup is and where those hand pieces are and where the tray is located, et cetera, it's not like something where it has to go in this one position. And if it doesn't fit there, well, now you're stuck. It's got a lot of flexible components and comes with different brackets. So you can really kind of fit it and customize it based on your setup. So the good thing is, regardless of what type of setup your practice may or may not have, they're really able to work with you and find between the compatibility. and just the mounting and preparation a good way to fit. And like I said, my experience at least has been very smooth transition. And the good thing with them is they're always willing to come out, talk in person. You're not talking to a machine. So at least whenever I've had questions, it's been an easy for me to at least communicate, you know, any. issues I've had and get a quick response back. So it's been a less than stressful transition that I was expecting to have. Yeah, NSK is a great company to work with, for sure. And they'll be around for many years to come, which is important when you buy equipment. In closing, this has been really very... insightful, Dr. Shamardi. Out of curiosity, what got you into the whole concept of hearing loss? Yeah, it's a great question. And I've been lecturing about this for about eight years now. And I think really once I started... in 2010 once i finished residency once i started working you know there's such a transition from being in school and seeing you know a few patients a day to suddenly seeing you know a dozen or more and the more i started working the more i started realizing gosh this this sound is really starting to you know beat up on my ears and I started doing some research and sure enough, saw there were decades of literature out there warning us about the problem. And I'm thinking, well, how come there's never been a solution? So that really kind of got me triggered to trying to develop a solution for our industry. And really, the more I dove into the literature, the scarier it was when you when you read the statistics, when you. understand and realize that not only is noise taken away one of our five senses as a result of our exposure, but the systemic health risks that are directly linked to noise-induced hearing loss. You talk about cardiovascular disease, diabetes, low preterm birth weight babies for pregnant moms. The amount of literature that's out there and readily available. is quite shocking. And so it's really been something I've been doing my best to try and educate the field on. It's funny that you look at PPE and how far we've come and, you know, loops 20 years ago were laughed off and this can't, you know, ever work. And, you know, two years ago, if we talked about wearing N95s, it's like that's never going to happen. And now it's literally a standard of care. Yet all this advancement in PPE and, you know, our ears and our sense of sound is one of our five senses. It's the one thing that from day one. despite every instrument that we're using bombarding us, it's the one thing that's always been ignored. So I'm hoping and hopeful that people will start taking it more seriously. And like I said, I do whatever I can to help spread that message. I guess it's a gradual process that clinicians don't really know that it's actually happening until they get to the point where then they know, and that's too late. Prevention is always that's right. And that's the greatest irony for us is that that's exactly what it is. You don't know until you've already lost it and it's too late. And the irony is that's the same thing that happens with our patients. We warn them about an infection or decay. They say they have no pain and they don't understand why they need to do something until, of course, it abscesses and blows up and they're calling on the weekend as an emergency. And by that point, of course, we can't save the tooth anymore and it's too late. And it's the same argument. And we're frustrated at our patients saying, you know, we've been telling you this for ages. Why didn't you listen to us? But then when it comes to hearing, we're kind of ignoring the same thing we preach from a dental standpoint. To our audience, if you're interested in the handpiece technology we were just talking about, the motor, check out NSK online. It's a great company to work with, and they'll be around for years to come to help you with any decisions you make about integrating their equipment into your office. And then EarAid is another product that is worth looking into, developed by Dr. Shamardi from Harvard, who's with us today, and we're happy to have him. And thank you very much, Dr. Shamardi, for your podcast. We really enjoyed it. Thanks so much. It was a pleasure being with you again, and always appreciate it. Look forward.