HIGH SPEED CUTTING INSTRUMENTS IN

PROSTHODONTICS
Introduction
In order to perform the intricate and detailed procedures associated with
restorative dentistry, the dentist must have a complete knowledge of the
purpose and application of the many instruments required. During each day of
his clinical experience the dentist operates on vital tissues within the oral
cavity where a millimeter or a fraction there of, is a very significant
dimension. A skillful application of sharp hand and rotary instruments requires
ability and coordination gained only by extensive training.
Before the advent of rotary instruments, removal of tooth tissue was
accomplished with sharp edged chisels, hatchets, and hoes. !hese hand
instruments possessed a cutting capability, which was used for clearing away
unsupported and undermined enamel resulting from dental caries. "alls and
floors of the cavity were formed by a planning and lateral scraping action of
these sharp edged instruments. At best, such efforts were crude, time
consuming and often difficult.
!he first, rotary instruments for cutting tooth tissue were modified hand
instruments. !hese, drill or bur heads could be twisted in the fingers to
produce a cutting or abrading action. In #$%& the finger ring was introduced
with a drill socket attached for adapting a series of long bundled burs or drills.
#
!his was the primitive application of the rotary principle. !he first drill having
flexible cable drive and the first angle hand piece were introduced by 'harles
(erry between #$)$ and #$&*. In #$+#, (orrison modified and adapted the
dental foot engine from the ,inger ,ewing machine. !his was followed by the
introduction of the electric dental engine utili-ing a cable arm in #$$.. In #/#0
the endless cord on a 1ointed arm was made available. !he earlier dental hand
pieces were capable of speeds from %)00 to &000 rpm.
In #/%0 the use of diamond abrasive paints became widespread. !he
diamond point is compared of a number of small diamond particles bound on a
rotary blank.
In #/%) Dr. 2.3. black, published a report on the non mechanical
preparation of cavities and in doing so introduced the air abrasive technique.
!he impact of Dr. Black4s revolutionary cutting technique on the dental
profession was considerable. !his was the first significant break in the long
established traditional method of cavity preparation. !he air abrasive principle
utili-ed particles of aluminium oxide propelled against the tooth surface by a
carbon dioxide stream under the pressure of ##0 psi, and funneled through a
tungsten carbide no--le with a lumen of 0.0#$ inch. !he penetration of enamel
and dentin was rapid but some what difficult to control.
*
In #/%/ "alsh and ,ymons published their initial findings relating to
the removal of tooth tissue with diamond points at rotational speeds upto
+0,000 rpm. !his report indicated the use of lighter forces and a resulting
increased cutting efficiency at these higher speeds.
In early #/)0, the ball5bearing hand piece was introduced.
In #/&., following the work of 6elson the first fluid turbine type
handpiece was introduced. !his instrument was capable of rotational speeds of
approximately )0,000 rpm and was limited to diamond instruments operated at
one speed only. In #/)%, air5driven hand pieces were developed. A continuous
belt5driven contra5angle which utili-ed a friction grip chuck and bur was
introduced, making possible cutting speeds of upto #)0,000 rpm.
By #/)+, many dentists were using rotational speeds upto .,00,000
rpm. !he introduction of air5bearing hand piece in the early #/)0 made
possible greater rotational speeds of approximately ),00,000 rpm.
In #/)., an ultrasonic method of tooth tissue removal was also
introduced, which used suitably shaped tips vibrating at frequencies ranging
from *,)0,000 to .,00,000 cycles per seconds.
!his brief historical back ground reveals that the profession has been
searching for a suitable method of tooth tissue removal. 7nly during last .0
.
years, this hunt has slowed down still the profession is trying to refine the
procedure and instruments.
Review of literature
A search through literature reveals various methods used in the past for
removal of tooth tissue. !he continuous development of newer methods till
#/&0, indicates that the earlier instruments had some disadvantages. Inspite of
the introduction of numerous tooth reduction instruments, and procedures, the
principles and the biologic ob1ectives have remained the same. !hese are as
follows.
#. !he operator should remove the least amount of tooth tissue consistent
with necessary mechanical retention.
*. !his should be done with the least barm to the periodontal tissues and the
pulp.
.. It should be done with the least discomfort to the patient.
%. 6o pathologic reactions should be initiated in the pulp.
Advantage of !ig! "eed
#. ,maller stones can be used at the increased speeds.
*. 8ess fatigue results both for the patient and operator.
.. Due to high speed, very light pressure is required.
%. 8ess vibrations are felt by the patient.
%
). !he chairside time for a given preparation is considerably reduced.
&. !rauma to the pulp is reduced.
+. !he efficiency and life of the cutting tools is increased.
$. Because of small tools, control is easy.
/. 9emoval of old amalgam and gold restorations is easy.
Diadvantage of !ig! "eed
#. !he increased speed creates increased temperatures in the tooth. !herefore
some method of cooling the tooth more efficiently is required not to in1ure
the pulp. !his necessitates additional equipment.
*. "hen a dentist changes from the lower speeds, which utili-e a pressure in
pounds, to high speeds which need only a pressure in ounces, he must
develop a new technique and retrain himself to a new tactile sense.
.. !o operate at high speeds good visibility of the cutting instrument is
necessary to avoid over cutting.
%. Due to the ease with which tooth tissue is removed, caution must be taken
not to in1ure the proximal enamel of the ad1acent healthy tooth and the
gingiva.
). :igh speeds result in greater wear on the working parts of the handpiece,
necessitating more frequent repairs and replacements.
&. ;nless used properly, high speeds have a tendency to create striations on a
tooth surface.
)
+. !he ideal preparation for any type of restoration cannot be accomplished
by using high speed equipment alone. !he final exactness and finishing
line can best be established by instruments revolving at moderate speeds.
T#"e of !ig! "eed intru$ent
:and piece can be divided into four types depending upon their speeds
as follows.
#. 8ow speed upto #0,000 rpm.
*. Intermediate speed *),000 to %),000 rpm.
.. :igh speeds )0,000 to #,00,000 rpm.
%. ;ltra high speeds #,00,000 rpm and over.
<ilpatric has further classified the ultra high speed handpiece into three
classes.
!ype I the gear driven centre5angle handpiece, upto#,*),000 rpm.
!ype II the belt driven contra5angle handpiece upto *,00,000 rpm.
!ype III turbine driven air contra5angle handpiece upto .,00,000 rpm and
higher.
Heat generation%
<nowledge of the physics tells us that, whenever there is friction
between two surfaces, heat is generated, which may bring about rise in
&
temperature of either or both the surfaces. !he same applies in the tooth
reduction procedures. :ere the rotating cutting tools come in contact with the
tooth surface and the heat is generated.
It was not until #/.0 that the workers began to investigate the heat rise
in the dental pulp.
!here are many factors that influence the rise in temperature which
takes place in cutting operations. !he greater the speed of rotation of the
cutting tool, the faster the tool revolves, the higher the resultant temperature. It
has been found that the temperature rise develops within #05#* seconds, after
the cutting operation is started. ,i-e of the cutting instrument has an important
bearing on heat generation, since, its diameter affects the cutting speed at its
periphery. 8arger the si-e of the cutting tool more the host generation.
A third factor is the pressure applied by the dentist during cutting
operation. As the pressure increases, greater will be the rise in temperature.
:udson and associates in #/)% conducted a study on temperature
developed in dental cutting instruments from their study they have concluded
that,
#. !he temperatures produced by dental burs in cutting human dentin ranged
from #*)=> to *+)=>. ,ince these temperatures are above those, said to be
+
tolerated by normal human dentin, it would seem advisable to use some
form of coolant.
*. A significant decrease in time required to accomplish a given operation is
apparent, when high operating speeds are used.
.. !he amounts of heat transferred to the tooth from the bur decreases, at
speeds above #*000 rpm, since cutting time at these speeds is reduced and
bur temperature remains.
Su&tantiall# contant and t!ere i le !eat trau$a to t!e vital tructure'
Coolant%
>rom the study of :udson and ,weeney, it is evident that the
temperatures reached during tooth reduction procedures are above those said
to be tolerated by normal human dentins. !his indicates that, some form of
coolant must be used, during the cutting operations, particularly when high
speeds are used.
?very means should be employed to keep the temperature down as
much as possible during cutting operations. 'oolants must employed which, to
be effective, should be applied at the point of contact between the cutting
instrument and the tooth tissue. !here are three types of coolants usually
employed in dental practice.
$
#. "ater.
*. ,pray of air and water
.. Air alone.
@eyton has shown that at speeds ranging from .0000 rpm to #+0000
rpm and with an application of four ounces of pressure, a temperature rise
within the tooth of less than #)=' occurred when water or air5water sprays
were employed. :e also found that even with a water coolant, excessive
temperatures developed, when large diameter instruments or excessive
pressure were applied with increased operating speeds. !his indicates that the
use of a coolant, does not eliminate the danger of excessive temperature rise.
A reduction in concentration of the amount of water used during cutting
procedure shows the significant temperature rise of the dental bur.
!he minimum volume of water to be applied was estimated at #.) ml
per minute.
!he question whether water in spray form should be used at mouth or
temperature seems to have no significance as far as temperature rise in the
tooth was concerned. !ylman is of the opinion that if the water reservoir is
kept at #00=>, it is most comfortable to the patient, less liable to be harmful to
the pulp and still reduces the heat of friction during cutting.
/
!here are certain other problems associated with the use of the
highspeed cutting tools. (ost of the hand pieces are so designed that a spray
or stream of water is directed from the head of the handpiece directly onto the
cutting operation. "here the water strikes the tooth and the cutting tool
directly, full benefit is obtained from the coolant. "here however, the abrasive
on the cutting tool, is on the surface away from the stream of water, water does
not flood the tooth surface being cut, resulting in excessive temperature rise.
!he overcome this difficulty perforated disks have been developed, which
permit the water to go through the openings and lubricate the disk and tooth on
the cutting side. !he use of perforated disk results in less temperature rise.
'onsequently when disks are non perforated, and when the stream of water
cannot be directed to the cutting contact areas, they should be used at speeds
not exceeding #0,000 rpm.
Another advantage of a water coolant lies in the fact that the tooth
debris from the cutting is removed rapidly, preventing the clogging of the
cutting tools. !his results in greater cutting efficiency of the stone. Also, it
prolongs the life and effectiveness of the instrument. It is essential that the
water be in intimate contact with the revolving instrument and the tooth tissue.
!o do this more effectively, 6elson recommended the addition of a wetting
agent to the water spray.
#0
Because the high speed technique requires a larger quantity of water as
a coolant, there is the problem of removing this water from the mouth. !o have
the dentist stop frequently to allow the patient to spit out the excess water is
time consuming. !he customary saliva e1ector has insufficient removal
capacity.
!o solve this problem, !hompson has suggested a washed field
technique.
!his technique adapts the suction or vacuum principle. It established
and maintains a powerful but gentle negative pressure of air in the mouth,
close to the field of operation.
Accompanying the air stream, is a flow of isothermal water which is
pro1ected copiously onto the operative field. !his water is entrained into the
vacuum air stream, which draws it rapidly across the operative area. !he
irrigant pulls away with it tooth cuttings and debris. !hese are taken into the
vacuum air stream and disposed off in a filter system. A clean, clearly visible
operative field is provided. !his technique has the distinct advantages that it
facilitates the use of high speed instruments, maintains visibility during
copious irrigation of the operative field, reduces operating time, improves the
patient4s well being and introduces a new concept of cleanliness. :uman
##
tissues are maintained in their natured wet safe pain, trauma and postoperative
complication, which may arise due to ingestion of tooth debris are reduced.
Desiccation of hard and soft tissues is avoided. :eat is eliminated thus
preserved the tissues.
(i&ration%
'utting a tooth may be very annoying and unpleasant to the patient but
still not be painful. In pain there is usually an involvement of the nerve
endings, either by trauma or extreme irritation, resulting in an acute, painful
reaction. (ost patients associate the sensation of vibration, noise, pressure and
the slight increase in cutting temperature with the sensation of pain.
'onsequently, if the factors of vibration, heat and pressure are reduced to a
minimum, the patient usually experience reduced or no pain.
7ne mechanical factor that influences vibration is the dental handpiece,
whether it is friction5bearing, ball bearing, high speed belt driven or turbine
ultra speed. "hen the friction bearing, conventional type of handpiece is used
at a speed of %)00 rpm to &000 rpm, it is connected by the conventional belt
and pulley system of the dental engine. In this case one may expect a high
order of vibration depending upon the condition of various mechanical parts,
their ad1ustment and speeds of their operation.
#*
@ulleys that are worn, a worn belt, or an improperly ad1usted belt will
cause vibrations that are transmitted down to the cutting tool. ,imilarly hand
piece which do not hold the cutting tool properly, which have worm bearing or
are out of ad1ustment will also cause vibration.
!he investigations of "alsh and ,ymmoss showed that vibration, when
applied to tooth, produced the most unfavorable response when the frequency
was between #00 cps and *00 cps. "hen the frequencies were above #000 cps,
they were generally beyond the upper threshold of perception of the average
patient. It is the lower frequencies, in the range of #00 *00 cps, that are
usually developed at the lower speeds, especially if the equipment is worm and
malad1usted.
:udson and ,weeney have reported the importance of having centricity
in the cutting tool. !hey found that eccentric burs when rotated at &000 to
#0000 rpm produced a lower frequency in the range of #005*00 cps, whereas a
true running bur at #0000 rpm produced vibrations in the frequency range
above the upper threshold.
!amner pointed out that only a part of an eccentric cutting tool is used
as it rotates, thus causing unfavorable impacts and vibrations, which fall into
the most annoying frequency range. !he disks and stones that are unmounted
and are screwed onto a mandrel very frequently are eccentric and therefore
#.
should not be used in high speed cutting operations. !he permanently mounted
instruments are indicated in preference to unmounted type.
@oorly built burs with blades not evenly cut or chipped will likewise
cause vibration. In using carbide burs, it is very important the see that none
have chipped blades.
'orrect ad1ustment of the belt is important in the reduction on and
elimination of vibration. A belt that is too loose increases the vibration pattern
transmitted directly to the tooth.
In the ultra highspeed hand pieces the metal chuck holding the cutting
instrument often is replaced by a rubber or plastic chuck. !his lessens the
vibration transmitted to the cutting instrument and facilitates the more rapid
cutting action.
In cutting with a water turbine handpiece at %),000 rpm the intensity of
vibrations was well tolerates by the patient.
(orrison and 2rinnel made the following observations.
!he deleterious effects of vibration are two fold in origin.
#. Amplitude.
*. ;ndesirable modulating frequencies.
#%
If we minimi-e or eliminate these factors, we can then reduce the
undesirable effects of vibration.
A$"litude% !he wave of vibration consists of frequency and amplitude.
At conventional speeds, amplitude is greater but frequency is less. At
higher speeds the reverse is true. !he greatest harm is caused by the amplitude
of vibration which is the factor, most destructive of instruments and which
causes the most apprehension in the patient and the greatest fatigue in the
dentist.
By increasing operating speeds, the amplitude and its effects are
reduced and a more satisfactory result is attained.
3ibration waves are measured in cycles per second. It has been shown
that rotation of approximately &000 rpm sets up a vibrational wave of
approximately #00 cps. As the rpm is increased the cps of the fundamental
vibration wave are increased until, at ranges of #00000 rpm, we have a
vibration wave of #&00 cps. It has been demonstrated that at wave of vibration
of over #.00 cps, vibration is practically imperceptible to the patient. !he
reason for this is not fully understood, but there are two theories for this
phenomenon.
#)
A#B !he "edensky inhibition phenomenon frequency increased to a point
where vibratory perception diminishes due to failure to perceive vibration.
!his is because ,timulation occurs during 9efractory @eriod of 9ecovery.
A*B 3ibratory perception depends upon the product of the amount of
stimulation Ai.e. pressureB multiplied by the frequency of stimulation
necessary for a reaction. !his is called 'hronaxie. As the speeds above
#,00,000 rpm, due to light pressure and high speeds, chronaxie is attained,
which is necessary for reaction.
!hus it can be concluded that, the more the rpm, the less the amplitude,
and the greater the frequency. 3ibratory perception will be lost in the ultra
highspeed range of #,00,000 rpm or more.
S"read of "at!ogenic organi$ &# Ultra "eed cutting "rocedure%
Atmospheric contamination through the spread of oral organisms
particularly from air turbine action has been a concern of the dental profession
for some time. Dental procedures tend to expose the operator to infectious
diseases. 9ecent studies suggest that the extent of aerosol produced by air
turbine may increase the normal ha-ard. A report involving patients with
pulmonary tuberculosis cultures were demonstrated on all petri dishes exposed
during cutting procedures, with the heaviest concentration being at * feet in
distances from the patients mouth. !his indicates that the dentist and his
#&
assistant are exposed to a serious health ha-ard when operating with an ultra
speed exposed instrument on patients having such pathogens in their oral flora.
"hen a patient4s history suggests the existence of tuberculosis, pneumonia,
influen-a, infections hepatitis or any infectious diseases including the common
cold, a protective face mask should be worn by both dentist and assistant.
During all ultrahigh speed cutting procedures, protective eye5glasses should be
worm routinely.
SUC)*+AC) PHENOMENON* !he operation of the turbine is switched
off by closing the compressed5air valve abruptly. !hen, owing to its own
kinetic energy, the turbine continues its rotation, so that the turbine starts
operating as an air pump. !his causes a negative pressure in the area of the
turbine shaft. !he negative pressure sucks air from the environment that
can be contaminated by aerosols of saliva and blood of the patient.
Si,e of cutting intru$ent and cutting "eed%
It has been pointed out by @eyton, and 6elson that, the important factor
of increased operating speeds is the instrument surface speed in fact per
minute rather than the revolution per minute of the instrument.
!he larger the diameter of the cutting instrument, the slower the speed
required at the spindle. !he specific phase in preparation of an abutment
should determine the si-e of the cutting instrument and the rpm that should be
#+
used. ?mploying superspeed for all operations places unnecessary strain upon
the patient and equipment. If the same effect can be accomplished by using a
larger instrument at a lower speed, but still remaining above the threshold of
perception, this should be done. :owever, oversi-ed cutting tools should not
be used at super speeds due to the difficulty of instrument control and
accuracy of cutting.
(I+RATION S-NDROME %

the perception of vibration, pain, touch
and temperature deteriorates. !he negative effect of local vibrations occurs
within the range )5#%00 h-, the most harmful being those below #& h-.
mechanical vibrations arise because the various machines operating at the
dentist4s workplace contain moving parts. !he main source is vibrating
power5driven or air5driven instruments, such as low5 and high5speed
handpieces as well as ultrasonic instruments. !he
vibrations emitted by these machines travel directly from the handles to the
operator4s hand. !hese are local vibrations.
+iologic re"one of dentin and "ul" to !ig! "eed cutting%
Dentin% As the contents of the dentinal tubules are in direct continuity with the
odontoblasts, and pulp, cutting or grinding the dentin causes a reaction in the
pulp and this may lead to changes in the dentin.
#$
An early experimental investigation into the effect of cavity preparation
on the dentin and pulp was carried out by >ish in #/.*. :e cut cavities in the
teeth of dogs and left the cavities open to the saliva. By sealing dyes into the
pulp chambers of the treated teeth he has shown that one of two reactions is
produced in the dentin.
In some cases there was sclerosis of the cut dentinal tubules which
forms a protective some sealing off the pulp from the in1ury and underneath
this region, there is a further growth of tubular dentine. !hese reactions are
produced by the stimulation of the odontoblasts. !he other reaction that
resulted was the formation of dead tracts. "ith this lesion some or all of the
odontoblasts, that are in connection with the cut tubules die. 7n the pulpal
aspect of these tubules, hyaline minerali-ed barrier, secondary dentine is laid
down, thereby sealing the lesion from the pulp.
Pul"% !he changes in the pulp have been studied by 8angeland and (orslard
and ,hovelton. !hey state that the damage to the pulp is to a large extent due
to the heat generated. !hey have shown that when precautions are taken to
minimi-e heat production by using burs rotated slowly in a speed reducing
handpieces, the only evidence of pulp damage was a slight reduction of the
odontoblast layer with the displacement of a small number of odontoblasts into
the dentinal tubules. "hen speeds upto ),000 rpm were employed, there was
more extensive displacement of odontoblasts associated with marked
#/
vacuoli-ation of the odontoblast layer, and local hemorrhages may be seen in
the pulp. As the speed was increased, the changes became more severe. "hen
tooth reduction was done under a stream or spray of water, the damage to the
pulp was markedly reduced.
@ulp changes associated with tooth reduction using the air abrasive
technique have been studied by <ennedy and using ultrasonic technique by
(itchell and Censon. !he changes in both the cases are similar to those
produced at the speeds of ),000 rpm.
!he effects on the pulp of using high speed rotary instruments such as
the air turbine have been investigated by (arsland and ,hovelton. !he
changes found are no severe than those produced at lower operating speeds
provided that adequate cooling of the cutting instrument by water 1et or
airDwater spray is ensured.
Alterations in the hard tissues of tooth cut by air turbines have been
observed. !he enamel over a wide area of crown may show minute cracks and
the dentin shows altered staining reactions as a result a local overheating.
9?'?6! D?3?87@(?6!E
.ANTI*SUC) +AC)/* @lanmeca compact dental units, the turbine drive
air is not shut off abruptly but controlled down by allowing the driving air
*0
to decrease gradually. !he software of the dental unit will keep on
supplying the drive air into the turbine according to carefully chosen
parameters. !his way there is no possibility for the build5up of a vacuum
effect that would cause suck5back.
'eramic bearings5 no need of lubrication and more resistant to autoclave
sterli-ation.
;se of quart- rods instead of fibre5optic.
?asy5to5use push5button bur releases.
,wivel systems.
!itanium handpieces.
,maller head si-e.
E0ECTRICA0 HIGH SPEED HANDPIECES
advantages areE
(ore power and torque than air turbine handpieces.
Better bur concentricity.
8ess vibration and noise.
Broad, controllable speed ranges.
*#
>orwardDreverse option are available.
"ith appropriate attachments, one system can be used for
restorative, prosthodontics, prophies and endodontics.
Disadvantages are E
:eavier than air turbine.
(ore expensive.
8earning curve may be required.
Attachment heads not as small as the small5head air turbines.
(ay not be able to fully replace the air turbine.
Infection control concerns.
Dicuion
It is for more than #*) years, that rotary instruments have been in use,
for tooth reduction operations, in different forms, from a hand rotary
instrument to ultra sonic instruments, which have the rotational speeds ranging
from very low speeds in case of band rotary instruments to ),00,000 rpm in
case of air bearing hand piece. !hese remarkable advances in the instruments
have greatly reduced fatigue in the operator because of the physical case of
manipulation and have considerably increased the comfort to the patient by
**
reducing the actual working time and pressures required for tooth reduction,
thereby minimi-ing the factors of heat generation and pain. !hough high speed
techniques have been a born to the dental profession, they have their can
limitations. It is interesting to not that, in spite of considerable improvements
in tooth reduction procedures and the instruments used for the same, the
principles and biologic ob1ectives have not changed.
!hese improved methods of tooth tissue removal have a potential to
damage the healthy teeth and surrounding structures, if they are used without
proper understanding of their working and if they are used without taking
proper care. Improper handling of these modern equipment may also be
different to the longevity and working capacity of the instruments themselves.
>or successful and efficient use of those cutting tools, certain factors
should be given consideration. :eat that is generated, while the tooth tissue is
being removed must be kept, down to the minimum and at the sametime,
whatever heat is generated, must be eliminated as efficiently and as quickly as
possible by employing coolants, in any one of three forms commonly used i.e.
water, airDwater spray or air alone. ,imultaneously with the coolant, if water or
airDwater spray is used, an efficient mechanism for remove of the water from
the oral cavity must be employed. 7therwise, the clinical procedure is delayed,
if the patient has to spit out the water, every now and then. By eliminating the
water evacuation equipment, we are losing one of the advantages of these high
*.
speed instruments i.e. reduced working time for a particular preparation. ;se
of efficient coolants, not only eliminate the heat generated, but at the same
time, keeps the operating area clean and free of any debris.
:igh speed cutting methods have a further advantages in that, they
reduce the annoyance that may be caused to the patient, when low speeds are
used with the modern high speed cutting devices, the vibration produced is of
a frequency that is generally beyond the upper threshold of perception of the
average patient.
@ressures that have to be employed in the use of high speeds are
considerably reduced, in comparison with those needed for low speeds.
!hus, when the factors of pressure, temperature and vibration are kept
within the tolerance limits, the patient comfort is certainly improved.
,i-e of the cutting tool to be used for particular tooth reduction
procedure is an important consideration, particularly while using high speeds.
7versi-ed cutting tools should be avoided, as they are difficult to control and
at the same time, the accuracy of tooth preparation on procedure is also
adversely affected.
Biologic reactions of the tooth tissues, particularly dentin and pulp,
should not be over locked, when high speeds are employed for tooth reduction
*%
operation. !hese responses have been studied by a number of people and they
have shown that, the response are not significantly different from those, when
low speeds are used, provided, effective coolants are employed.
!hus it can be concluded that, high speed equipments for tooth
reduction if used with proper understanding and due care, provide definite
advantages over the conventional low speed cutting procedures. !his fact
places the high speed devices at definitely a higher level as against their low
speed counterparts.
Concluion
#. :igh speed cutting devices, if used with a thorough understanding of their
mechanism and due care to the biologic integrity of teeth and surrounding
structure, are a boon to dentistry.
*. In the process of tooth reduction using high speeds considerable amount of
heat is generated and an effective coolant is a must for preservation of
tooth integrity and patient comfort.
.. 3ibration is increased with the increase in speed, but it is beyond the
threshold of prerception of the normal human beings and hence not
harmful.
*)
%. Biologic reactions of the dentin and pulp, to high speed cutting, cannot be
overlooked.
Su$$ar#
A brief history of rotary instruments has been presented. A critical
evaluation of the high speed cutting devices, as to their advantages,
disadvantages, and precautions to be taken during their use, has been assessed
at length. Biologic reactions of dentin and pulp, to high speed cutting have
been discussed in brief.
*&
Content
I. Introduction
II. 9eview of 8iterature
a. Advantages of high speeds
b. Disadvantages of high speeds
c. !ypes of high speed instruments
d. :eat generation
e. 'oolants
f. 3ibration
g. ,pread of pathogenic organisms
h. ,i-e of cutting instruments and cutting speeds
i. Biologic responses of dentin and pulp to high speed cutting
I. Discussion
II. 'onclusion
III. ,ummary
*+