Dental Equipment and Care

Chapter 2 Dental Equipment and Care



SELECTING THE APPROPRIATE DENTAL DELIVERY SYSTEM


A variety of equipment is available, which leads to the frequently asked question: “What type of dental equipment should I buy?” There are several factors to consider, depending on the individual practice. How much and what type of dentistry will be performed? How much space is available? How much capital is available to purchase the equipment? Is the practice prepared to equip for future department expansion, or just for the immediate needs?


When purchasing dental equipment, frequency of use, type of use, space available for equipment, and the cost should be evaluated before making a decision. For example, if endodontic therapy is to be performed, purchase of an air-driven unit is recommended. Other advanced level dental procedures also require specialized equipment.


After reviewing your own practice situation and goals, the equipment suited to your practice should become more apparent. The purchase of dental equipment provides an excellent return on investment.1 The dental service is one of the most cost-efficient departments in the veterinary hospital.


A variety of dental instruments and supplies are needed, and selecting instruments that allow efficiency and effectiveness during dental procedures is a must. This includes having a variety of sizes of some instrument types in order to work with the different sizes of teeth and oral cavities that veterinarians encounter.



Suggested Minimum Instrument List



• This list contains the instruments necessary for doing dental cleanings, routine and surgical extractions, and basic periodontal procedures, in addition to the major equipment that will clean teeth, polish teeth, and section teeth for extractions.


Oral Examination



• Fine Shepherd hook explorer, calibrated probe.

• First Sight disclosing solution.

• Welch Allyn penlight for transilluminating teeth.

• Intraoral radiographic equipment and supplies.


Dental Prophylaxis



• Mini 5 Gracey curette 5/6 or 7/8.

• Columbia curette 4R/4L.

• Barnhart curette 5/6.

• Gracey curette 13/14.

• After Five curettes (for deep periodontal pockets).

• Short-shanked Gracey curettes (for cats and toy breeds).

• Morse 0-00 scaler for cats.

• Jaquette sickle scaler for dogs.


Basic Oral Surgery



• Number 3 scalpel handle.

• Scalpel blades: #11, #12, #15 or 15c.

• Canine large periosteal elevator Molt #4.

• Feline and small dog periosteal elevator Molt #2.

• Freer periosteal elevator.

• Miller 5-0 (3-mm) surgical bone curette.

• Apical elevator or root tip pick.

• Root tip forceps.

• Large and small breed extraction forceps.

• Adson-Brown thumb forceps.

• Five-inch needle holders.

• Iris scissors.

• La Grange scissors (for periodontal surgery).

• A combination of various sized luxators; a set of winged elevators, with or without small, medium, and wide elevators for extractions; small, medium, and large, left and right pennant-shaped elevators.

• Conical sharpening stone to sharpen luxators and winged elevators.

• Arkansas stone with oil to sharpen curettes and scalers.

• Burs: size 699L, 701L, 701LS, 702, #2, #4, #6, #8. Diamond burs for round burs are beneficial for bone removal and alveoloplasty.

• Suture material 4-0 absorbable, 5-0 for cats.


POWER EQUIPMENT



• When purchasing power equipment, the practitioner should consider the cost of the unit, intended location for the compressor and dental consoles, noise levels at the location, availability at the clinic for equipment maintenance, and present and future dental caseload.


Features to Consider



Foot Pedal



Advantage



• Allows hands to work uninterrupted, rather than switching on and off manually.


Variable Speed



Advantage



• Allows for a broader range of work with more control.


Reverse Direction



Advantage



• Can reverse direction with caution to back out of wrapped-up hair.


Disadvantage



• A mandrel or screw-in prophy cup may become unscrewed if turned in the direction opposite to its design (snap-on prophy cups are available).


Accessories



• Prophy angles are used to polish during prophylaxis, restorations, and other times when abrasives are used.

• Contra angles are used to change the angle of rotation of the device used on the teeth.

• Reduction contra angles are used to reduce speed at an angle.

• Acceleration contra angles are used to increase speed at which the device spins.

• Handpieces are used to create force and to hold contra angles, prophy angles, burs, and other instruments.


Uses



• Prophylaxis.

• Periodontics.

• Endodontics.

• Restorations.

• Exodontics.

• Orthodontics.

• Orthodontic laboratory.

• Oral surgery.

• Prosthodontics.


Electric Motor Handpieces



Comments



• These are handpieces with electric motors built in (Fig. 2-1).

• A control box connects the handpiece electrically.

• Speed range 3,000 to 30,000 rpm; with accelerating contra angles speed can be increased to 125,000 rpm. (These contra angles are expensive.)

image

Fig. 2-1



Advantages



• Most cost less than air-driven units.

• Low maintenance.

• Portability.

• Small size.

• More torque.

• They are popular in Europe and gaining popularity in the United States in human practices due to decreased incidence of air embolism.


Disadvantages



• Handpiece and motor break down with heavy use.

• Except for models with accessories, inability to run water through handpiece as a coolant for dental tissue.

• Slow cutting speed.

• Increased torque creates more heat (potential thermal tissue injury).

• Some are cumbersome to use.


Air-Driven Power Equipment



Comments



• Air-driven systems have three components: the air power source; the tubing, hoses, connectors, and controls; and the handpieces. They can be powered safely by an air compressor or by a tank of compressed carbon dioxide or nitrogen. Compressors are rated by horsepower (hp) and the ability to deliver a flow of air. Most dental handpieces require the compressor to maintain 30 to 40 pounds per square inch (psi) at a flow of 3 cubic feet per minute at the handpiece. The control section is an array of air and water switches, regulators (valves), and hoses that control the flow of air and water into the hoses and, in turn, into the handpieces. The control section can be a mobile stand, cart, wall-mounted extension arm, over-the-patient delivery system, or small countertop unit.


Advantages



• Air acts as coolant to the handpiece.

• Water passes through the handpiece and acts as coolant and irrigant for the dental tissues.

• Longer life of the compressor and handpiece than electric motor–driven handpieces.

• Ability to run at higher speeds, than electric motor–driven handpieces, for rapid performance.

• Less torque than electric motor–driven systems and therefore less heat created at the cutting surface.

• Air-driven units generally come with an air and water syringe built into the unit that is used to provide irrigation and cooling, air drying, or both, improving visualization during dental procedures.

• Air compressor units are easier and less expensive to maintain than delivery systems powered by carbon dioxide or nitrogen.


Disadvantages



• Larger size than an electric delivery system

• Noisy if not using a small “silent” compressor.

• More expensive than electric motor–driven units.

• Spray mist forms aerosol and may create a fomite problem.

• Accumulation of water in the oral cavity.

• Noise from a high-speed handpiece may contribute to hearing loss.


Variable Features



• These are features the practitioner should consider when purchasing these units.


Electric foot switches


Comment


• The electric foot switch compressor operates with an electrical circuit to turn the compressor on and off, and air is delivered directly to the handpiece without storage.


Advantage


• Require low horsepower and thus units at table side can be smaller.


Disadvantage


• Handpiece is either on full speed or off; there is no intermediate speed.


Air rheostat controls


Comments


• The compressor is turned on and off by a preset pressure switch and runs only to fill the storage tank

• Compressors of less than ¾ hp are running more than they are off. This leads to overheating and temporary shutdown.

• If the practitioner’s intent is infrequent use, the smaller, chairside units work well.

• If frequent use or the use of multiple dental stations is anticipated, a larger, remote compressor with a storage tank is the best selection. A compressor of at least 1 hp is recommended if either two stations or a sonic air scaler is in use.


Advantage


• Wide variability in speeds.


Disadvantage


• Greater expense than electric foot-switch units.


Remote compressors


Comment


• Compressors can be located away from the dental operatory. This removes another space-consuming item from the dental operatory and allows for multiple station use from a single power source.


Advantages


• Can be used to power multiple stations

• Many smaller, table-side compressor control units without compressors are compact, can be moved around, can be used at different locations, and can be stored out of the way.

• Removes compressor noise from working area.


Disadvantages


• Requires space for ventilation and cooling

• Requires personnel safety considerations regarding noise level.

• Requires a location where compressor noise will not interfere with practice routine.

• Adherence to maintenance schedule is more at risk if compressor is outside the operatory.

• Pressure decreases with increasing distance from the dental delivery system. The remote compressor should be ideally within 50 feet of the dental operatory.


Table-side compressors


Comment


• Primary considerations for selection of a table-side compressor are space in the dental area, enough power and air storage for current and future use, and noise element for staff in the treatment area.


Advantages


• Can be stored in a different location when not in use

• Can be moved easily.


Disadvantages


• Self-contained units may require additional in-line care and water filtration systems for restorative dentistry

• Low power of some units translates into low volume of air flow and low air pressure.

• Excessive noise of some units.


Oil-free versus oil-containing compressors


Comments


• Air heats up as it is compressed, and this heat is transmitted to the compressor

• Compressors are cooled by either air or oil.

• Air-cooled oil-free compressors do not have oil to check or change.

• As a general rule, oil-free compressors are noisier and more expensive than the oil-containing variety.

• To overcome the problem of monitoring oil level with a dipstick, several oil-containing models have view ports for observing the oil level.

• In-line filters to separate oil and water are recommended with all types of compressors.


“Whisper-quiet” compressors


Comments


• Traditional air compressors are fairly noisy.

• Very quiet refrigerator compressors have been converted from pumping refrigerator coolant to pumping air.

• These units are available in portable carts, portable cabinets, and countertop units.

• The single-unit compressor rates around ½ hp. If multi-station use or a sonic scaler handpiece is being considered, a double-unit 1-hp compressor should be considered.

• Because converted refrigerator compressors contain oil, the oil level must be monitored and changed according to the manufacturer’s recommendation.


Advantages


• Quiet compressor

• Available tabletop models.


Disadvantages


• Most units contain oil, and oil levels must be maintained

• Expensive.

• If used for long periods without stopping, some models may overheat and shut down until cool; this may take 30 to 60 minutes.


Air-Driven Alternatives Other Than by Air Compressor




Carbon dioxide


Comment


• Tanks can be rented from medical supply services and can be used, with a regulator gauge and quick disconnect couplings, to drive high-speed handpieces.


Advantages


• No maintenance

• Saves the cost of an air compressor.

• Is not flammable.


Disadvantage


• Rental of tanks and ordering more carbon dioxide.


Nitrogen


Comments


• Nitrogen offers the same advantages and disadvantages as carbon dioxide; however, nitrogen is less expensive than carbon dioxide.


Caution


• Oxygen should not be used to power dental handpieces, because a spark could cause an explosion.

Delivery systems used in veterinary dentistry offer various combinations of accessories and handpieces. A typical top-of-the-line setup consists of two high-speed handpieces, one low-speed handpiece with a straight attachment, a prophylaxis angle, a contra angle, and a three-way air and water syringe. Other useful accessories frequently seen as attachments on the delivery system are a suction apparatus, a sonic scaler that can be substituted for one of the high-speed handpieces, fiberoptics for the handpieces, a bright light wand, and a curing unit for light-cure materials. Two styles of tubing for the handpieces are available: coiled and straight. The coiled tubing can be kept off the floor and out of the way more easily than the straight type but has much more operator-fatiguing drag and pull than the straight tubing.



Three-way syringes


Comments

The three-way syringe is used for the following (Fig. 2-2, A):


• Flushing the oral cavity for better visualization

• Rinsing chemicals off dental structures.

• Air-drying tooth structures during restorations and other procedures.

• Air-drying teeth to visualize calculus deposits that turn chalky when dry.2

image

Fig. 2-2



Automatic switches and mechanical switching


Comments


• Some units have switches that turn air on and off when handpieces are taken from or placed in their holders

• Other units require mechanical switching by the operator.

• Automatic switches are desirable, but they present another potential mechanical failure problem.


Automatic drain valves


Comment


• When pressure is released from the air storage tank, condensed water is released.


Advantages


• Valves require less maintenance because water is drained automatically

• Compressor tank will last longer (decreases rust).


Disadvantages


• One more piece of equipment that may break down

• Does not always work.


Oil-level indicators


Comment


• A view port is located at the same level as the oil stored inside the compressor (Fig. 2-2, B).


Advantages


• Checking the oil level may be performed without the mess of a dipstick

• The color of the oil may be inspected periodically.


Adjustable chairside air and water pressure controls


Comment


• Some delivery systems have individual adjustable valves available for each handpiece.


Advantage


• More accommodating for the needs of different handpieces (e.g., a sonic scaler may require higher air pressure, which could be detrimental to certain prophy angles on a low-speed handpiece). Manufacturer recommendations should be consulted for each handpiece.


Compressor Maintenance



• All compressors with air storage tanks require periodic drainage of condensation from the tank (Fig. 2-2, C).

• The last-stage regulator should be set between 30 and 40 psi (Fig. 2-2, D).

• The pressure in the tank may be 80 to 120 psi, depending on the brand.


Compressor Accessories



• Filters to filter out oil and water from the compressed air. These provide for drier air and less chance of bonding material failures

• Dryers to dry the air.

• Water filters to filter the water before it enters the handpiece. Some locales have more impurities in the water than others. This can also affect procedural technical success.


Handpieces



• Handpieces enable the operator to work on teeth. They hold the mechanical cutting and finishing instruments used to modify tooth structure

• Many types of handpieces are available, and they can be categorized into three basic types: low-speed, high-speed, and sonic scalers.


General maintenance


• A handpiece should never be turned on without a bur or “blank” inserted into the chuck to prevent damage to the chuck

• Follow the manufacturer’s recommendations on handpiece lubrication and air pressure.

• Lubricant should be placed in the smaller of the two large holes (Fig. 2-3, A and B).

image

Fig. 2-3



Low-speed handpieces


Comments


• Low-speed air-driven handpieces operate within 5,000 to 20,000 rpm. Low-speed handpieces have two kinds of connections with the contra angle, E-type and Doriot-type

• The E-type handpiece has a quick release, pull-off end for E-type prophy and contra-angle nose cones (Fig. 2-4).

• Doriot-type handpieces have a twist-and-lock end for Doriot-type prophy and contra angles.

• Disposable prophy angles and handpiece burs or diamond discs require a Doriot-type handpiece.

image

Fig. 2-4



Uses


• They can be used for polishing with prophy angles

• Contra angles can be attached to allow use of burs, endodontic files, polishing discs, and other specialized instruments requiring slower speeds and higher torque.


Advantages


• High torque; less likely to “stall out.”

• Slower speed for cutting bone.


Disadvantages


• Low speed is a disadvantage when drilling into or sectioning teeth; increases working time and tissue heat

• May shatter the tooth if the bur binds while cutting the tooth.

• May create thermal injury because of the slow speed and pressure between the bur and tooth surface (drilling pressure).

• Usually do not have water as a coolant and irrigant.


Autoclave option


Comment



• Many of the newer low-speed handpieces can be autoclaved.


Advantage



• Increases rust resistance.


Maintenance



• Lubricate according to manufacturer’s instructions

• If a heavy oil is used, spray with a light oil (WD-40) once every 2 weeks to help dissolve oil accumulations.

• Run the handpiece for 20 to 30 seconds after lubrication.

• Sterilize between patients.


Accessories: prophy angles


Comments



• Prophy angles are used to polish teeth

• There are two types of prophy angle rubber cup attachments: snap-on and screw-on. Which to use is an individual preference, but it must match the attachment configuration of the end of the prophy angle. Some prophy angles accept either type of cup.


Circular action prophy angles



Comments



• These prophy angles rotate 360 degrees

• Metal models are manufactured, some to be disposed of when they break and some to be repaired.

• Plastic models are disposable and are designed for single use.


Advantages



• Circular prophy angles tend to be inexpensive

• The inexpensive models are usually replaced rather than repaired. They may last for a few months of use.


Disadvantages



• Require disassembling and lubricating

• May “spit” oil, contaminating the prepared dental surface.

• May incur hair entanglement from the patient.


Oscillating prophy angles



Comments



• The oscillating prophy angle oscillates back and forth 90 degrees

• This style is a sealed unit. Now also available as a plastic disposable model (Twist2it, Flushing, NY).


Advantages



• This style does not require lubrication

Related posts:

  1. Regional and Local Anesthesia
  2. Anesthesia and Pain Management in Dental and Oral Procedures
  3. Dental Prophylaxis and Periodontal Disease Stages
  4. Periodontal Therapy and Surgery

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Dental Equipment and Care

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