High and low torque handpieces: cutting dynamics, enamel cracking and tooth temperature.
OBJECTIVE
The aim of these experiments was to compare the cutting dynamics of high-speed high-torque (speed-increasing) and high-speed low-torque (air-turbine) handpieces and evaluate the effect of handpiece torque and bur type on sub-surface enamel cracking. Temperature changes were also recorded in teeth during cavity preparation with high and low torque handpieces with diamond and tungsten carbide (TC) burs. The null hypothesis of this study was that high torque handpieces cause more damage to tooth structure during cutting and lead to a rise in temperature within the pulp-chamber.


METHODS
Images of the dynamic interactions between burs and enamel were recorded at video rate using a confocal microscope. Central incisors were mounted on a specially made servomotor driven stage for cutting with a type 57 TC bur. The two handpiece types were used with simultaneous recording of cutting load and rate. Sub-surface enamel cracking caused by the use of diamond and TC burs with high and low torque was also examined. Lower third molars were sectioned horizontally to remove the cusp tips and then the two remaining crowns cemented together with cyanoacrylate adhesive, by their flat surfaces. Axial surfaces of the crowns were then prepared with the burs and handpieces. The teeth were then separated and the original sectioned surface examined for any cracks using a confocal microscope. Heat generation was measured using thermocouples placed into the pulp chambers of extracted premolars, with diamond and TC burs/high-low torque handpiece variables, when cutting occlusal and cervical cavities.


RESULTS
When lightly loaded the two handpiece types performed similarly. However, marked differences in cutting mechanisms were noted when increased forces were applied to the handpieces with, generally, an increase in cutting rate. The air turbine could not cope with steady heavy loads, tending to stall. 'Rippling' was seen in the interface as this stall developed, coinciding with the bur 'clearing' itself. No differences were noted between different handpieces and burs, in terms of sub-surface enamel cracking. Similarly, no differences were recorded for temperature rise during cavity preparation.


CONCLUSIONS
Differences in cutting mechanisms were seen between handpieces with high and low torque, especially when the loads and cutting rates were increased. The speed increasing handpiece was better able to cope with increased loading. Nevertheless, there was no evidence of increased tooth cracking or heating with this type handpiece, indicating that these do not have any deleterious effects on the tooth.
Watson
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Division of Conservative Dentistry, Guy's, King's & St Thomas' Dental Institute, KCL, Guy's Hospital, London Bridge. timothy.f.watson@kcl.ac.uk
Flanagan
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Stone
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D000704:Analysis of Variance; D001831:Body Temperature; D003737:Dental Cavity Preparation / Q000295:instrumentation*; D003743:Dental Enamel / Q000293:injuries; D003748:Dental Equipment; D003754:Dental High-Speed Equipment; D003755:Dental High-Speed Technique; D003782:Dental Pulp / Q000502:physiology; D006801:Humans; D007180:Incisor; D008437:Maxilla; D018613:Microscopy, Confocal; D019415:Torque; D014741:Video Recording