True Drill-Less Dentistry: Are We There Yet?
It is no secret that medical science has advanced significantly in recent years, and that includes dentistry. We now have resin composite cavity fillings in addition to traditional amalgam fillings, optical scanning technology, and state-of-the-art digital x-ray machines that capture panoramic images and provide a highly comfortable experience for patients.
But what about dental drills, a.k.a dental handpieces? Those devices that emit that nerve-wracking whine as they enter patients’ mouths. Will they be replaced soon? Why haven’t they been replaced already?
Purpose of Dental Handpieces
Dental handpieces are used primarily to remove decaying tooth tissue before inserting a cavity filling or as part of root canal procedures. Some handpieces are high speed and others are low speed. Some use air as their power source while others use an electric motor controlled by a digital console.
For a more in-depth look at dental handpieces, check out our previous news post about them.
So with this technologically advanced world we live in, is there a viable alternative to dental drills?
One modern method that dental professionals use to remove tooth decay instead of drills is called air abrasion. This method basically means sandblasting the patient’s tooth. A tool blows a powerful stream of tiny particles onto the patient’s tooth, and the particles bounce off the tooth and remove the decaying hard tissue.
Air abrasion is a simple treatment, leaves more of the healthy hard tissue behind, reduces the need for anesthesia, generates no heat or vibration, and reduces the risk of fracturing the patient’s tooth.
Sounds like it’s time to throw out dental handpieces and start replacing them with air abrasion units ASAP, right? Actually, not so fast. Air abrasion does not work on all types of cavities; deep cavities, cavities requiring the removal of hard enamel, and damaged teeth requiring the preparation of crowns cannot be treated with air abrasion. Also, air abrasion is not entirely pain free: the air and particles used can trigger sensitivity in certain patients’ teeth.
Air abrasion is a great alternative to drilling some of the time, but it still cannot replace drills for procedures requiring more “heavy lifting.”
Dental Hard-Tissue Lasers
Medical treatments utilizing laser technology have become widely accepted by the public as the sleek, attractive, less-painful alternative to traditional methods, and dentistry is no different. Soft-tissue lasers have become the standard of care for many dental treatments. Hard-tissue lasers, however, are a different story.
Lasers operate by directing a beamed with a spray of air and water to keep the tooth cool. The laser beam heats the water particles in the patient’s tooth until they expand and remove the decayed tissue.
When used on hard-tissue, lasers do not produce the same odor or shrill whining noise that drills do. Erbium lasers, like air abrasion, do not crack the tooth’s enamel and reduce the need for anesthesia. In fact, lasers seem to make it more difficult for the patient’s nerve fibers to register pain during the procedure. Lasers also create an ideal tooth surface for bonding glass ionomers and resin composites because they dissolve away the excess dentin particles and do not leave any oil or smear contamination for the dentist to deal with.
Once again though, the dental laser’s main perceived advantage over the dental drill is that it rarely requires anesthesia and is more appealing to most patients.
So why are lasers not replacing dental handpieces entirely?
One main reason is cost. Dental laser machines cost as much as $50,000 to $60,000, much more than dental handpieces.
Another reason is lack of clinical data. Very little clinical trials and research have been done into the effectiveness of dental lasers to treat hard tissue decay. According to an article published in the Wall Street journal in April of 2013, a 2002 Japanese study of 50 adult cavities found that 68% of the patients felt no pain when lasers were used for treatment, and 6% of the cavity patients felt “intolerable pain” and requested anesthesia.
These types of studies are still few in number, and many dentists cannot justify investing so much money in hard-tissue dental lasers just to avoid using anesthesia on patients.
Basically, dental professionals are collectively still waiting for firm evidence on how effective lasers are at treating tooth decay. Some have purchased hard-tissue lasers and love them, but many prefer to stick with the patient-frightening but also clinically proven dental drill.
Air abrasion offers dentists an alternative for some types of cavity treatment, but dental handpieces are still necessary for more complicated procedures.
Hard-tissue dental lasers provide a treatment option that dentists can more easily market to patients because little or no anesthesia is involved, and because lasers are highly regarded by the general public. But the high cost and small clinical evidence makes it difficult for many dentists to switch to hard-tissue lasers.