John Flucke, DDS, is a clinician with a deep passion for technology, and he is always looking for the latest development that can benefit his patients. Shortly after graduating dental school in 1987, he began practicing in Lee's Summit, Missouri, where he ultimately opened a state-of-the-art facility in 2007. Flucke's extensive knowledge of dental technology has made him a frequent lecturer at major dental educational events, a contributor to many dental publications, and an internationally recognized key opinion leader. In addition, he consults with manufacturers to help them develop techniques, technologies, and products, which allows him to see things evolve from the "duct tape stage" to completion. Recently, he gave Inside Dentistry a chance to tap into his passion in a discussion about dental handpieces.

Inside Dentistry (ID): The advantage most often ascribed to electric handpieces is their ability to deliver consistent torque. What other advantages do they offer when compared with air-driven handpieces, and what are their disadvantages?

John Flucke, DDS (JF): The advantages are many! The control with electrics is much greater due to their greater torque. That means that they don't stall and can be used with a continuous pressure to "mill" the axial and occlusal surfaces of crown preparations.

The high torque also allows procedures to be completed considerably faster. No one wants dental appointments to take longer than they have to, and patients appreciate the speed with which we can complete the same appointment in noticeably less time. That includes things such as removing existing crowns or performing endodontic access procedures, especially when the restoration is zirconia.

Being able to precisely set the speed allows for incredibly accurate margins. A doctor can complete the gross reduction and then dial the speed down to finish margins to an incredibly precise degree. This benefit is also a result of the consistent torque because there is no chance of stalling-even at very slow RPMs.

Because electric handpieces have the ability to run in reverse, diamond burs can be run in either direction and cut efficiently. This allows the doctor to set the rotation so that a diamond bur can "pull" itself through interproximal reductions. Because air-driven handpieces are only able to rotate in a single direction, they "pull" through one side of a reduction but tend to "walk back" when reducing the opposing wall.

The high torque achieved by electric handpieces also means that there is no need for a latch grip slow-speed handpiece for caries removal. Many doctors use a round carbide bur for precise caries removal. This is because of the lower RPM of slow-speed handpieces but also because air-driven slow-speed handpieces have more torque than air-driven high-speed handpieces. Because electric handpieces provide consistent high torque no matter the RPM, preparation and caries removal can be accomplished with a single handpiece. The doctor simply dials down the RPM and begins the caries removal process. This eliminates the need for two handpieces as well as reduces bur inventory.

(ID): Handpieces are used for both high-speed and slow-speed applications. Are today's air-driven or electric handpieces better suited for one or the other?

(JF): Air-driven handpiece systems require a two-handpiece workflow to accomplish both high-speed and slow-speed applications. However, electric handpiece systems eliminate the need for routine use and setup of a slow-speed handpiece. High-speed electric handpieces can really be more accurately referred to as "all-speed electric handpieces." Because a good electric handpiece system eliminates the need to purchase, maintain, and set up two handpieces for every restorative procedure, the cost savings can be significant.

(ID): In recent years, handpiece manufacturers have been working to improve performance, but they have also been working to improve usability and patient experience. What advances in ergonomics and comfort regarding shape, weight, noise, or other factors have been most impactful?

(JF): The audible "whine" of an air-driven handpiece has been proven to cause hearing damage to doctors after years of constant exposure. Electric handpieces are driven by gears and not an air turbine. This eliminates the well-known whine, which not only damages doctors' hearing but also makes many patients uncomfortable while in the dental office. Although I won't go so far as to say that using an electric handpiece can eliminate patient fears, I have had patients comment on the difference in the noise and that they prefer the sound of the electric handpiece.

(ID): What advances in handpiece infection control and maintenance should clinicians be aware of and which ones can truly make a difference for practices and their patients?

(JF): Air-driven handpieces have seen some great advances in safety. When purchasing, doctors should look for options with an anti-retraction valve, which prevents debris and bioburden from being aspirated into the handpiece. They should also look for a ceramic push button on the chuck that is designed to prevent any heat buildup in the handpiece head from injuring a patient. Due to the high torque and gear-driven mechanics of electric handpieces, a few years ago, there were reports of electric handpieces continuing to turn even though the gears were worn and required maintenance. These gummed up gears created excessive heat due to friction, and there were isolated cases of patient burns from the push button contacting soft tissue. A ceramic push button is insulated and prevents this from happening.

This brings up the subject of maintenance. I would highly recommend that practices implement a countertop lubrication system. These run air and lubricant through handpieces prior to sterilization and greatly extend their lifespans. Proper use of such a system will help to keep maintenance costs low.

(ID): When it comes to specialty handpieces, such as implant, endodontic, or surgical ones, are there any specific considerations affecting selection that clinicians should be aware of?

(JF): There are some electric systems that let the doctor use the same controller for all procedures and simply switch the attachment needed. The biggest feature that I would recommend is the ability to program these handpieces to the specific RPM and torque level that the doctor wants. Being able to change the RPM and torque means that the handpiece system can evolve with the doctor if he or she happens to want to change to a different endodontic file system or implant system.

(ID): Some handpieces now feature integrated smart technology and Bluetooth connectivity to facilitate real-time monitoring of performance and maintenance needs. What cutting-edge features of handpieces do you find to be the most useful, and are there any features that you'd like to see integrated that haven't been?

(JF): Personally, I love the ability to be able to change anything that I want when it comes to handpieces. Finding a single system that lets me do every procedure was a huge plus for me. I love the fact that I don't have to change anything but the attachment to perform every possible task. I also like being able to tell the controller that I want a specific RPM and then knowing that the system will deliver exactly what I ask for.

As far as new features, I'd love to be able to monitor the operating temperature of the gears. That would help me to know when a handpiece needs maintenance before it fails. It would also be nice for the system to be able to tell me its maintenance history and usage history. I have to imagine that that's on the horizon because all of the technology that we use is simply getting smarter all the time.