R E S E A R C H ABSTRACT

Background. High-speed handpieces’

spray ports direct coolant at
the cutting interface. The A D A
J
authors evaluated the

The effect of
✷ ✷
effect of the number of ®

N
ports and their positions

CON

IO
handpiece spray on cutting rates, or CRs.

T
T

A
N

I
AA RI N G E D U 1
C
Methods. The authors U

R 2
performed cutting studies TTIICCLLEE
patterns on cutting on a machinable ceramic block
using an established testing regimen.

efficiency One-port, three-port and four-port hand-

pieces from one manufacturer were oper-
ated at maximum torque and rotation
speed under a water flow of 25 milliliters
SHARON C. SIEGEL, M.S., D.D.S.; J. ANTHONY VON
per minute. The authors made 6-millimeter
FRAUNHOFER, M.S.C., Ph.D., F.A.D.M., F.R.S.C.
long edge and groove cuts in 13-mm cross-
section blocks using six medium-grit dia-

T
here appear to be no clear guidelines for den-
tists to use when choosing handpieces, and
the great variety of handpieces available
complicates the selection process. Despite the
number of handpieces available, the litera-
ture on the characteristics of different instruments and
their comparative performances is sparse. Rather than
basing decisions on clearly defined cri-
The number of teria, selection usually is predicated on
spray ports price, feel, weight, size, after-sales serv-
ice and, to a degree, the type of hand-
determines the
piece used during dental education.
access of Articles about the effectiveness of hand-
coolant at the piece sterilization1-3 and the effect of
cutting sterilization on handpiece longevity and
interface, cutting performance have been pub-
4
mond burs for each handpiece. Each bur
cut a total of 78 mm. The authors deter-
mined CR as the time to transect the block
and analyzed the data by two-way analysis
of variance with post hoc Scheffé tests.
Results. CRs varied by the type of cut
and the number of spray ports. No differ-
ences were found in CRs for the three
handpieces during edge cutting. The one-
port handpiece cut significantly slower
(P < .001) than did the three- and four-port
handpieces during groove cutting.
Conclusion. The data indicate that the
number of handpiece spray ports, and their
positioning relative to the bur affect water
supply to the cutting interface and, conse-
quently, the CR under these study

conditions.
which affects lished, as have articles addressing per-
Clinical Implications. Optimal cut-
formance testing of handpieces.4-7 Little
the cutting ting efficiency requires good coolant access,
attention, however, has been paid to the
rate. issue of coolant delivery at the cutting especially within restricted areas. A
interface. multiple-port handpiece may be advanta-
Protecting the health and vitality of pulpal tissues geous when preparing the interproximal
through cooling the bur/tooth interface with water region for a crown or a proximal box, owing
during a cutting procedure has been established for to the better water spray pattern. Dentists
decades.8-12 Although a survey conducted in 2000 showed should consider the influence of the
that many dental schools recognize the importance of number of spray ports when selecting
water cooling, most do not make specific flow-rate rec- handpieces for cutting procedures.
ommendations.13 Using higher coolant flow rates to
enhance thermal protection of the pulp is recognized in
Europe,14,15 and another study conducted in 2000 demon-
strated clearly that faster cutting rates, or CRs, were
found with higher flow rates.16
High-speed handpieces have one or more spray ports

184 JADA, Vol. 133, February 2002

Copyright ©2002 American Dental Association. All rights reserved.

that direct a stream or mist of coolant at the
bur/tooth interface to provide cooling and debris
removal during cutting. Dental handpieces differ
in their design and construction; one obvious dif-
ference is the number and positioning of coolant
spray ports. Traditionally, high-speed handpieces
had only one spray port, located at the 6 o’clock
position (Figure 1). Manufacturers, however, have
developed high-speed handpieces with multiple
spray ports, notably with three spray ports in the
2, 6 and 10 o’clock positions and four spray ports
in the 3, 6, 9 and 12 o’clock positions. There is
little information on the optimum number or posi-
tioning of spray ports or the effect of the design
on cutting efficiency. The literature also does not
indicate whether differences exist in the cooling
efficiency of different handpiece designs. One
handpiece manufacturer indicated that three- and
four-port heads were designed to ensure that
there still was sufficient coolant spray for pulpal
safety if one or more ports become obstructed
(William Sleinetz, B.S., KaVo America Corp.,
Lake Zurich, Ill., personal communication, June
30, 2000).
An initial study17 indicated that CR differences
were found when the same bur was used under
different spray regimens. In fact, under the same
applied load and bur rotation speed, markedly
different CRs were found when the number and
positioning of spray ports varied, particularly if
one or two spray ports were blocked.
We conducted this current study to evaluate
the effect of the number of spray ports and their
positions on diamond bur CRs. This is an impor-
tant consideration for practitioners when they are
selecting new handpieces, as well as for dentists
who routinely perform a variety of complex cut-
ting procedures within restricted areas.
METHODS AND MATERIALS
We conducted the cutting studies employing a
previously established testing regimen18,19 for dia-
mond burs using three high-speed handpieces
manufactured by KaVo America Corp.: the one-
port 635B, the three-port 647B and the four-port
649B. We selected these handpieces because
KaVo America Corp. produced one-, three- and
four-port head handpieces that all had an auto-
matic air pressure regulation valve that ensured
a constant bur speed. The one-port handpiece was
designed for pediatric use and had a smaller head
size than did the three- and four-port head hand-
pieces, but all three handpieces had similar rota-
Copyright ©2002 American Dental Association. All rights reserved.
R E S E A R C H
1 Port
Bur
Spray Port
4 Ports
3 Ports
Figure 1. High-speed handpiece heads.
tion speeds, output power and torques (Table),
which allowed us to compare the three hand-
pieces’ CRs.
The test platform we used was an L-shaped
acrylic framework with a frictionless bearing
fixed in the vertical component of the framework
(Figure 2). When the handpieces were mounted in
the bearing assembly, they could rotate freely
during use. We loaded each handpiece so there
was a force of 91.5 grams (0.9 newtons) at the
contact interface between the dental bur and the
cutting substrate. We achieved this applied cut-
ting force by attaching a 147.5-g weight to the
handpiece head. The actual force at the bur tip is
determined by the following formula based on the
principle of lever arms:
Load at bur/machinable ceramic interface =
weight ×
distance from pivot point to weight
___________________________
distance from pivot point to bur tip =
147.5 g × 49 millimeters = 91.5 g
___________
79 mm
We selected this load since the literature indi-
cates that the average applied load during
restorative procedures is in the range of 50 to
150 g.17-20 We performed all of the cutting studies
with the handpieces at maximum output power,
torque and bur rotation speed. Before each set of
cutting studies, we measured the coolant (tap
water) flow rate and ensured that it was it was 25
milliliters per minute. During cutting, we held
the bur parallel to a machinable ceramic (Macor,
JADA, Vol. 133, February 2002 185
R E S E A R C H

TABLE

DENTAL HANDPIECE PARAMETERS.

HANDPIECE HEAD HEAD OUTPUT TORQUE ROTATION AIR
MODEL DIAMETER LENGTH POWER (NEWTON SPEED PRESSURE
NUMBER (MM*) (MM) CENTIMETERS) (ROTATIONS (BAR)
(NUMBER OF PER MINUTE
SPRAY PORTS) 1,000)

635B (1) 11.0 12.4 12.5 0.10 420 (7.09 × 2.5

103 s†-1)

647B (3) 12.4 14.5 15.0 0.15 370 (5.74 × 2.8

103 s -1)

649B (4) 12.4 14.5 17.1 0.17 370 (5.74 × 2.8

103 s -1)

* mm: Millimeters.
† s: Seconds.

Bur

Edge Cut
Machinable Ceramic

Bur

Groove Cut Machinable Ceramic

Figure 2. Test cutting assembly. Figure 3. Cross-section of groove and edge cutting.

Corning Inc., Corning, N.Y.) bar and pulled per-
pendicularly down onto it, simulating clinical
practice.
We used Macor, which is 55 percent fluorophlo-
gopite mica and 45 percent borosilicate glass,
because its hardness (Knoop hardness number of
250), elastic modulus (66.9 gigapascals) and
thermal properties are comparable with those of
dental enamel.17-19 We used 13-mm cross-section
rectangular Macor bars and medium-grit 856-016
diamond burs (Brasseler USA, Savannah, Ga.).
We used a 6-mm length of each bur to section
through the 3-mm-thick Macor bars. We made six
cuts with six different burs in each handpiece, for
a total cutting distance of 78 mm/bur.
We performed two sets of cutting studies on the
Macor bars. In the first series, we positioned the
burs one bur diameter from the edge of the bar to
make edge cuts (Figure 3). This cutting method
simulated tooth preparation for crowns—for
example, axial wall or occlusal reduction. In the
second series, we positioned the burs at least one
to two bur diameters from the edge of the bar to
make a groove cut (Figure 3). This cutting method
simulated interproximal cutting for crowns, as
well as for operative box and groove preparations.
We determined CRs as the time it took the bur
to transect the Macor bar, and we recorded the
CRs as mm per minute. We analyzed the data by
two-way analysis of variance with the number of
spray ports and the type of cutting as test factors.
We performed post hoc Scheffé tests at an a priori
α = 0.05 to identify differences between the groups.
RESULTS
The cutting data are summarized in Figure 4 and
Figure 5. We found no significant differences
(P > .05) between the CRs for the three-port and

186 JADA, Vol. 133, February 2002

Copyright ©2002 American Dental Association. All rights reserved.
 R E S E A R C H

four-port heads when they were used for edge or

30
groove cutting. The CRs for groove cuts made with

(MILLIMETERS PER MINUTE)

the one-port handpieces, however, were signifi- 25
cantly lower (P < .01) than those for the three- and

CUTTING RATE
20
four-port handpieces. Further, the CRs for groove
cuts made with the one-port handpiece were sig- 15
nificantly lower (P < .01) than those for the edge
10
cuts. We found no differences (P > .05) in CRs
among the three handpieces during edge cutting. 5

DISCUSSION 0
3 Ports 4 Ports 1 Port
In restorative dentistry, clinicians often advance HANDPIECE
the bur against a single side or plane of the tooth;
for example, during buccal/lingual axial wall
Figure 4. Histogram of mean edge cutting rate (using
crown preparation. In simple terms, this may be three handpiece spray nozzle designs).
described as edge cutting. Likewise, clinicians
face situations in operative dentistry in which the
bur will be required to cut bilaterally, that is, to 25

(MILLIMETERS PER MINUTE)

cut through tooth or restorative material, in effect
20
cutting a groove. Groove cutting also is encoun- CUTTING RATE

tered in prosthodontics during axial wall prepara-

tion in the interproximal region—one of the most
difficult situations that clinicians may face during
crown preparation. The relationship between the
proximal tooth and the mesial/distal wall of the
crown preparation essentially becomes “a groove”
during cutting. Another approach that also cre-
ates a groove during cutting is when clinicians
maintain a thin “shelf” of enamel between the
tooth being prepared and the adjacent tooth.
Clearly, facilitating tooth preparation under these
circumstances is advantageous to patients and
clinicians.
Since it has been shown that the CRs for teeth
and other substrates are markedly affected by
coolant flow rates,14-16 clinicians seek to provide
maximal coolant flow rates at operative sites. The
findings from our current study indicate that CRs
are determined by the number of spray ports on
the handpiece and by the cutting location. We
found faster CRs with edge cutting compared
with groove cutting when we used a one-port
handpiece, but we found no difference in CRs
between cutting methods for the three-port and
four-port handpieces. Although the CRs for the
four-port handpiece were greater than those for
the three- and one-port handpieces, the difference
was not significant except for with the one-port
handpiece during groove cutting.
The differences in CRs during edge and groove
cutting with a one-port handpiece arise from the
restricted access of the water spray during the
latter cutting method. During edge cutting, access
15
10
5
0
3 Ports 4 Ports 1 Port
HANDPIECE
Figure 5. Histogram of mean groove cutting rate
(using three handpiece spray nozzle designs).
of the coolant spray at the cutting interface still is
important, but it appears to be less significant
than during groove cutting. It follows that during
groove cutting (for example, in interproximal
axial wall preparation) a multiport handpiece
offers a clear advantage in terms of cutting effi-
ciency. Poor coolant access within shielded
regions deleteriously affects cutting efficiency
and, possibly, may result in elevated tempera-
tures during cutting. Further studies are neces-
sary to determine whether cutting facilitated by
multiport heads is paralleled by greater control of
heat generated during cutting.
CONCLUSIONS
Previous studies have shown that the amount of
coolant spray water delivered at the bur/cut sur-
face interface markedly affects the observed
CR.14-16 In the present study, we identified the
number and positioning of spray ports in a high-
speed handpiece as additional factors influencing

JADA, Vol. 133, February 2002 187

Copyright ©2002 American Dental Association. All rights reserved.
R E S E A R C H

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188 JADA, Vol. 133, February 2002

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