By Jeff Carter, DDS
Dr. Doug Herbert
Having spent the last several years of my career involved with office design and dealing with things like the color of the steel posts surrounding the new dumpster, it is often easy to lose sight of the basic fundamentals of dentistry. The art and science of restorative dentistry is dependent on essential equipment functioning as near to perfection as possible. To direct our focus back to a more fundamental level, I have called upon a dear friend and highly successful dental practitioner of more than 30 years - Dr. Doug Herbert of Leesburg, Va. (pictured at left). We can always count on Doug to be candid with us. Over the years, Doug has probably purchased more dental equipment, technology, and gadgets than any dentist in America. His wife (and highly respected practice-management consultant), Esther Herbert, has the receipts to prove it.
Jeff: In your opinion, what is the most important piece of equipment in the dental office?
Doug: That’s an easy one. The handpiece (any handpiece) is the single most important and utilized piece of equipment in the dental office. To me, it is inconceivable that a doctor would settle for second- or third-tier handpiece technology. I consider an air-turbine handpiece to be a second- or third-tier product when compared to an electric handpiece. The torque and versatility of an electric handpiece are unmatched, so go for the juice, so to speak.
Air turbines have one effective cutting speed - high! That fact is a challenge when cutting teeth, cutting bone is an entirely different issue. An electric handpiece has great torque available at any speed. With a sharp bur, proper air and water spray, you could cut a chrome bumper with an electric handpiece if you desired. (Jeff: Knowing Doug, he has probably tried this.)
The benefit of an electric handpiece to the doctor is that it translates to efficiency, precision, less stress, and a superior result. The benefit of an electric handpiece to the patient is superior treatment results, less noise, and generally less time in the treatment chair. The benefit of an electric handpiece for a tooth is less vibration during treatment time, as well as less heat and less drilling time. Let’s face it - teeth don’t like to be drilled. Lingering on a preparation with a dull bur, minimal amounts of water and air coolant, will contribute to unnecessary endodontics in the future. Of course, compromising the vitality of a tooth can be done with any type of handpiece, but it is most effectively avoided with an electric handpiece.
I feel strongly that all doctors should consider an electric handpiece if they are interested in a quantum leap in their ability to deliver high-quality treatment. The closest analogy would be the impact of going from the reflected light of the overhead light and intraoral mirror to fiber optics. We all remember what a tremendous leap forward that was!
Jeff: What can an electric handpiece do that a pneumatic cannot?
Doug: Everything. In my opinion, the versatility of an electric makes the air turbine obsolete. The only reason to use an air turbine is to save money and that is a very short-sighted goal with something so critical to the success of your practice.
Jeff: What features are important to consider when purchasing an electric handpiece?
Doug: Doctors should consider noise level, weight, ease of changing heads, the “feel” in your hand, ease of adjustability of the control unit, and ease of maintenance. Also, consider brushless motors which require less maintenance.
Reversibility is very important for endodontic procedures. Because most manufacturers use E-type attachments, you can interchange attachments with different manufacturer’s motors.
Jeff: What companies manufacture electric handpieces?
Doug: J. Morita, Brasseler, Dentsply, KaVo, Sirona, Twist2it, Dental EZ Group, Lares, A-dec, Sybron Endo, MTI Precision Products, Bien-Air, and Asepti.
Jeff: If you were to purchase a new electric handpiece today, which would you choose?
Doug: I would revisit all manufacturers and choose the model that best fits in my hand, has control box features that are easy to manipulate, and is the quietest. I have used both KaVo motors with KaVo accessory heads as well as Bien-Air motors with KaVo heads.
Jeff: Because of the increased torque of an electric, did you change the types of burs you were using for specific procedures?
Doug: No, I did not change my bur selection making the switch from pneumatic to electric. I still use diamonds to reduce the enamel and carbides to reduce the dentin. I typically finish my preparations with a fine diamond.
Jeff: You told me a story about trying to fix one of your early electric handpiece motors. After taking apart the unit, you were challenged with several O-rings that were measured in tenths of a millimeter. You called the manufacturer and ordered new brushes. After replacing the brushes, you were able to get the O-rings back in place and salvage the unit. Many doctors hear these kinds of stories and are fearful about the maintenance of electrics and tackling any repair jobs.
Doug: The new models have improved significantly and maintenance issues should not be a factor. I disassemble, sterilize, and lubricate heads every day. I also only purchase brushless motors to minimize repair issues.
Jeff: Any suggestions to manufacturers to improve electric handpieces?
Doug: Electric handpieces are heavier than pneumatics. If possible, it would be great if the electric motors could be made even lighter and the overall balance of the assembled unit be improved.
Jeff: Anything else?
Doug: Any doctor considering an electric handpiece should do extensive research. Go to a meeting and test out several manufacturers’ models. The vendors typically provide handpiece demonstration units where you can experience the feel and cutting properties first-hand of an electric. You can also test an electric alongside a pneumatic if you need further confirmation of the electric’s superiority.
And please, do not let cost be a factor when purchasing an electric handpiece. You want quality and what feels the best!
Jeff: If you would like to know what Doug really thinks, please e-mail him at [email protected].
Author’s Note: On a sad note, since the writing of my last column, Dr. Jim Pride passed away. He was the innovator and driving force behind many of the principles we use today in office design. I first learned of the “Pride” operatory concept in 1978 while in dental school. Twenty-six years later, the Practice Design Group, Unthank Design, and many other office designers are still utilizing updated versions of the Pride operatory concept. His presence will be sorely missed. His impact on dentistry continues forward.
Dr. Jeff Carter is co-owner of the Practice Design Group, based in Austin, Texas. PDG specializes in providing architectural, interior design and equipment, and technology integration services to dentists nationwide. Dr. Carter may be reached at (512) 295-2224 or by e-mail at [email protected].
