Dental Products

What negatively affects the quality of dental technology??

The general, but also the most common and true answer to this question is that the eventual problem for the final customer is caused predominantly by inappropriate choice of unit, sales organization, or underestimation of technical servicing. These three pillars of quality are closely interrelated and must not be separated, because they cannot exist independently. Even the most expensive and highest quality dental unit will fail to function properly without a qualified installation and service.

The power media constitute another important aspect of quality or lack of quality:

  • The electricity from the power media usually complies with the set standards. The electrical connection of the dental unit and chair and the whole electrical power network must be equipped with a residual-current device and the whole installation is subject to revision.

  • The compressed air must be free of oil, condensed water and mechanical impurities. The latest legislative trends also require the air to be free of micro-organisms.

  • Water is the most common source of failure and impairment of dental technology. Water hardness, mechanical impurities and especially bacteria cause the spray jets to choke, the inlet hoses to clog and the valve seats of dental units to deteriorate.

The quality and reliable operation of the dental instruments and handpieces is affected in particular by:

  • Way you work.

  • Quality of the instruments used (drills).

  • Incorrect choice of instruments for the operation performed.

  • Incorrect treatment.

  • Work without cooling the instrument or without suction.

  • Incorrect sterilization.

  • Disinfection using aggressive disinfectants.

  • Use of high-speed handpieces on microengines with no internal cooling is also a common mistake.

  • Work with unit not equipped with retraction valves in the turbine and the microengineor in the unit itself.

  • Work with poor quality or incorrectly set unit.

  • Insufficient cooling of the treated place. Above the speed of 3,000 revolutions per minute there is a need for effective cooling. For high-speed handpieces, a cooling of at least 50 ml of spray water per minute is necessary.

  • Insufficient performance of drilling systems (air turbines, inefficient turbines) results in the increase of axial and radial pressure on the instrument that subsequently shortens its service life.

  • The manufacturer of dental instruments CHIRANA Medical, Inc., recommends the use of geared handpieces, which save the microengines, increase the quality of treatment and rationalize it. We consider the concept of handpieces split into a bottom part and exchangeable heads to be the best solution that also saves your money.

  • Insufficient disinfection and cleaning of the dental spittoon system, the sucking hoses and the inlet hoses of the instruments/ microengine, turbine, combined syringe/ lead to enhanced failure rates of the instruments.

  • Neglecting the prescribed rotation speed for the treatment or instrument e.g. a milling instrument for milling the crown at the speed of 200,000 revolutions per minute causes "tearing off" of the gearing of a high-speed handpiece. The manufacturer prescribes a range of revolutions from 40 thousand to the max. of 80 thousand revolutions per minute, depending on the diameter of the instrument.

  • Hygiene and treatment of the suction system, the inlet hoses of the instruments, the automatic separator automatics or the amalgam trapping device are an important prerequisite for the proper functioning of the entire unit including the instruments.

  • Aggressive disinfectants have no place in the dental practice.

  • Do not forget about the preventive inspections of your dental technology, they will help you save costs of extensive repairs.

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Source: documentation of CHIRANA Medical, Inc.

 

What is the peripheral speed of the turbine handpiece rotor with a diameter of 11.2mm?

A simple calculation reveals to us what's going on in the rotor of the turbine whilst it is running at 350,000 revolutions per minute:

the diameter of the turbine rotor

11,2mm

no load speed

350 000 za minútu

the perimeter of the turbine rotor

3,14 x 11,2 = 35,168mm

Calculation: 35.168 x 350,000 = 12,308,800mm distance travelled by the peripheral point of the turbine rotor per minute, the peripheral speed is: 12,308 km x 60 = 738,528 km/h

This is the speed at which a piece of dirt or a miniature drop of water "attacks" the bearings of the rotor. Therefore, the emphasis of the manufacturer on correct maintenance of the handpiece is justified and results in significant extension of its service life.

At the speed of 350,000 revolutions per minute the little ball of the miniature bearing in the turbine revolves around its own axis more than a million times. The centrifugal force of the little ball equals 40,000 times the ball's weight.

Improper maintenance and use of the turbines result in premature deterioration of the turbine rotor. Remember that the turbine is a "soft source of revolutions" and, therefore, excessive pressure on the drill can be a cause of its short service life.

Source: documentation of CHIRANA Medical, Inc.

The dental turbine handpiece (turbine) is an excellent representative of precise mechanics. It is manufactured at the highest possible accuracy, in microns (0.001 mm). To give you a better idea, the particles of cigarette smoke have the size within the range from 0.05 to 1 micron.

The revolutions of the turbines with no load speed are on average 350 thousand per minute. The peripheral speed of the turbine rotor reaches the speed level of a training jet. Any impurity is 40 thousand fold heavier in the environment of the rotating turbine due to the centrifugal force.

Turbines really are a curiosity in technology in general, as they operate both mechanically and chemically, in a very non-demanding environment.

Quality turbine rotors are dynamically balanced, in order to minimize vibrations, which would be perceived as very unpleasant by both the doctor and the patient. Therefore, non-professional replacement of the bearings is a source of decrease of user quality and premature failure of the turbines. The turbines must endure the conditions of autoclaving sterilization, i.e. approximately 2 pressure bars at temperatures up to 135°C without any harm.

How to prevent premature deterioration of the turbine handpieces? The above mentioned information is dealt with in more details as regards the following issues:

1. The most important requirement is to maintain maximum purity of the inner parts – the space of the turbine rotor. In greased turbines you must also use the certified cleaning and lubricating product, which cleans and lubricated the miniature bearings of a turbine rotor under the pressure of approx. 2 bars.
CHIRANA Medical, Inc., includes in its manufacturing programme the turbines with minimized coast down time label H, the turbine handpieces with closed bearings, the so called non-greased label F. The latter require a weekly lubrication of the collet clamping system. Closed bearings prevent the dirt from entering into the orbits of the bearings, thus contributing to lenghtening the service life of the turbines.

2. Dirt and dampness may be brought into the space of the rotor by low-quality drive air from the compressor. A non oil compressor guarantees that the microparticles of synthetic oil (common in oil compressors) do not get into the space of the rotor and do not deteriorate the oil intended for cleaning and lubrication of the bearings. Another troubling quality of the drive air is the humidity caused by the condensed vapours of the intake air. Condensate dryers are used to remove the humidity from the drive air. But such a device is not a part of the compressed air distribution, it is necessary to discharge the condensate from the air container located on the compressor on a daily basis.
Put oil compressors out of operation.
Note: oil mist causes insufficient adhesion of the tooth filling to the tooth and thus impairs the dentist’s work.

3. In order for the turbine to operate in optimal conditions, it is necessary to check the pressure of the drive air during regular inspections. The value must comply with the pressure recommended by the turbine manufacturer. Due to low pressure it appears to the doctor, that the turbine does not have sufficient power, and therefore he subconsciously increases the downforce on the turbine. By doing this he damages the miniature bearings, the speed drops and overheating of the tooth occurs. The temperature over 47°C is critical for the pulp. It dies away and this process is irreversible!
On the other hand a higher pressure than is recommended causes the turbine to spin at higher speed, the ultimate effect of which is identical to the effect of low pressure. Premature damage of the bearings due to overheating of the ball cage.

4. There are special demands on the clamping part of the rotation instrument (shank/spindle), and in particular on its dimensional tolerance, which should equal to + 0-0.01 mm for the diameter of 1.6 based on the ISO standard. Shanks that do not meet the tolerance may not be used in the collets of the type FG (friction). An important parameter of the collets is the extraction power, which must not be lower than 2.3 KP, allowing for the breakage of the shank in the collet in case the instrument gets stuck whilst at the same time preventing the instrument from falling out of the equipment. You need to check the surface of the shank, there should not be any scratches, which could prematurely damage the collet on it. A non-functional collet cannot be used and requires a challenging service intervention. Clean and check the dimension of the instrument shanks by the calibre.

5. In modern turbines the collet is controlled by a button mechanism. Proper functioning of this mechanism depends on the purity of the inner part of the turbine shaft, in which the collet is laser-welded. If you fail to regularly clean and lubricate the collet from the inside, the collet will remain open, i.e. malfunctioning.
Lubricate the collet from within once a week with a cleaning and lubricating substance (from the side of drill insertion). It will clean and lubricate the sliding areas of the disconnecting mechanism and ensure the correct functioning of the turbine.

6. Before inserting the drill into the collet check the smoothness and cleanliness of the instrument shank. The shank must not be rusty. Remove any spikes at the top of the shank with fine sandpaper or do not use such a drill!
Refrain from using any drill, the diameter of the working part of which is greater than 2 mm, or if the instrument is bent, non-centric.
Before treatment of the turbine, remove the instrument from the collet. Do not leave the instrument in the collet in the off position.
The service time of the turbine is also affected by the length of the instrument used. Use the instruments lengths according to the manufacturer's recommendation.
ISO compliant drills create basic conditions for the correct functioning of the turbine handpiece. Blunt and poor quality drills and discs do by no means save your money!

7. Work with a turbine is of different character than work with a microengine handpiece. The turbine is a so called soft source of revolutions and therefore the clamping force on the turbine the doctor uses matters greatly.
If your instrument is sharp and centric and you have optimal drive pressure, work with the turbine with a so called "light hand". In this way, you will not reduce speed, you will get maximum removal rates and minimal tooth warming - you will save the turbine and yourself by reaching a minimal proportion time.
An increased pressure on the turbine results in the opposite of the previous sentence. The compressive force should equal about 20 dkg; try signing the shell of a fresh chicken egg without cracking it!

8. Ergonomic control of the switching off mechanism by a button requires you not to push the button while the turbine is running. The fractions of a second will not waste your time; on the other hand they might cause the button to wear out prematurely. This will damage the switching off mechanism of the collet and the turbine will be non-functional.

9. The operation of a turbine requires effective cooling of the instrument by a water-air mixture. For effective cooling the treated place has to be cooled by the volume of 50 ml of water per min. (Water cooling requires revolutions over 3,000 per min. for microengine instruments).
The required amount of cooling water has to be sucked out by a large suction pump for better visibility of the operation field and in order to comply with the standards of hygiene. Never use the turbine without effective cooling.

10. Perform only surface disinfection; do not immerse the turbines in any disinfectant baths. Do not use aggressive disinfectants. For the sterilization of the turbines follow the instructions of the manufacturer.

11. Follow the instructions for cleaning and lubrication of the turbine in the instruction manual attached to the turbine. It is important for the lubricant and treatment substance to be inserted into the rotor area of the turbine under pressure.
Check the cleanliness of the substance coming out of the turbine by putting the turbine into white paper wadding during the application of the treatment spray. Allow for any excess treatment substance to drain on a holder for about 15 minutes.

12. Perform a thorough cleaning and lubrication of the clamping system of the collet once a week. After applying the spray onto the collet opening, press the control button of the turn off mechanism of the collet several times. It will ensure its correct functioning.

One of the most important factors, affecting the smooth running and operation of the dental unit is the quality of the intake water. The quality of the water entering and passing through the dental device is important in terms of two basic parameters, which are:

  • the water hardness

  • he microbiological quality of water

Water hardness has an adverse effect on the quality and functionality of some elements and parts of the dental unit. The microbiological quality of water has a negative impact on the health of the treated patients.

Water hardness

Water that contains larger amounts of dissolved calcareous and magnesium salts is called hard water. Depending on their content level, the elements cause temporary water hardness (calcium and magnesium bicarbonate) and permanent water hardness (sulphates).

Temporary hardness changes with heating the water, or gradually with the change of its temperature by settling into carbon dioxide and poorly dissoluble calcium carbonate. Removal of the substances that cause water hardness is called water softening, which can be performed in several ways:

  • by distillation we get pure water H2O – both temporary and permanent hardness are removed

  • by adding sodium carbonate to hard water, calcareous ions are removed by the process of precipitation of calcium carbonate

  • by adding ion exchangers, when the water passes through a special substance containing sodium ions, which replace the calcareous ions - the passing water turns soft as the sodium ions do not cause hardness.

Water hardness is most frequently expressed in the so-called. German degrees [° dH] in the following scale:

1.

Soft water

0 – 7oN

2.

Medium-hard water

7 – 14oN

3.

Hard water

14 – 21oN

4.

Very hard water

above 21oN

The water hardness in Central Europe ranges from 5° to 35°dH. Overall water hardness is the sum of carbonate and permanent hardness. The unit of hardness is the degree of hardness mmol/l, which is converted into German and French degrees (1 mmol/l = 5,6°dH). According to the legislation the recommended value for drinking water the calcium and magnesium content ranging from 1.1 to 5 mmol/l, i.e., water hardness 6,16°- 28°dH).

For proper and smooth functioning of the dental unit it is important for the incoming water to have a hardness of less than 12°dH. If the incoming water has higher hardness than specified, your dental unit can be provided with an additional compressed water container. The ACWC bottle has to be filled only with softened or demineralised drinking water, which has to be boiled in order to ensure bacteriological cleanliness. However, as a complex and lasting solution it is good to ensure continuous softening of water for the distribution system in the office or in the entire building by filter plants intended for that purpose. The most common and simplest principle for softening water is the application of the so called ion exchange resin by means of the specialised automated equipment, built onto the inlet of the water distribution system. Specialized companies can assist you with the selection and installation of the water treatment plants. This investment will in the long run bring savings regarding service costs, but certainly also longer service life of the dental tool and other water-dependent devices.

The microbiological quality of water

The quality of water in water distribution networks as well as further in the dental surgeries is very important in terms of maintaining internal hygiene in dental practice. Various manufacturers deal with this problem and offer solutions and devices for upgrading the dental water distribution. These devices must comply with the basic premise that the cooling, or rinsing water, which comes into contact with patients must at any point of exit have the quality of drinking water in terms of germs content.

The control of drinking water quality and its health safety is determined by a series of more than 80 indicators of water quality, representing the physical, chemical, biological and microbiological properties of water. The limit values of water quality indicators are defined by the legislation of the given countries.

In the drinking water regulations for food industry or health care it is stated that drinking water must be deprived of germs. This requirement shall be considered satisfied if the drinking water does not contain any E. coli (Escherichia coli) in at least 100 ml of water (maximum limit). Coliform germs must not be present in 100 ml of water.
The number of colonies in drinking water should not exceed the value of 100 KBE at incubation temperature of 10° to ± 2°C and at incubation temperature of 36° ± 1°C. The presence of coliform bacteria or Escherichia coli indicates serious flaws in the protection of the water source, the treatment, the distribution and the health security of drinking water.
In terms of internal hygiene of water, it is important for the drinking water in the water distribution networks, attached to dental facilities, to meet the applicable regulations on drinking water.

There are 2 circuits of waterways in CHIRANA Medical, Inc. dental units. The first circuit is for flushing and rinsing water, i.e. filling the patient's glass for rinsing their mouth and for rinsing the dental spittoon bowl. The second circuit is for cooling of the instruments inside the doctor's table. CHIRANA Medical Inc. dental units are dispatched hygienically clean, i.e. they have passed the tests with drinking water corresponding to the given regulations (regular inspection of the distribution channels by a health officer) and prior to packaging and shipment the water in the distribution system of the dental units is drained, as also the presence of clean drinking water may give rise to the germs.

Drinking water gets into the dental surgeries from the public tap and should conform to the regulations on drinking water. This fact is regularly checked by controls established for this purpose by the public health authorities. Nevertheless, in reality the contamination level exceeding 100 KBE may occur temporarily. Drinking water does not have to be absolutely free of germs, i.e. sterile and germs may multiply in the closed branches of residential water systems. Germs can grow and subsequently spread around the residential water tap. It is a huge risk if such water enters the fine pipes of the dental units, where after switching off (e.g. during the weekend), the water does not run freely, but becomes "standing-water" for a certain time. Moreover, there are also heating elements in the dental units and the temperature of the water regularly reaches above 37°C. This is how bacteria may proliferate on the inner sides of the distribution hoses of the dental kits in practice. E.g. it is possible to detect the presence of mucus on a removed hose cut in half. It is basically a thick carpet of micro-organisms that are partially harmless, but in certain cases agents of impurity, and even fecal germs can be found.

It is therefore understandable that the dental unit manufacturers are trying to prevent them from the above mentioned threats connected to lack of sanitation in the residential distribution pipes. A variety of additional decontamination devices are used, mostly maximalist solutions, i.e. solutions that comply with the standard EN 1717, under which the device is effectively separate from the water supply.
Our company currently recommends the use of the device made by the company Metasys (decontamination WEK system), which in addition to separation from the water supply allows for the removal of germs by continuous application of special disinfectant on the basis of hydrogen peroxide (2%). A concentrate of 235 ppm (0.00235%) is used for the continuous disinfection. According to the regulation on drinking water, one may add 0.1 mg/l of hydrogen peroxide to drinking water for oxidation.

Dental unit manufacturers use disinfection facilities for decontamination of inner hygiene of the water that comes into contact with the patients, with mostly hydrogen peroxide-based solutions with a high oxidative effect. Decontamination treatment is carried out before the beginning of work after a prolonged switching off of the dental unit and at the end of each work. However, for this purpose, the Dental unit must be equipped with a waterways system of hygiene.

Another additional option, done in combination with the application hydrogen peroxide is the simultaneous use of the UV unit (low pressure mercury vapour discharge lamp), which, in conjunction with the oxygen separated from the peroxide destroys organisms. The wavelength of the UV-radiation used is less than 450 nm. Such a device requires regular replacement of the UV lamp (at least once a year), due to its decreasing efficiency.

It is possible to have your CHIRANA Medical dental unit upgraded with a system of hygiene for the disinfection of waterways for cooling the instruments. It is a disinfection device based on application of a special hydrogen peroxide based solution (3% H2O2), which automatically ensures, the cleaning of the waterways of the dental unit including the instrument hose and the instrument itself when you start the disinfection programme. CHIRANA Medical offers this option for all the models at very reasonable prices.

On top of that, CHIRANA Medical dental units can be upgraded by a hygiene system of suction hoses "H1", which ensures the treatment of the suction elements of the dental unit, including the amalgam separator and the subsequent exhaust hoses.
To ensure the disinfection of both water circuits of the dental unit, the dental kit can be upgraded with a continuous disinfection device by the company Metasys-WEK. This device ensures the internal hygiene of the waterways, the instrument hoses, the cup filling system including the rinsing of the spittoon bowl. The WEK device requires the use of special charges on the basis of H2O2 under the trade name of GreenCleanWK.

Dental unit manufacturer information:

CHIRANA Medical, Inc. systematically deals with the problem of internal hygiene of the dental device. The company is in continuous contact with the manufacturers and suppliers of water treatment devices using reverse osmosis, ion exchange resin application or UV application disinfection.
Since we do not manufacture these devices, we recommend our customers to turn to specialized companies that are able to carry out the relevant water analyses and to recommend you a suitable device for installation.

Dental unit manufacturer recommendations:

  1. Before the installation it is necessary to check the quality of drinking water in the residential tap. It should comply with the relevant regulations and standards.

  2. Water hardness of the water supplied to the dental unit must be less than 12°dH, otherwise it is necessary to install a water treatment plant or supply suitable soft water to the dental unit waterways from an additional compressed water tank.

  3. Use the decontamination of instrument tubes upgrade for the dental units, including the instrument hoses and the instruments themselves, i.e. a system of hygiene of the company CHIRANA Medical.

  4. Use the hygienic system of suction and exhaust hoses "H1" for the dental units

  5. Use the water separation and continuous disinfection of waterways upgrade WEK, compliant with the standard EN1717 for the dental units

  6. Use an additional integrated compressed water tank, filled with suitable water in terms of water hardness and microbiology for the water supply of the dental units. The dental unit thus becomes independent from the public water network and any risks of unsatisfactory water application are eliminated.

Solution for decontamination of dental units CHIRANA Medical, Inc.:

In case a health officer detects bacteria in the dental unit due to the presence of contaminated water at the end of the instrument, or in the oral end piece, it is necessary to perform decontamination of the entire water distribution system of the dental unit. Decontamination is performed by trained service personnel and the manufacturer. The decontamination procedure is as follows:

  1. Disconnect the water hose from the water inlet in the supply case.

  2. Carry out a health inspection of the drinking water from the residential tap.

  3. By means of a special CHIRANA Medical decontamination unit, connected to the inlet water hose (green hose + ending) a solution of hydrogen peroxide (3% H2O2) is brought into the water distribution system. CHIRANA Medical, Inc. supplies the disinfectant solution. (Compressed air for the adjusted decontamination unit is obtained by connecting it to the air distribution channel according to the CHIRANA Medical connection scheme).

  4. By gradual draining of the solution from the instrument hoses, cup filler and spittoon bowl rinsing, the disinfectant solution is left to work within the distribution system for about 2-3 hours.

  5. Consequently, it is necessary to fill up the bottle of the decontamination unit with clean drinking water or distilled water and rinse the entire distribution system (the instrument hoses, cup filler, bowl rinsing).

  6. Have a health officer check the output water from the instrument hoses and cup filler. In case of bacteria detection (contamination) repeat the whole decontamination procedure.

  7. In case of positive sanitary inspection result, connect the dental unit to the tap water distribution system that complies with the required quality of drinking water.

Source: Documentation of CHIRANA Medical, Inc.