AIR Abrasion
AIR Abrasion
AIR Abrasion
A I R ABRASION
Air abrasion improves both speed and accuracy in degrees. The Airdent and other air abrasion devices
treating incipient pit and fissure caries in virgin became popular quickly in the 1950s, because they
molars. Air abrasion devices are high-energy sand- produced less heat and vibration than a belt-driven
blasting and tooth cutting systems. The high- handpiece. At their introduction in 1950, Dr.
energy particles emitted cut faster and more pre- Black stated that air abrasion systems were an
cisely than traditional sandblasters. The cutting adjunct and not a replacement for the dental hand-
path of these devices is 100 ro 1000 times smallet piece.^ This is still true.
than that of their sandblaster counterparts. The
cutting beam diameter averages about 300 [Am, but In the late 1950s, the use of air abrasion devices
they can be made as small as 100 ^im. declined after the introduction ofthe Borden Air
Rotor, the first air turbine handpiece, even though
HISTORY both had valuable uses. The rapid cutting burs
used in the Air Rotor and the aimost universal
Air abrasion, also referred to as advanced particle acceptance of G.V. Black's extension-for-preven-
beam technology, or microabrasive technology, was tion preparations diverted dentists' interest in air
invented by Dr. Robert Black in 1943.''The prin- abrasion devices. The technology went into a slum-
ciples, uses, and limitations of air abrasion devices, ber for the next 50 years.
defined in the 1950s, still provide the basis for the
units currently being produced. In December 1982, the Food and Drug Admin-
istration (FDA) approved the sale of a redesigned
The first air abrasion system, which was offered air abrasion device, giving rise to a reemergencc of
as an alternative to a slow-speed, belt-driven hand- this technology in the dental profession (KV-1,
piece, was the Airdent air abrasion unit (manufac- Kreative Inc., Albany, Oregon; KCP series, Ameri-
tured and sold by SS White Co., Piscataway, New can Dental Technologies, Corpus Christi, Texas;
Jersey, in 1951).' Its placement in over 20 dental MicroPrep, Sunrise Technologies, Fremont, Cali-
schools around the country initiated postgraduate fornia). Currently available air abrasion devices are
courses in air abrasion technology. By 1955, the considerably more sophisticated and precise than
Airdent had been adopted by over 2000 dentists in the earlier units. New metering systems have been
the United States alone. developed to control the flow of abrasive particles.
Many units have cutting beams as narrow as
The Airdent was heavy, weighing well over 100
500 |Am. By increasing the beam working distance,
pounds, and massive (over 4 feet high, over 2 feet
this beam can be increased to over I mm. The
deep, and about 18 inches wide). Its pressure tank
revamped technology offers a clinician considerable
contained carbon dioxide (or a number of other
control ofthe particle beam as well as a pulsing fea-
gases) to provide a high-viscosity gaseous propei-
ture that can double the efficiency ofthe device.
lant. In spite of its awkward size, the unit had a
small, 0.018-inch {460-nm) tip and delivered a
30-nm beam of aluminum oxide particles; these PHYSICAL PROPERTIES
particles left the tip traveling at over 1000 feet per The physics for air abrasion technology was made
second, which is in the realm of supersonics. All apparent in 1829 by Gaspard Coriolis with the dis-
this was done with a divergent angle of only 3.5 covery ofthe formula E ^ 1/2MV2. The particles
290 Tooth-Colored Restoratives
from these devices are emitted as a well-defined, Likewise, it can be used to remove sealants to
sharply focused beam. examine beneath them for suspected decay.
A number of variables interact in the use of an Diagnosis of pits and fissures
air abrasion device, including the following:
Air abrasion devices are useful in detecting pit and
• Particle energy, which is related to air pressure fissure caries.''"'' When a darkened area is detected,
and other factors one or more short bursts of particles removes the
stain or organic plug, while removing only a few
• Beam intensity, which is related to the particle microns of healthy tooth structure. If the tooth is
flow-rate, particle type, particle size, nozzle caries-free, a sealant can be placed as a preventive
diameter, and nozzle design measure. When underlying decay is discovered, it
• Beam working distance, which is determined by can be removed by air abrasion. Since the dentist
the operator controls the duration (the dwell time) and range
(the beam working distance) of these bursts, by
• Beam incident angle, which is determined by holding the handpiece about an inch above the
the operator tooth, he or she can remove material in tiny incre-
• Dwell time, or the time the device is held in one ments and preserve the maximum amount of
spot, which is determined by the operator healthy tooth structure.
The controls on the devices usually include Treatment of pits and fissures
on/off, abrasion flow, air pressure, and choice of
Air abrasion devices allow a trained dentist to cut
nozzle (usually 0.011 or 0.018 inches in diameter).
conservative preparations in pits and Hssures for
The air sources are either an accessory compressor
placing preventive resin restorations (Figure D-1).
or compressed nitrogen. The aluminum oxide par-
It is possible to conservatively open pits and fis-
ticles emitted are typically 25 to 29 [Xm in size
sures in teeth where caries is suspected, and deepen
(average, 27.5 \im). Some systems offer a wider
pits andfissureswith negligible widening between
range in particle size, spreading 20 ^m or more.
the walls.
Air pressure is typically 40 to 100 psi (average,
70 psi). The_ average flow rate is 2 to 3 g per Cleaning
minute, and dwell time is typically 20 to 45 sec-
onds per tooth. Air abrasion can also be used to clean a tooth prior
to etching if oil contamination from the handpiece
is suspected (eg, from sterilization procedures).
CLINICAL USES
Air abrasion devices cut tooth structure, especially Cementation of a crown
enamel, with a precise, rapid, and quiet beam of Internal (metal) surfaces of crowns and the tooth
energy. They produce less heat, pressure, and vibra- itself can be sandblasted immediately before cemen-
tion than conventional cutting tools, and result in tation or re-cementation to improve adhesion.
less crazing on enamel. Patients treated witb air
abrasion require less anesthesia. Tn one survey, Effect on bonding
90% of patients reported little or no discomfort Some laboratory studies show that the use of these
after having teeth restored with this procedure.'^ devices improves bond strengths to enamel and
dentin.** This may have no clinical significance,
Disadvantages of air abrasion include (1) the however, because almost all bonding agents have
dentist's loss of tactile sense, (2) large size of the bond strengths higher than the cohesive strength of
unit, (3) high cost, (4) possible gingival tissue enamel and dentin.
hemorrhage, and (5) noisy suction system for clear-
ing the air of particles.
CLINICAL SAFETY
Debris removal Air abrasion devices cut hard tooth structure faster
This technology can be used to remove debris and than soft tooth structure. That is, they cut enamel
repair leaking margins of composite restorations. (and old composite) the fastest, then healthy dentin,
Appendix D: Air Abrasion 291
affected dentin, infected dentin, and lastly soft tissue. When an air abrasion device is used, the tip
In the hands of improperly trained or inexperienced (the nozzle) should not contact the tooth. Its
dentists, air abrasion devices can be dangerous and movement over the tooth is completely directed
cause significant iatrogenic destruction of tooth by what the operator sees. There is no tactile guid-
structure. Adequate training is important. Air abra- ance. The use of magnification is a necessity, since
sion devices also easily cut such hard restorative sub- cutting must be done with direct vision and the
stances as porcelain, but they are less effective than preparations are small. Use of a mirror while cut-
burs and diamonds in removing gold or amalgam. ting is problematic because scattered particles
292 Tooth-Colored Restoratives
bounce off it, turning the surface frosty and use- 3. Morrison AH, Berman L. Evaluation ofthe Airdent
less. Disposable mirrors have to be discarded after unit: preliminary report. J Am Dent Assoc 1953;46:
each use. 298-303.
The clinician and assistant should wear pro- 4. Goldberg MA. Airbrasive: patient reactions. J Dent
tective eyewear (with tnagnification) and a face Res 1952;31:504-5.
shield. It is best to isolate the working field with
a rubber dam, although in some cases this is not 5. Brockmann SL, Scott RL, EickJD. The effect of an
possible (eg, for crown cementation, partially air-polishing device cn tensile bond strengths of a den-
erupted teeth, etc.)- The dental assistant should tal sealant. Quintessence Int 1989;20:2Il-7.
use high-volume evacuation to remove excess
particles. 6. Laurell K, Lord W, Beck M. Kinetic cavity prepa-
ration effects on bonding to enamel or dentin [abstract].
J Denr Res 1993;72(Spec Issue):273.
REFERENCES
7. Burbach G. Micro-invasive cavity preparation with
1. Black RB. Airbrasive: some fundamentals. J Am an air abrasive unit. GP Insider 1993;2:55-8.
Dent Assoc 1950;4l:701-10.
8. Goldstein RE, Parkins FM. Air-abrasive technol-
2. Black RB. Application and reevaluation of air abra- ogy: its new role in restorative dentistry. J Am Dent
sive technique. J Am Dent Assoc ]955;50:408-l4. Assoc 1994:125:551-7