dental handpiece for oral surgery

[dentigerous]

Hey all,

Just wondering if anyone knows is it safe to use a high speed dental handpiece for oral surgery procedures (extractions)?


thanks

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[Kabek]

Hey all,

Just wondering if anyone knows is it safe to use a high speed dental handpiece for oral surgery procedures (extractions)?


thanks

It isn't the standard of care to use a traditional high speed for surgical extractions, possible air embolism, etc. You will want to use something like an Impact Air which can run on a traditional unit or with a nitrogen tank.

Another option would be an electrical handpiece such as a Stryker.

Lastly, the all mighty Hall off the nitrogen tank which you could also use for any automotive work.

As a GP your best option most likely will be an Impact Air since you can run it on your traditional chair and get it in your contra angle which you are used to using.

Hope that helps.

 

[aphistis]

No.

Nonfatal Cerebral Air Embolism After Dental Surgery

Magni, Giuseppina MD, PhD; Imperiale, Carmela; Rosa, Giovanni; Favaro, Roberto
Anesthesia & Analgesia Volume 106(1), January 2008, pp 249-251

Abstract: After removal of four impacted third molars under general anesthesia, our patient developed subcutaneous emphysema, pneumothorax, pneumopericardium, and pneumomediastinum. Soon thereafter, coma with generalized epileptic status ensued. A cerebral magnetic resonance and single photon emission computed tomography showed hypoperfusion of the right thalamus and parietal, temporal, and frontal cortices. The likely mechanism was injection of air by the high-speed dental drill through the soft tissue adjacent to the roots of the lower molars. We were unable to find any previous report of systemic air embolism after oral surgery.

Pneumomediastinum, pneumothorax, venous air embolism, and even death, have been reported as complications after dental surgery; most of these cases were associated with the use of dental equipment that directed pressurized air or water into gingival defects produced by dental procedures.1–3 Systemic air embolism has been reported as a complication of various surgical operations and invasive maneuvers and is, more often than not, an iatrogenic complication.4,5 Coma ensuing from cerebral air embolism after dental surgery has not been described.

Emphasis mine.

 

[mike3kgt]

No.



Emphasis mine.

Do we have any published data on non-third molar procedures and emphysema risk using regular dental handpiece. I prefer traditional handpiece to that of an Impact Air, then again, I'm a GP so it's what I use all the time. The air spray makes it easier to see root tips etc. I know it's always quoted as the reason not to use regular handpiece but wouldn't you assume that risk for emphysema would be significantly higher with large flaps and facial spaces in easy accessed position (i.e. significant third molar extraction) rather than that of troughing around root tips on the upper area or sectioning a #19?

 

[aphistis]

Do we have any published data on non-third molar procedures and emphysema risk using regular dental handpiece.

I don't know of any. I doubt anyone would want to put their name on a study whose primary method involves intentionally placing the experimental group at risk for a potentially fatal complication.

I prefer traditional handpiece to that of an Impact Air, then again, I'm a GP so it's what I use all the time. The air spray makes it easier to see root tips etc.

I see what you're saying, but in my opinion it doesn't justify the additional risk to the patient. Access is important, but you can achieve it by good flap design and hemostasis, without introducing the added risk of injecting pressurized air into the surgical field. By unnecessarily exposing the patient to a potentially life-threatening (if infrequent) complication, you tilt the risk/benefit ratio for the procedure significantly away from the patient.

I know it's always quoted as the reason not to use regular handpiece but wouldn't you assume that risk for emphysema would be significantly higher with large flaps and facial spaces in easy accessed position (i.e. significant third molar extraction) rather than that of troughing around root tips on the upper area or sectioning a #19?

Without evidence it's hard to compare. Facial spaces are only part of the question, though; you also have to consider what happens if, say, the patient moves unexpectedly, or the assistant bumps your handpiece with her suction, or you simply move the handpiece carelessly. If you inadvertently nick a vein while the handpiece is running, you're essentially injecting air intravascularly, and could be looking at a retrograde cerebral air embolism. Is a matter of minor convenience really worth taking that chance?

Venous drainage from the head and neck is essentially a passive process, H&N veins have no valves to protect against retrograde flow, and air will tend to rise upward in blood vessels just like in any other fluid system. Put together, that means you have no mechnical protection against air backflow into the brain, a minimal pressure gradient for the air to overcome, and unfavorable fluid mechanics working in favor of the outcome we want to avoid.

I honestly have no idea how frequently complications like this occur. I don't know anyone personally who has had an incident like this, but if it occurred, I have to think you'd be positively screwed from a liability standpoint (and that's on top of the obvious humanitarian issues of having killed or neurologically maimed a patient). To me, it's just not good patient care. Do yourself and your patients both a tremendous favor and just buy a surgical handpiece.

 

[koobpheej]

I have a question about air embolism--in thoracic or abdominal surgery it is essentially inevitable. Why is so much more dangerous in dental surgery?

 

[IcedOMFS]

. I prefer traditional handpiece to that of an Impact Air, then again, I'm a GP so it's what I use all the time. The air spray makes it easier to see root tips etc. I know it's always quoted as the reason not to use regular handpiece but wouldn't you assume that risk for emphysema would be significantly higher

After reading this paragraph, I can only assume that you are an idiot... Someone should take your license away.

 

[dentigerous]

could one use an electrical implant handpiece for oral surgery procedures to minimize risk of air embolism

 

[aphistis]

could one use an electrical implant handpiece for oral surgery procedures to minimize risk of air embolism

This is getting ridiculous. Just buy a friggin' Hall drill already.

 

[mike3kgt]

After reading this paragraph, I can only assume that you are an idiot... Someone should take your license away.

Is this honestly how you speak to a fellow colleague? You have to think outside the resident box because how you speak to each other in residency has no function to the real world private practice. If I EVER had an oral surgeon speak to me like this in private practice when I ask a legitimate dental question, I guarantee that surgeon would NEVER get a referral from me ever again. I see this behavior too often from residents in oral surgery and those who get behind a computer screen become even worse. Maybe you too could become one of those oral surgeons I see who have to advertise in the local paper because you will ostracize your referral source. In fact, those surgeons who have supported me through the years (and rarely have to bail me out) will consistently get my high quality patient referrals. I send out the capitation and low-income to the others.

I have practiced in a high end prosthetic practice and a lower end community health practice. The dentists who I have been working for in both settings have a cumulative 70+ years experience in general dentistry and have always used traditional high speeds when sectioning or troughing teeth and never, ever had emphysema complications.

I have taken out thousands of teeth in my short career and never had a serious complication. I know how to select cases and I work in a practice that has several ImpactAir handpieces and have used both for extraction procedures.

I appreciate aphistis' comments because they are of a professional in all of his posts. It was a legitimate question, thank you for the response.

You on the other hand, are not professional.

 

[aphistis]

I have a question about air embolism--in thoracic or abdominal surgery it is essentially inevitable. Why is so much more dangerous in dental surgery?

An embolism is a collection of matter (blood clots, air, fat, amniotic fluid) in a blood vessel and preventing blood flow through it. The air introduced to the thoracic or abdominal cavities during surgeries does not constitute an embolism. Whoever told you this is incorrect.

 

[armorshell]

Season 4, episode 15 of House, M.D. is the only evidence I need that dental procedures can cause an air embolus.

 

[Antz002]

Season 4, episode 15 of House, M.D. is the only evidence I need that dental procedures can cause an air embolus.

LOL! Good ol' House - fountain of medical knowledge and the character who expresses himself in ways we all wish we could 😉

 

[dentigerous]

what bout the use of sterile water vs. saline irrigation. Will using sterile water really cause tissue necrosis being that's hypotonic?



thanks

 

[throgsneck]

Hey all,

Just wondering if anyone knows is it safe to use a high speed dental handpiece for oral surgery procedures (extractions)?


thanks

I don't think that there should be any problem in using that but you should be able to drill properly....

 

[aphistis]

I don't think that there should be any problem in using that but you should be able to drill properly....

Um. Have you read the rest of the thread?

 

[CanuckDDS]

Um. Have you read the rest of the thread?

aphitis...who cares about air embolism if you've been a dentist for 27 years and have never had a single one?! Right? 🙄

Ignorant and lucky, traits acquired only through years of experience and only if you can "drill properly"...

 

[throgsneck]

Um. Have you read the rest of the thread?

Yes, i have, but i will still persist with my answer.

 

[toofache32]

As was previously noted, air embolism is air entering the blood vessels. Air emphysema is air entering the soft tissue, and is of concern when using dental handpieces under a flap. I'm not aware of any studies addressing the incidence, but there are plenty of case reports. While it sounds like people get away with it most of the time, you won't have a leg to stand on when you do get an air emphysema. I treated 2 of these patients during oral surgery residency where a regular dental handpiece was used:

 

[Guy Smiley]

As was previously noted, air embolism is air entering the blood vessels. Air emphysema is air entering the soft tissue, and is of concern when using dental handpieces under a flap. I'm not aware of any studies addressing the incidence, but there are plenty of case reports. While it sounds like people get away with it most of the time, you won't have a leg to stand on when you do get an air emphysema. I treated 2 of these patients during oral surgery residency where a regular dental handpiece was used:

How do you treat something like this?

 

[toofache32]

How do you treat something like this?

Mainly needs time to resolve. Antibiotics are a good idea since a bunch of oral bugs have been spread into the fascial planes.

 

[IcedOMFS]

Is this honestly how you speak to a fellow colleague? You have to think outside the resident box because how you speak to each other in residency has no function to the real world private practice. If I EVER had an oral surgeon speak to me like this in private practice when I ask a legitimate dental question, I guarantee that surgeon would NEVER get a referral from me ever again. I see this behavior too often from residents in oral surgery and those who get behind a computer screen become even worse. Maybe you too could become one of those oral surgeons I see who have to advertise in the local paper because you will ostracize your referral source. In fact, those surgeons who have supported me through the years (and rarely have to bail me out) will consistently get my high quality patient referrals. I send out the capitation and low-income to the others.

I have practiced in a high end prosthetic practice and a lower end community health practice. The dentists who I have been working for in both settings have a cumulative 70+ years experience in general dentistry and have always used traditional high speeds when sectioning or troughing teeth and never, ever had emphysema complications.

I have taken out thousands of teeth in my short career and never had a serious complication. I know how to select cases and I work in a practice that has several ImpactAir handpieces and have used both for extraction procedures.

I appreciate aphistis' comments because they are of a professional in all of his posts. It was a legitimate question, thank you for the response.

You on the other hand, are not professional.

Dude, I am not going to respond to your first paragraph other than to say settle down and untie the knot from your thong.

I fail to see how the absence of a rare, but potentially life-threatening complication from a sample size of procedures too small to show such an event bears any relevance on the inappropriateness of using a forward venting air-driven dental handpiece for dentoalveolar surgery.

Personal opinion or personal experience is the lowest level of evidence available, and the fact that you are throwing 70, or 100, or 150 years of 'experience' as justification for practising below an acceptable level of care actually weakens your position. You sound like a quack.

http://www.quackwatch.org/01QuackeryRelatedTopics/quackdef.html

Lemierre's syndrome and descending necrotizing mediastinitis are such horrible complications. We had a DNM last year. The patient lived, but had to have a thoracotomy, debridement of neck, and was in ICU for weeks. All because some archaic dentist who had never had a complication in over 30 years of practise thought that meant he didn't have to use a proper surgical handpiece.

Rather than getting offended that someone called you out in a way you found upsetting and then trying to obfuscate the issue and attack me on irrelevant areas like to whom you send your referrals, maybe you should try and grow beyond the ignorance you are incorporating into your practise. That is the real act of unprofessionalism.

Here's a start:
http://www.ncbi.nlm.nih.gov/pubmed/8238061

 

[54807]

Our OS lecture directly cites that the Impact Air 45 was marketed at one point as the "OS handpiece for general dentists" and even the manual online suggests that is still the case. Then it says the handpiece does not have bur-end exhaust; 'but you better check it everytime cuz we can't guarantee it' attitude is in the manual. It suggests it's not good for flaps, yet it is good for apicos, osteoplasty, etc. All require flaps..... Then it also says don't allow the backside of the head to get under a flap....it's a small handpiece so with a large flap I bet this is sorta easy to do. No?

So it might just not be that there are a bunch of 'stupid GPs' out there, but some lack of understanding of the limitations of handpieces that are blatently marketed to GPs for OS.

Maybe that's the case with other handpieces that are the cause for this hostile discussion...

 

[aphistis]

Dude, I am not going to respond to your first paragraph other than to say settle down and untie the knot from your thong.

I fail to see how the absence of a rare, but potentially life-threatening complication from a sample size of procedures too small to show such an event bears any relevance on the inappropriateness of using a forward venting air-driven dental handpiece for dentoalveolar surgery.

Personal opinion or personal experience is the lowest level of evidence available, and the fact that you are throwing 70, or 100, or 150 years of 'experience' as justification for practising below an acceptable level of care actually weakens your position. You sound like a quack.

http://www.quackwatch.org/01QuackeryRelatedTopics/quackdef.html

Lemierre's syndrome and descending necrotizing mediastinitis are such horrible complications. We had a DNM last year. The patient lived, but had to have a thoracotomy, debridement of neck, and was in ICU for weeks. All because some archaic dentist who had never had a complication in over 30 years of practise thought that meant he didn't have to use a proper surgical handpiece.

Rather than getting offended that someone called you out in a way you found upsetting and then trying to obfuscate the issue and attack me on irrelevant areas like to whom you send your referrals, maybe you should try and grow beyond the ignorance you are incorporating into your practise. That is the real act of unprofessionalism.

Here's a start:
http://www.ncbi.nlm.nih.gov/pubmed/8238061

👍

 

[CanuckDDS]

👍

Dude, I am not going to respond to your first paragraph other than to say settle down and untie the knot from your thong.

I fail to see how the absence of a rare, but potentially life-threatening complication from a sample size of procedures too small to show such an event bears any relevance on the inappropriateness of using a forward venting air-driven dental handpiece for dentoalveolar surgery.

Personal opinion or personal experience is the lowest level of evidence available, and the fact that you are throwing 70, or 100, or 150 years of 'experience' as justification for practising below an acceptable level of care actually weakens your position. You sound like a quack.

http://www.quackwatch.org/01QuackeryRelatedTopics/quackdef.html

Lemierre's syndrome and descending necrotizing mediastinitis are such horrible complications. We had a DNM last year. The patient lived, but had to have a thoracotomy, debridement of neck, and was in ICU for weeks. All because some archaic dentist who had never had a complication in over 30 years of practise thought that meant he didn't have to use a proper surgical handpiece.

Rather than getting offended that someone called you out in a way you found upsetting and then trying to obfuscate the issue and attack me on irrelevant areas like to whom you send your referrals, maybe you should try and grow beyond the ignorance you are incorporating into your practise. That is the real act of unprofessionalism.

Here's a start:
http://www.ncbi.nlm.nih.gov/pubmed/8238061