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Air Abrasion Technology

Dental Treatment Without the Drill

A Consultation with Dr. Ben G. Amini

This article is endorsed by the
American Academy of Cosmetic Dentistry.

Dear Doctor,
My dentist says she wants to use an air abrasion instrument to prepare my teeth for a filling, which sounds really scary — can you tell me more about it?

Air abrasion technology.

Dear Fiona,
It may sound scary, but actually it isn’t. And the good news is this technology may replace, or reduce, the amount of drilling that is needed to remove tooth decay. In many situations, this new tool can remove the decayed tooth structure, while leaving healthy tooth structure intact — or at least with minimal loss. It hardly makes any noise while it’s working, and best of all you may not need an anesthetic (numbing) injection.

Sound better? While this technology is just now finding its way into many dental offices, the idea behind it isn’t exactly new; air abrasion instruments were first introduced in the mid-20th century. However, recent advances in high-volume suction pumps (to remove the dust created) and improved bonding materials (to replace lost or damaged tooth structure with natural looking fillings) have sparked the renewed development of the system.

What is air abrasion, also known as particle abrasion? Essentially, it’s a minimally invasive technology that uses a stream of fine particles (instead of a rotating drill bur) to remove decayed or in some cases stained areas of surface enamel from a tooth or teeth. It can also abrade the tooth surfaces, cleaning and roughening them in readiness for bonding of tooth structure to dental restorative materials. In fact, particle abrasion has been demonstrated to notably increase bond strength. The technique is also quite effective at cleaning contaminants such as blood, saliva and temporary cements from tooth surfaces during dental procedures. The particles (often composed of aluminum oxide, an abrasive powder) are propelled at high speed by pressurized air, and are controlled as they pass through the nozzle of a hand-held instrument. They can be precisely aimed at the affected areas of a tooth, allowing removal of decay, which is softer than healthy tooth structure, with relative ease.

Air abrasion technology can be used in many procedures: It’s an excellent way to smooth out superficial defects (such as chips) in the tooth’s hard enamel covering; when used as a cavity-removal tool, it can minimize the removal of healthy tooth structure; it can effectively remove superficial stains and organic debris from tooth surfaces; and it can be used to treat tooth structure with sealants or other restorations in the most conservative way possible.

In addition, air abrasion eliminates the harsh sound and jarring vibration of the dental drill, so it’s a great tool to use for kids and people with dental anxiety… or anyone who is uncomfortable with the sound or sensation of the drill. What’s more, in many cases local anesthesia may not be necessary with air abrasion tools — welcome relief for those averse to the injections (numbing shots).

Of course, air abrasion does have some limitations. It’s not an efficient method of removing large cavities or old amalgam restorations (fillings). It requires careful isolation of the tooth or teeth being worked on from the rest of the mouth (often with a rubber dam — usually a thin sheet of silicone or latex), and using high-volume suction to keep the abrasive particles from being swallowed or spread through the air. However, one objection dentists sometimes have is the occasional “sandstorm” the particles can create in the dental office, if an adequate isolation protocol is not in place.

And finally, as you point out, the equipment is relatively new and unfamiliar to many patients (and maybe even to some dentists). Still, because of its clear advantages, many dentists expect that air abrasion technology will find increasing use in more dental offices. And who knows, the whine of the dental drill may one day become as rare as the clip-clop of a horse-drawn carriage.