Escolar Documentos
Profissional Documentos
Cultura Documentos
PRACTICE
cations. In general engineering, ten standards to provide unifor- burs due to wear when used on
the cutting instrument (that is, mity in dental burs. Never- enamel.
the mill or cutter) is fixed while theless, dentists are faced with The 1899 catalog of Claudius
the workpiece is brought into a tremendous variety of sizes Ash and Sons Ltd. listed “dia-
contact with the cutting tool (in and shapes of diamond burs, mond burs for trimming and
other words, a general principle with little standardization in polishing enamel margins” and
of a fixed tool and a moving nomenclature among manufac- advised lubricating the burs
workpiece). turers. Furthermore, there are well with water and running
In contrast, the workpiece in no standards covering bur-cut- them at high speed.16 The 1913
dentistry (the tooth) is fixed ting efficacy. The question of catalog of the S.S. White Dental
while the tool (the handpiece bur-cutting efficacy resurfaced Manufacturing Co. described a
and bur) is brought into contact with the introduction of the sin- “diamond starting point” as a
with it. Engineering cutting and gle-patient-use, or disposable, di- narrow diamond wheel for re-
drilling are slow-speed opera- amond rotary instruments in the moving enamel when excavat-
tions (5,000 to 10,000 revolu- mid-1980s. The efficacy of these ing a natural tooth.17
tions per minute, or rpm) while
THE MODERN DIAMOND
dental cutting procedures are
The introduction and BUR
performed over an incredibly
wide range of speeds (25,000 to subsequent mass The modern diamond bur was
450,000 rpm). A further compli- production of the created in 1932 by W.H.
cating factor is that there are Drendel, a German industrial-
high-speed air-turbine
few pertinent and/or quantifi- ist, who developed a process for
able cutting data in the dental dental contra-angle bonding diamond points to
literature. It is still not clear handpiece in 1957 stainless steel shapes or
whether the interaction be- blanks.15 By 1939, diamond burs
was the stimulus for
tween bur and tooth (through were widely used in Europe and
the removal of hard tissue) universal acceptance had been introduced in the
should be classified as cutting of diamond burs by United States in 12 shapes, all
or abrasion or should simply be in large sizes.18 Widespread ac-
the profession.
given the overall designation of ceptance of diamond burs was
tribological (literally, frictional) limited from 1939 through 1946
procedures. instruments is important to the because of the expense and im-
In practice, a dentist works profession, but there are few re- practical shapes and sizes then
on sound or carious enamel and ports on their performance.11-14 available. However, interest in
dentin, polymeric materials, ce- diamond burs was growing be-
THE FIRST DIAMOND
ramics and metals using high- BURS
cause of the wartime critical
or low-speed handpieces, a vari- shortage of steel, silicon carbide
ety of burs and different hand- Before the 1890s, silicon carbide and other abrasive materials
piece loadings under variable discs and stones were used to used in rotary cutting instru-
coolant regimens. However, cut enamel because carbon steel ments.
most of the original studies on burs were inefficient at cutting The years after World War II
dental burs were performed be- enamel.2 In 1897, Willman and were marked by tremendous so-
fore the advent of ultra-high- Schroeder, from the University cial upheavals as well as in-
speed handpieces (300,000 to of Berlin, Germany, were credit- creased levels of disposable in-
400,000 rpm)3,4,7,9 and, to this ed with making the first dia- come and burgeoning state and
day, reports on cutting studies mond dental bur.1 These early federal economies. The general
are few and far between in the burs were made by hammering public became increasingly
literature. diamond powder into the sur- aware of oral hygiene and de-
The International Organiza- face of soft copper or iron veloped a desire for improved
tion for Standardization, the blanks.2,15 The development of materials and treatment modal-
American National Standards diamond burs was stimulated, ities, while dentists wanted dia-
Institute and the American at least in part, by the rapid mond burs with shapes and grit
Dental Association10 have writ- loss of shape of silicon carbide sizes that were more easily in-
MANUFACTURE OF
DIAMOND BURS
Shank of Bur
Diamond burs have one or more
layers of diamond chips at-
tached to a shank that inserts
into the head of the handpiece.
The shank usually is fabricated
from a high-strength metal
such as tool steel, stainless steel
or another alloy. The working or
cutting end of the shank is ma-
chined to a specific shape or Figure 1. Schematic diagram of a dental diamond bur.
blank and the diamond chips
are attached. The dimensions chromium matrix.20 The bulk electrodeposition
and shapes of the blanks deter- Electrodeposition stages. process is performed in a nickel-
mine the ultimate size and The overall electrodeposition plating solution, commonly
shape of the finished product process is performed in several nickel sulfamate, maintained
and are the basis for the num- stages. In the first stage, the under carefully controlled con-
bering or designation systems shank portion of the blank is ditions of pH and temperature.22
used by manufacturers. coated with an inert (noncon- This nickel-plating bath also
The diamond chips are at- ducting) material that precludes contains diamond particles.
tached to the machined metal metal deposition on the coated Under the solution and elec-
blank in various ways. The area; in this way, the portion of trode agitation conditions of the
most common method used the bur to be inserted into the electrodeposition process, the
today is by electrolytic codeposi- handpiece is protected from re- diamond chips deposit with the
tion of natural or synthetic dia- ceiving any electrodeposit. The nickel to form a coherent layer
mond particles with a matrix prepared stainless steel blanks on the bur blank. This initial
metal onto the blank. The pro- are then flash-plated or strike- plating process tacks the dia-
cess is similar to the original plated with a thin coating of mond particles onto the desig-
Drendel process,15 which is a nickel, commonly in an acid- nated cutting portion of the
codeposition procedure that me- nickel-chloride solution.21 This blank. The burs are then trans-
chanically locks the diamond removes any passive films and ferred to a second or build-up
particles onto the blank within slightly etches the exposed sur- nickel-plating bath where they
a nickel or duplex nickel- face of the blank. remain until the desired degree
vacuum, to its final shape and size of the chips deposited onto ments, with disposable, or sin-
density. These sintered dia- the blank; the chips are selected gle-patient-use, burs following
mond instruments are typically by being sifted in a sieve of a this trend. Many companies
very expensive but are claimed designated grit size or mesh. produce disposable burs, some
to exhibit extended service lives The mesh size (sieve aperture) is of which have been doing so for
(M. Logan, Brasseler USA, oral inversely related to the diameter more than 10 years. Most man-
communication, July 7, 1994). (in micrometers) of the particles ufacturers produce coarse- and
Manufacturers of convention- being sieved. Thus, the higher medium-grit burs, and some
al diamond burs claim that the numerical designation of the also produce fine-grit burs with
multilayering of the diamond mesh or sieve, the smaller (finer) both natural and synthetic dia-
particles produces a better- the diamond particle. Typically, mond chips being used.
quality, more efficient and a medium-grit diamond bur has The disposable diamond bur
longer-lasting product. Their ra- 90- to 120-µm chips, which was developed, at least in part,
tionale is that as the diamond in response to the recommenda-
chips are worn or abraded from Because of differ- tion by the Centers for Disease
the matrix, subsurface or deep- Control and Prevention and the
er chips are exposed for the cut- ences in the dimen- ADA that organized dentistry
ting process. This multilayered sions of the diamond should minimize cross-contami-
bur is more expensive to pro- particles used by in- nation risks.25 Clinical use of dis-
duce, with the increased cost posable items absolutely pre-
passed on to the dentist. dividual manufactur- vents transfer of microorganisms
ers, rugosities can between patients, provided that
DIAMOND PARTICLES
vary quite markedly the items are used on only one
The diamond particles used in patient.26 Clearly, burs can be a
dental burs vary among manu- among burs of the mode of transmission of infec-
facturers, and the important pa- same nominal coarse- tious diseases (for example, hep-
rameters include natural vs. ness from different atitis B, herpes virus and human
synthetic diamonds, the chip immunodeficiency virus) through
size and shape as well as the in- companies. blood, saliva and soft tissue.
dividual particle faceting. The CDC and ADA mandate
However, the influence of these equates to a mesh size of 120 to thorough cleansing and steril-
parameters on the cutting effi- 140. A coarse-grit bur commonly ization of multiuse burs.25,27,28
ciency of dental diamond burs is is fabricated with chips sieved Cleaning includes presoaking,
still not fully understood.12 through a mesh size of 80 to 100 hand scrubbing or ultrasonic
Natural diamonds are more and contains 150- to 160-µm- cleaning and then drying before
irregular in shape than synthet- diameter particles. packaging for the sterilization
ics, and it has been suggested The manufacturer’s quality process.26 Further, many manu-
that this irregularity makes controls determine the range of facturers recommend that dia-
them easier to deposit within chip dimensions within the mesh mond burs be run against a
the nickel matrix (L. Clark, sizing used for each category of sharpening stone before ultra-
Abrasive Technology Inc., oral bur (that is, superfine, fine, sonic cleaning or that the tips
communication, Jan. 31, 1994). medium and coarse). Inevitably, be scrubbed with a wire brush
As a result, most bur manufac- chip sizing varies among burs to remove any organic debris
turers favor the use of natural from different manufacturers before sterilization (M. Logan,
diamonds.12 and within batches of burs from Brasseler USA, oral communi-
Because of differences in the the same manufacturer. cation, July 7, 1994). Because
dimensions of the diamond par- these procedures are time-con-
SINGLE-PATIENT-USE
ticles used by individual manu- DIAMOND BURS
suming and the ADA recom-
facturers, rugosities can vary mends use of disposable items
quite markedly among burs of In recent years, there has been whenever possible, the clinical
the same nominal coarseness a growing need within the den- use of disposable burs may be
from different companies. Bur tal profession for inexpensive, advantageous.
coarseness is determined by the effective and disposable instru- Disposable diamond burs are
the disposable burs, fewer dia- ucts and help dentists deliver Baltimore St., Maryland at
Baltimore.
Baltimore, Md. 21201-
mond-containing layers, re- care more quickly with less 1586. Address reprint
stricted availability of bur trauma to the dental pulp. ■ requests to Dr. Siegel.
section E:28.
shapes and less-stringent quali- 17. S.S. White Den-
1. De Tomasi A. Storia ed evoluzione delle tal Manufacturing Co.
ty control measures. frese diamantate in odontoiatria [The history Dental catalog. 1913:120.
Typically, inspection of dis- and evolution of diamond burs in dentistry]. 18. Huntley RC. Adaptation of modern in-
Odontostomatol Implanto Protesi struments with efficient operating speeds in
posable burs for defects is done 1976;2(2):72-4. restorative dentistry. North-West Dent
on a random-sample basis, with 2. Vinski I. Two hundred and fifty years of 1956;25(1):63-8.
rotary instruments in dentistry. Br Dent J 19. Koblintz FF, Tateosian FD, Roemer FD,
a limited number of inspections 1979;146(7):217-23. Steen SD, Glenn JF. An overview of cutting
being made throughout the 3. Walsh JP, Symmons HF. A comparison of and wear related phenomena. In: The cutting
the heat production and mechanical efficiency edge: interfacial dynamics of cutting and
manufacturing process. In con- of diamond instruments, stones, and burs at grinding. Bethesda, Md.: U.S. Department of
trast, each multiuse diamond 3,000 and 60,000 rpm. N Z Dent J Health, Education, and Welfare; 1976; DHEW
1949;45(219):28-32. publication no. (NIH)76-760:151-68.
bur is inspected up to four times 4. Peyton FA, Henry EE. Problems of cavity 20. Harkness N, Davies H. The cleaning of
during the manufacturing pro- preparation with modern instruments. New dental diamond burs. Br Dent J
York Dent J 1952;22:147-57. 1983;154(2):42-5.
cess. Nevertheless, recent stud- 5. Ingraham R, Tanner HM. The adaptation 21. von Fraunhofer JA. Basic metal finish-
ies suggest that disposable dia- of modern instruments and increased operat- ing. London: Elek Science; 1976:74-94.
ing speeds to restorative procedures. JADA 22. Daniel P. Making diamond tools the in-
mond burs are of acceptable 1953;47(3):311-23. gredients for a successful formula. Indust
quality and should provide ade- 6. Van de Waa CP. High speed rotary in- Diamond Rev 1967;27:466-70.
struments in operative dentistry: review of 23. Phillips RW. Skinner’s science of dental
quate clinical service.12,13 the literature. JADA 1956;53(3):298-304. materials. 9th ed. Philadelphia: Saunders;
7. Hartley JL, Hudson DC, Sweeney WT, 1991:564-5.
CONCLUSIONS Dickson G. Methods for evaluation of rotating 24. Pines M, Schulman A, Vaidyanathan
diamond-abrasive dental instruments. JADA TK. SEM evaluation of commercial diamond
Dentists should be knowledge- 1957;54(5):637-44. stones (Abstract no. 509). J Dent Res
8. Janota M. Use of scanning electron mi- 1981:437.
able consumers regarding their croscopy for evaluating diamond points. J 25. Centers for Disease Control and
professional armamentarium. Prosthet Dent 1973;29(1):88-93. Prevention. Recommended infection-control
9. Larsen NH. The efficient use of carbide practices for dentistry. MMWR Morb Mortal
The International Organization burs and diamond points for cavity prepara- Wkly Rep 1993;42:3-12.
for Standardization has pro- tion: part 1. Dent Digest 1949;55(10):442-8. 26. Miller CH, Patenik CJ. Infection control
10. Revised American National Standards and management of hazardous materials for
posed a systematic numbering Institute/American Dental Association the dental team. St. Louis: Mosby-Year Book;
system for diamond burs, but it Specification No. 23 for dental excavating 1994:191-2.
burs. 1982:1-16. 27. [American Dental Association] Council
has not been universally adopt- 11. Christensen GJ, Christensen RP. Single on Dental Materials, Instruments, and Equip-
ed. While it is reasonable for patient-use diamond rotary instruments. Clin ment, Council on Dental Practice, Council on
Res Associates News 1991;15(6):1-2. Dental Therapeutics. Infection control recom-
manufacturers to maintain pro- 12. Siegel SC, von Fraunhofer JA. Assessing mendations for the dental office and the den-
prietary information regarding the cutting efficiency of dental diamond burs. tal laboratory. JADA 1988;116(2):241-8.
JADA 1996;127(6):763-72. 28. [American Dental Association] Council
their products, the basic manu- 13. Christensen GJ, Christensen RP. Single on Dental Materials, Instruments, and Equip-
facturing details should be patient-use diamond rotary instruments. Clin ment, Council on Dental Therapeutics, Coun-
Res Associates News 1996;20(9):1-2. cil on Dental Research, Council on Dental
available to the dentist. This 14. Cohen BD, Bowley JF, Sheridan PJ. An Practice. Infection control recommendations
might encourage greater inter- evaluation of operator preference of diamond for the dental office and the dental laboratory.
burs in coronal tooth preparation. Compend JADA 1992;123(8)(Supplement):1-8.
action between the profession Contin Educ Dent 1997;18(2):158-64. 29. Naylor WP, Beatty MW. Materials and
and manufacturers, and lead to 15. Walsh JP. Critical review of cutting in- techniques in fixed prosthodontics. Dent Clin
struments in cavity preparation: I. diamond North Am 1992;36(3):655-92.
improved dental burs. stone. Int Dent J 1953;4(1):36-43.
Much is still not known 16. Ash C. and sons. Dental catalog. 1899;