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Fluid Abrasion an old story or a new one?

Back in the early 1990’s Air Abrasion units were re-launched (they started life back in 1945) with great excitement, alongside Nd:YAG Lasers – only to cover their operators with powder! The KCP units launched at Alexandra Palace in 1990, were huge, expensive units plugged into the mains but what has changed since?

The early 2000’s saw the introduction of the Velopex Aquacut. This, in combination with the Velopex Diode Laser, offered more than the capabilities of hard and soft tissue laser units – at one quarter of the price.

On the surface, the Aquacut is a simple piece of equipment. Simple powders, simple controls and powered simply by compressed air. However, the story gets a little more interesting when you dwell on the name – Aquacut. What at first seems to be an odd title for an air abrasion system aptly describes the unique British concept of Fluid Abrasion. By adding a plastic tip to the standard Aquacut handpice and plumbing this tip into a fluid reservoir you benefit from the venturri effect to produce a ‘water curtain’ around the stream of dry powder. Seems straight forward – except the powder and water combine to enable the system to cut with a‘slurry’. This slurry cutting effect is not only gentle on tooth tissue and nearby olfactory senses (the Velopex cutting fluid uses vanilla to give a pleasant aroma) it enhances cutting speed by a factor of 2. The increased weight of the impact of powder and water combined offers the ‘edge’ that previous generations of systems have lacked. It also has the added benefit of keeping the powder ‘bound’ in the fluid thus reducing the signature mess normally associated with abrasion. The latest Quattro models offered by Velopex are further enhanced by streamlined plumbing which increases their cutting speed over previous models. Additionally, the Quattro foot control allows the operator to produce both a dry air stream as well as a water spray – this gives the fluid abrasion handpiece the action of a conventional 3-in-1 syringe. So no more swopping handpieces several times during a procedure to wash and dry! The foot control is so designed to ensure that the handpiece is washed with air when the foot leaves the pedal thus ensuring that no powder is left behind for the autoclave to ‘bake’ in place.

Dumb powders acting smart

The simple powders normally associated with air abrasion: Sodium Bicarbonate and Aluminium Oxide act differently when used in the slurry technique provided by the Aquacut Quattro. In fact, you find that the simple powders can be quite smart. Take Sodium Bicarbonate for an example. This is a widely used prophylaxis medium that is sharp but not hard. When used in an Aquacut Quattro it is an extremely effective stain removal system. Ideal for using before the scaler when doing a scale and polish – it will not remove the scale but does a great job on the stain and will not damage enamel. This means that using this technique first allows you to follow up and simply renove any scale left behind – saving valuable minutes. The powder comes into its own, though, when used on soft caries. In this application, it will remove the soft decay down to the point when the underlying dentine is then harder than the Sodium Bicarbonate itself. If you run a probe over the newly exposed dentine it will feel ‘leathery’. There is no chance of an exposure as it will not cut the newly exposed dentine. With Aluminium Oxide you have a medium that is hard but not sharp. It will selectively remove composite in preference to enamel – and enamel in preference to dentine. This means that a patient who presents with leaking margins around an old composite can be treated immediately without the requirement of anaesthesia. This technique will minimise the removal of sound tooth structure as the process will remove the composite in preference. Due to the rough surface produced by the powder, the old composite can be selectively removed to allow new composite surface to be bonded on top. Thus refurbishing and repairing composites becomes easy, minimal and quick. Conventially, this patient would be booked a new appointment of around 40 minutes, given an injection of anaesthesia and the old composite removed – with some enamel. The cavity would then be refilled.

Fissure sealants (preventative resin restorations) can be very easily performed. Using Sodium Bicarbonate to clean the fissue and then Aluminimum Oxide to ‘chase’ down any staining. The cohort of the population that this technique would be used on – have a heathly dispespect for the dental profession. To be able to perform a procedure with no sound, no vibration, no heat - quickly and effectively – you’re sure to be a playground talking point!


So here we are with an Aquacut Quattro – but what can it do for you? Let’s start with bonding and sealing. With modern dental materials, the rougher the surface we are trying to stick something to – the better the retention. The better the retention1, the longer that the restoration will last. Abrasion as a technique is widely accepted as a way to improve the surface for bonding2 compared to bur cut tooth material. This means that whenever you are going to be bonding, use Aluminium Oxide in an Aquacut Quattro to ‘condition’ the tooth surface. The only time you will also require an etch (phosphoric acid) will be if your bonding agent requires this (please check you bonding agents requirements). For self etch type materials – further etching will not be required. This means that crown preparations, old amalgam restorations (where the amalgam has been removed) orthodontic bracket placements3, endodontic closure and filling4, sealing5 and lab work prior to cementation (and the intra-oral site where the work will be positioned) are all candidates for ‘conditioning’ by the Aquacut Quattro.

But what do users really think?

The foregoing comments cover the use of the equipment from a Velopex point of view - but what do users of the equipment think? To find out, Mark Chapman, Sales and Marketing Director, met up with Peterborough Dentist Simon Nicol to find out the latest. Dr Nicol has been using an Aquacut for over 5 years, upgrading from the original model to a 3-in-1 unit after 18 Months of use. Mark started by asking the obvious question: “What do you use your Aquacut for?”. In answer Simon enthused about stain removal, cleaning cavities after the removal of amalgam, tidying up composites – particularly around the margins. Using the unit for minor laboratory type work also featured highly - cleaning out de-bonded temporary crowns, prior to replacement as well as those Maryland bridges that are no longer where they were originally placed! The vast majority of Simons work is done without the use of local anaesthetic: “I rarely give any injections before conservation work using the Aquacut – the patients are happy enough and much more comfortable not being numb for hours afterwards.”.

From my own teenage daughter who has great teeth with no fillings, I know that the younger element of the population make somewhat reluctant dental patients – but what do they think about the Aquacut? From Dr Nicol’s point of view: “It’s fantastic for kids! I can clean out a suspect fissue and then open it up, if required, place a sealant – almost without the patient noticing and certainly without an injection!”.  Dr Nicol is not the first Velopex Aquacut customer to comment in this way, Dr Mike Mulcahy volunteered: “This unit has revolutionized my fissue sealants: quick, easy, patient friendly – it’s fantastic.”. Not only is the Aquacut quiet, gentle and patient friendly it is very efficient for removing stain within a fissue. This allows the clinician to accurately clean and check that the fissue is sound (sodium bicarbonate) before slight opening and etching of the fissure with Aluminium Oxide – prior to sealing.

Clinical Cases

Case 1 (pictures courtesy Dr S. Nicol)
14 year old female presented with dark ‘marks’ around a fissue. All other teeth in reasonable condition – she is on a waiting list for Orthodontics.

Fissue cleaned and opened (dry) prior to fissure sealant. Into dentine – with no requirement for anaesthesia. This procedure took only 5 minutes from start to completion, the patient was comfortable during the entire procedure.

Case 2 (pictures courtesy Dr S. Nicol)

39 year old female patient, smoker, presented for regular scale and polish appoinment

Before and after, showing the stain removal properties of the Aquacut

A man for all seasons

The Aquacut Quattro is sometimes viewed by NHS practitioners as something for private dentistry – but with 1 UDA for stain removal and 3 UDAs for treatment – it is very much in NHS territory. For private dentistry, it is perfectly suited for any application leading to the use of composite as it not only removes sound material (composite, enamel and dentine) but leaves the surface prepared perfectly for bonding.

For more information, please see: www.velopex.com

Mark Chapman can be contacted on: 07734 044877

1.    Michalakis K, Pissiotis AL, Kang K, Hirayama H, Garefis PD, Petridis H.
The effect of thermal cycling and air abrasion on cement failure loads of 4 provisional luting agents used for the cementation of implant-supported fixed partial dentures.
Division of Graduate and Postgraduate Prosthodontics, Tufts University, School of Dental Medicine, Boston, MA, USA
Int J Oral Maxillofac Implants. 2007 Jul-Aug;22(4):569-74.

2.    Ishikawa Y, Ohashi N, Koizumi H, Tanoue N, Nishiyama N, Matsumura H.
Effects of alumina air-abrasion and acidic priming agents on bonding between SUS XM27 steel and auto-polymerizing acrylic resin.
Department of Fixed Prosthodontics, Nihon University School of Dentistry.
J Oral Sci. 2007 Sep;49(3):191-5

3.    Thompson MA, Drummond JL, BeGole EA.
Bond strength analysis of custom base variables in indirect bonding techniques.
College of Dentistry, University of Illinois at Chicago, Chicago, Ill 60612-7212, USA.
Am J Orthod Dentofacial Orthop. 2008 Jan;133(1):9.e15-20

4.    Kelsey WP 3rd, Latta MA, Kelsey MR
A Comparison of the Retention of Three Endodontic Dowel Systems Following Different Surface Treatments.
Associate Dean for Academic Affairs, Creighton University School of Dentistry, Omaha, NE, USA
J Prosthodont. 2007 Dec 14
5.    Mazzoleni S, De Francesco M, Perazzolo D, Favero L, Bressan E, Ferro R, Stellini E.
Comparative evaluation of different techniques of surface preparation for occlusal sealing.
Department of Paediatric Dentistry, University of Padua, Italy
Eur J Paediatr Dent. 2007 Sep;8(3):119-23.

Case 1

Click image to see enlarged version

Case 2

Click image to see enlarged version
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