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Mechanisms of atomization from rotary dental instruments and its mitigation

Research output: Contribution to journalArticlepeer-review

Antonis Sergis, William Wade, Jennifer Elizabeth Gallagher, Alexander Morrell, Shanon Patel, Chris Dickinson, Najla Nizarali, Eric Whaites, Joanna Johnson, Owen Addison, Yannis Hardalupas

Original languageEnglish
Pages (from-to)261-267
Number of pages7
JournalJournal of Dental Research
Volume100
Issue number3
DOIs
Accepted/In press17 Nov 2020
Published1 Mar 2021

Bibliographical note

Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Spray visualisation was generously supported as part of the COVID-19 response by Photron (Europe) Ltd and LaVision UK Ltd. Measurements were supported by Guy’s and St Thomas NHS Foundation Trust, the British Endodontic Society, and the UK Engineering and Physical Sciences Research Council (EP/V038141/1). Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Spray visualisation was generously supported as part of the COVID-19 response by Photron (Europe) Ltd and LaVision UK Ltd. Measurements were supported by Guy?s and St Thomas NHS Foundation Trust, the British Endodontic Society, and the UK Engineering and Physical Sciences Research Council (EP/V038141/1). Publisher Copyright: © International & American Associations for Dental Research 2020. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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Abstract

Since the onset of coronavirus disease 2019, the potential risk of dental procedural generated spray emissions (including aerosols and splatters), for severe acute respiratory syndrome coronavirus 2 transmission, has challenged care providers and policy makers alike. New studies have described the production and dissemination of sprays during simulated dental procedures, but findings lack generalizability beyond their measurements setting. This study aims to describe the fundamental mechanisms associated with spray production from rotary dental instrumentation with particular focus on what are currently considered high-risk components—namely, the production of small droplets that may remain suspended in the room environment for extended periods and the dispersal of high-velocity droplets resulting in formites at distant surfaces. Procedural sprays were parametrically studied with variables including rotation speed, burr-to-tooth contact, and coolant premisting modified and visualized using high-speed imaging and broadband or monochromatic laser light–sheet illumination. Droplet velocities were estimated and probability density maps for all laser illuminated sprays generated. The impact of varying the coolant parameters on heating during instrumentation was considered. Complex structured sprays were produced by water-cooled rotary instruments, which, in the worst case of an air turbine, included droplet projection speeds in excess of 12 m/s and the formation of millions of small droplets that may remain suspended. Elimination of premisting (mixing of coolant water and air prior to burr contact) resulted in a significant reduction in small droplets, but radial atomization may still occur and is modified by burr-to-tooth contact. Spatial probability distribution mapping identified a threshold for rotation speeds for radial atomization between 80,000 and 100,000 rpm. In this operatory mode, cutting efficiency is reduced but sufficient coolant effectiveness appears to be maintained. Multiple mechanisms for atomization of fluids from rotatory instrumentation exist, but parameters can be controlled to modify key spray characteristics during the current crisis.

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