Airbrasive : some fundamentals
Robert B. Black, D.D.S., Corpus Christi, Texas
Airbrasive is essentially a nonmechanical
method of treating teeth which employs
the use of kinetics for its action.1 Its prin­
cipal purposes are those of preparing
teeth for restoration and removing stain
and calculus from exposed surfaces of
their crowns. Its conception and devel­
opment were stimulated by the fact that
conventional methods of preparing teeth
for restoration are seriously disturbing to
the greater percentage of patients, and
possess characteristics which create fear
and apprehension in association with
dental services.
The purpose of this paper is to discuss
the factors which stimulated the develop­
ment of airbrasive, the principles on
which the process is based, its intended
purposes, the equipment which makes
the technic possible, its indications and
limitations, a report on the work done to
date, and some fundamentals relative to
its use.
F A C T O R S A S S O C IA T E D W I T H
O F R O T A R Y IN S T R U M E N T S
A careful analysis of the physical pheno­
mena associated with the use of the bur
or other modifications of rotary instru­
ments reveals four factors, each of which
contributes to the general aversion as­
sociated with their use. These are: (1)
pressure, or. force of application; (2)
vibration (bone-conducted noises) ; (3)
heat, and (4) mechanical stimulation.
Pressure • The force with which the in­
strument is applied to the tooth creates
apprehension and is thus conducive to
tension for two reasons:
1. The patient, being acutely con­
scious of this force, becomes fearful lest '
the instrument slip and injure the ad­
jacent soft tissue.
2. As the cutting action approaches
the dentinoenamel junction, the patient
anticipates fearfully that the nerve will
be penetrated.
Although the operator is reasonably
sure that neither of these eventualities
will happen, it is often extremely diffi­
cult to instil this feeling of confidence
into the mind of the patient.
Vibration • The remarks of patients seem
to suggest that vibration, which is an in­
herent quality of all forms of rotary in­
struments, is often the greatest single
source of irritation associated with the
USE mechanical cutting of tooth structure.
Although vibration cannot be considered
a cause of pain and probably is not harm­
ful to the dental pulp, it very often is
extremely disturbing to the patient. The
vibrations set up by the rotary instrument
are interpreted as noise through bone
conduction. There are many who claim
I. Black, R. B., Technic for nonmechanical prepara­
tion of cavities and prophylaxis. J.A.D.A. 32:955 {Aug.}
701
 702 • THE JO U R N A L OF THE A M ER IC A N DENTAL ASSO CIATIO N
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Fig. 1 • Physical phenom ena associated with
the use o f the bur
this factor to be m ore unpleasant than
any actual pain that m ay occu r during
the operation.
H eat • H eat is the inevitable by-product
o f friction, and it is intrinsically asso­
ciated with the use o f all form s o f rotary
instruments. H eat is not only a principal
cause o f pain, but it always presents a
potential danger to the dental pulp. This
factor has long been recognized by the
profession as most undesirable, even
dangerous, and many attempts have been
m ade to control it. It is a disturbing fact
that the dentist, making a conscientious
attempt to restore a tooth to useful fu n c­
tion, occasionally nullifies his efforts by
inadvertently overheating the dental tis­
sues by excessive grinding thereby caus­
ing the death o f the pulp and the even­
tual loss o f the tooth.
M echanical Stimulation • T h e blades o f
the bur or the crystalline irregularities o f
rotary stones or diam onds are capable o f
creating various degrees o f pain during
the operation by direct stimulation o f the
fibers in the dentinal tubules. This source
o f pulpal stimulation is entirely inde­
pendent o f that caused by heat, as is in ­
dicated when pain is experienced as a
result o f pressing a sharp explorer tine
or other ob ject against sensitive dentin.
T h e pain caused by m echanical stimula­
tion is doubtless secondary in intensity
to that caused by heat.
Significant as these factors may be in
relation to the attitude o f the patient
tow ard dentistry, o f almost equal im ­
portance are other factors associated
with the use o f m echanical handpieces
in their effect on the dentist. For ex­
ample, the force necessary to apply the
bur is often extremely tiring and co n ­
ducive to tension. T ogeth er with this
tension is the constant tendency o f the
bur to creep, crawl, or jum p, making
finger bracing absolutely essential, and
further contributing to the drain on the
operator’ s energy. C utting tooth structure
from certain angles and under certain
conditions frequently lends to hand­
piece chatter, w hich is not only unpleas­
ant and nerve wracking to the patient
and dentist, but m ay be dam aging be­
cause o f its traum atic action on the sur­
rounding investing tissues o f the tooth
(Fig. 1 ). •
A IR B R A S IV E M E T H O D O F C U T T IN G
TOOTH STRU CTU RE
It had long been strongly felt that some
basically different m ethod must exist
w hich w ould make it possible and p rac­
tical to prepare teeth fo r restoration
w ithout subjecting both the patient and
the dentist to the tension which or­
dinarily is associated with the use o f
rotary instruments. It seemed probable
that once this m ethod was developed
people w h o are prone to neglect their
teeth because o f fear w ou ld tend to ac­
cept dentistry’s services with the result
that m ore teeth w ould be preserved for
useful function.
It was recognized that in order to be
successful, such a m ethod w ould have to
be subject to precise control in order to
con form the cutting action to accepted
 BLACK . . . VO LUM E 41, DECEMBER 1950 • 703

and proved principles o f tooth prepara­

tion. It was further recognized that in
order fo r such a m ethod to be successful
it w ou ld have to be capable o f a ccom ­
plishing the cutting o f tooth structure
rapidly and with substantial freedom
from the unpleasant characteristics co m ­
m only associated with the use o f rotary
instruments.
Since the early use o f airbrasive as a
m ethod o f preparation o f teeth fo r resto­
ration, over tw o thousand cases have
been com pleted with substantial elimina­
tion o f rotary instruments. These cases
include 82 preparations fo r cast gold
inlays, 1,398 fo r amalgams, 401 fo r sili­ Fig. 2 • Physical phenom ena associated with
cate fillings, 47 for jacket crowns and 183 the use of airbrasive
prophylaxes. Experience has consistently
indicated that:
com plished with a thermal variable o f
1. Cavities may be prepared in a
but one or tw o degrees when cutting
manner w hich fulfils the basic require­
enamel. N o noises associated with the
ments for successful tooth restoration
operation are conducted by bone (Fig.
with little or no use o f rotary instru­
ments. Cavity preparations com pleted by 2 ).
In cases where the tooth is hyper­
means o f airbrasive and finished with
sensitive or hyperem ic, pulpal stimula­
hand instruments do not differ in any
tion m ay be experienced in various de­
essential respect from those prepared by
grees. Generally, the stimulation may be
means o f burs and stones.
controlled by reducing the pressure o f
2. This m ethod o f preparing teeth for
the propellant, or by reducing the
restoration does not stimulate fear and
am ount o f abrasive m ixed with the p ro­
apprehension.
pellant, or both. Even in cases where
3. Patients accept this type o f serv­
pulpal stimulation or actual pain has
ice w h o otherwise would neglect and
been experienced, the patient usually is
eventually lose their teeth.
quite em phatic in his preference fo r the
T h e cutting o f tooth structure is ac­ nonm echanical over the m echanical
com plished rapidly and with com plete m ethod o f tooth preparation because o f
freedom from vibration. T h e pressure the absence o f vibration, and apprehen­
exerted against the tooth during the o p ­ sion resulting from force being exerted
eration is so slight as to be unnoticed by against the tooth.
the patient. Actually, it amounts to about It must not be deducted that air­
10 G m ., or approxim ately one third o f an brasive will ever replace the use o f
ou nce as com pared with the substantial rotary instruments. Airbrasive does not
force o f 2 pounds or m ore ordinarily ex­ entirely duplicate the functions o f the
erted during the use o f the bur. T h e heat bur or stone, and conditions occasionally
problem is practically nonexistent during are encountered where the use o f rotary
the cutting action in com parison with the instruments is desirable. It is not con ­
very substantial thermal gain accom pany­ sidered practical, fo r example, to bevel
in g the use o f all rotary instruments. T h e enamel margins with airbrasive. It is
cutting action o f airbrasive may be ac- incapable o f rem ov in g .soft carious den-
704 • THE JO U R N A L OF THE A M ER IC A N DENTAL ASSO CIATIO N

be provided the operator before the

equipment is m ade available. D uring the
past year m any o f the dental colleges
throughout the country have cooperated
in preparing adequate courses o f air­
brasive instruction and training.

T H E A IR D E N T U N IT

Airdent equipment, like its mechanical

counterpart, consists essentially o f a unit
(Fig. 3 ) , foo t control, and handpiece.
T h e unit provides a source o f suitable
gaseous propellant, a means o f regulating
its pressure, reservoirs fo r storing the
abrasives, and a means o f accurately
metering the am ount o f abrasive which
is m ixed into the propellant. It further
provides fo r a means o f selecting w hich­
ever type o f abrasive is desired, depending
on the type o f operation to be per­
form ed. Gages are necessary fo r reveal­
ing to the operator the exact propellent
pressure and abrasive m ixture used. In
Fig. 3 • A irdent unit order to recover tooth debris and spent
abrasive from the area o f operation, the
unit contains a suction hood, a source
tin. It also is incapable o f polishing the
surfaces o f metal o r silicate fillings.
Experience has demonstrated, h ow ­
ever, that airbrasive is an invaluable sup­
plementary instrument fo r accom plish­
ing most o f the difficult cutting o f hard
tooth structure involved in the prepara­
tion o f teeth for fillings and jacket
crowns, and also fo r rem oving heavy
deposits, stubborn stains and calculus
from the exposed surfaces o f tooth
crowns.
In the successful application o f kinetics
as a m ethod o f perform ing dental o p ­
erations it is im perative that the operator
be thoroughly fam iliar with the charac­
teristics o f the instrument and the fu n d a­
mentals governing the proper utiliza­
tion o f its action. As the principles on
w hich airbrasive is based and the m ethod
for its use are so radically different from
those o f rotary instruments, it is essential
Fig. 4 • D etail o f airbrasive handpiece show­
that a course o f instruction and training ing pattern of the abrasive stream.
 BLACK . . . VO LUM E 41, DECEMBER 1950 • 705

Fig. 5 • A ngle of divergence

o f abrasive cutting stream.
In block below is shown the
type of cut obtained in using
corresponding section o f the
cutting stream indicated by
arrow. A rrow points to 10
mm. (nozzle tip distance)
section o f the stream
fOMM SMM

o f vacuum , a means o f separating the
tooth debris and abrasive particles from
the air, and a place for storing this waste
material until it can be rem oved fo r dis­
posal.
T h e foot control, in contrast to
that em ployed with the conventional
unit, is a simple on and o ff push switch
operated by the foot. It activates an
electric valve w hich instantly starts or
stops the flow o f the abrasive to the
handpiece.
T h e handpiece consists essentially o f a
handle, an adjustable contra-angle and
a small nozzle. T h e nozzle, constructed o f
sintered tungsten carbide, is approxi­
mately Ys inch in length and has an in­
side diam eter o f 0.018 inch. W ith or­
dinary use, the nozzle should last several
months before having to be replaced.
air may be and has been used as a
propellant, carbon dioxide was fou n d to
possess certain advantages fo r this pur­
pose. It is practically free from moisture,
nontoxic in low concentrations, inex­
pensive, convenient and almost uni­
versally available.
T h e abrasive em ployed fo r cutting
tooth structure is aluminum oxide. It
possesses a hardness o f 9 on M ohs’ scale
and its particles possess sharp edges and
pointed corners when properly prepared.
It is stable, non toxic and relatively in­
expensive.
T h e pressure em ployed fo r the p ropel­
lant may vary from 30 to 80 pounds per

B A SIC P R IN C IP L E S O F A IR B R A SIV E

Airbrasive depends for its action on a

fine stream o f suitable gas carrying a
controlled quantity o f small abrasive
particles (Fig. 4 ) . W hen used for cutting
tooth structure, a hard abrasive having
an average particle size o f 30 m icrons is
em ployed. A ny portion o f the tooth
against w hich this stream is directed is
cut away rapidly. W hen used for p ro ­
Fig. 6 • Precision machine constructed for
phylaxis a soft p ow der is substituted fo r making carefully controlled cuts in blocks of
the hard abrasive, and any stain or ca l­ different materials. T hese cuts, when com ­
culus against w hich the stream is directed p leted, w ere sectioned in order to study rela­
tion betw een nozzle tip distance and nozzle
is rem oved rapidly. A lthough compressed angulation
706 • THE JO U R N A L OF THE A M ER IC A N DENTAL ASSO CIATIO N
Fig. 7 • Variable distance cut m ade in con-
trolled-cut m achine, nozzle tip distance of 1
mm. at right extrem ity, and 15 mm. at the
other extrem ity
square inch behind the nozzle, depending
on the character o f the w ork being ac­
complished.
Character of the Abrasive Stream • T h e
abrasive escapes from the nozzle in a
cone-shaped stream, the walls o f which
diverge from its long axis at an angle o f
approxim ately 3 degrees (Fig. 5 ) . T h e
particles o f abrasive in the stream travel
at speeds in excess o f 1,000 feet p er sec­
ond, which is well into the realm o f
supersonics.
In utilizing the stream o f rapidly m o v ­
ing abrasive particles to establish outline
form and to determine the pitch o f cavity
walls it is im portant that the operator
first thoroughly understand the relation
which exists between the distance at
which the nozzle tip is held from the
tooth surface and the angulation o f the
nozzle with respect to the proposed cav­
ity wall. As an aid in establishing the
principles o f this relation a m achine was
constructed for establishing controlled
cuts in blocks o f solid material (Fig. 6 ).
In a block o f com pact bone approxi­
mately 1 inch in length a cut is started
at one end, em ploying a nozzle tip dis­
tance o f 1 mm. and an angulation o f 90
degrees. A small electrically drawn car­
riage to which the handpiece is attached
then draws the handpiece the entire
length o f the block o f bone at a uniform
rate o f speed. T h e distance o f the nozzle
tip from the bone surface increases to a
m axim um o f 15 mm . when the other end
o f the bone block is reached (Fig. 7 ).
T h e bone block is then sectioned in
order to determine the angulation o f the
long axis o f the nozzle relative to the
walls o f the cut (Fig. 8 ) . It will be
noted that with a nozzle tip distance o f
1 mm. the angulation is zero. T h e long
axis o f the nozzle is parallel to the
desired pitch o f the cavity wall. A t 5
mm . nozzle tip distance, nozzle angula­
tion is approxim ately 13 degrees, at 10
mm. it is approxim ately 23 degrees, and
at 15 m m . it is approxim ately 35 degrees.
These figures must be considered as
approximations and should be used only
as a guide because they are materially
influenced by the variables o f time and
the depth o f the cut. A lthough it is im ­
portant that the operator be familar
with the theory underlying the relation
between nozzle tip distance and nozzle
angulation, in the final analysis the ability
to m anipulate the handpiece effectively
is established only after considerable ef­
fort and practice (Fig. 9 ) . T o acquire
any skill, a certain am ount o f patience is
needed, but once acquired, it will be
fou n d that airbrasive requires consider­
ably less effort to operate and is m uch
less conducive to tension than the m e­
chanical handpiece.
C utting Speed • A ny m ethod employed
fo r the preparation o f teeth fo r restora-
Fig. 8 • Cross sections through three different
planes o f variable distance cut. Cross section
at the right shows typical straight line cut.
T h e oth er two cross sections show angle cuts
made with nozzle tip distances of 7.5 mm. and
15 mm. respectively
 BLACK . . . VO LUM E 41, DECEMBER 1950 • 707

tion must be capable o f rem oving tooth

structure at a rate com patible with the
requirements o f efficiency and econom y.
Carefully conducted experiments have
indicated that the cutting speed o f rotary
instruments may vary between wide
limits (Fig. 1 0 ). Influencing factors are
the nature o f the instrument— bur, stone,
or diam ond— its diameter, speed in rpm
at which it is used, and pressure with
which it is applied. A n ordinary no. 561
chrom e plated dental bur is capable o f
rem oving approxim ately 6 mg. o f enamel
in 30 seconds at 1,725 rpm when ap­
plied with the pressure o f 2 pounds. A
3/s inch green grit stone at 1,725 rpm
applied with a pressure o f 1.75 pounds is
capable o f rem oving approxim ately 15
mg. o f enamel in 30 seconds and a
inch diam ond disk at 6,000 rpm applied
with a pressure o f 3 ounces is capable o f
rem oving 27 mg. o f enamel from a tooth
in 30 seconds. Fig. 9 • Using the A irdent practice fixture on
Conversely, the cutting action o f air- extracted teeth
brasive is influenced by such factors as
propellent pressure, type and particle
size o f the abrasive used, abrasive m ix­ H andpiece C ontrol • T h e im portance o f
ture, nozzle bore and length, nozzle dis­ practice and experience in the use o f the
tance from the enamel surface, and nozzle airbrasive handpiece cannot be overem ­
angulation. Using aluminum oxide with phasized. T h e operator must develop
a propellent pressure o f 80 pounds per close coordination between the eye, hand
square inch, a nozzle o f 0.018 inch in ­ and foot. Because there is n o tactile re­
side diameter, and nozzle tip distance o f lation between the instrument and tooth
from 7 to 13 mm. with an angle o f 90 being operated on, the operator must rely
degrees, airbrasive is capable o f rem ov­ almost solely on his visual sense. G ood
ing 30 mg. o f enamel in 30 seconds, or eyesight and good lighting are im ­
1 mg. per second. perative.

H andpiece R eaction ' T h e reaction Basic T ypes of Cuts • Regardless o f the

force o f the m echanical handpiece is
substantial and irregular because o f v i­
bration and the ever present tendency
o f the handpiece to creep or ju m p. T h e
reaction force o f the airbrasive hand­
piece is constant and o f low magnitude
regardless o f the nature o f the substance
being cut, or the angle o f its surface.
Thus it is never necessary to em ploy
finger bracing during its use. T h e fingers
are em ployed solely for steady rests.
type, size or location o f the cavity being
prepared, the principles involved for the
establishment o f cavity walls and floor do
not vary. O n ce these principles are un­
derstood by the operator, he should be
able to apply them anywhere. T here are
two basic types o f cuts w hich m ay be em ­
ployed with the airbrasive handpiece for
the establishment o f outline form and
cavity walls. These are : ( 1 ) the straight
line cut and (2 ) the angle cut. Both o f
 708 • T H E J O U R N A L O F T H E A M E R I C A N D E N T A L A S S O C IA T IO N

these cuts have advantages and are
valuable when utilized in the proper
place.
Straight line cut • The straight line
cut is employed where a high degree of
definition is desired. This type of cut
utilizes close nozzle distances and is pre­
cise and narrow. Its cross section greatly
resembles that which would be produced
by the edge of a diamond or carborun­
dum disk (Fig. 11). The straight line cut
usually is employed where the angle of
the wall must be controlled closely, as
for a gold inlay. It also is used for isola­
tion and removal of proximal walls for
Class II restorations.
Angle cut • The angle cut employs the
use of greater nozzle distance, together
with the required nozzle angulation. As
the nozzle distance from the substance
being cut increases, the angle of the walls
increases proportionately (Fig. 12). In
establishing a wall of a given angle, the
nozzle angle relative to the cavity wall
must be increased proportionately as
greater nozzle distances are employed.
The advantages afforded by the employ­
ment of the angle cut are: ( 1 ) greater
cutting speed and ( 2 ) less visual inter­
ference.
Angle cuts are indicated principally
for the preparation of Class I cavities
for amalgam 'fillings and for occlusal
dovetails for Class II amalgam fillings.
CONCLUSIONS
Airbrasive provides a method of estab­
lishing conventional tooth preparations
which is largely free of the unpleasant

1 1 ..... 1 1 “ I------ . 1
AIRBRASIVE (HYDROGEN — AL203) — 75 LB. PRESSURE — NOZZLE TIP DISTANCE 7 MM.

AIRBRASIVE HELIUM — (AL203>— 75 LB. PRESSURE — NOZZLE TIP DISTANCE 7 MM.

AIRBRASIVE (02— AL203>— 75 LB. PRESSURE

a AIRBRASIVE (C02— AL20 3>— 75 LB. PRESSURE

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DIAMOND DISK — 6,000 RPM — 3 OZ. FORCE

1DIAMOND STONE — DIAf 1. y4 INCH — 6,000 RPM-— 3 OZ. FOI CE

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DIAMOND POINT — 6,00« ) RPM — 2 OZ. FORCE
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10 20 30 40 50 60 70
WEIGHT OF ENAMEL REMOVED IN MILLIGRAMS
(Time of cut — 30 Seconds)

F ig . 10 • C u ttin g sp eed s o f various d en ta l in strum ents


characteristics associated with the use o f
the bur. Its con cept and developm ent
were stimulated chiefly by the almost uni­
versal public aversion to the use o f rotary
instruments. Airbrasive is not capable o f
Fig. 11 • T ypical straight line cut. A b o v e:
Nozzle tip distance o f 1 mm. and nozzle long
axis parallel to walls o f the cut. B elow : Walls
of cut are parallel to long axis o f the nozzle.
Nozzle tip distance is about 1 mm.
BLACK . . . VO LUM E 41, DECEMBER 1950 • 709
Fig. 12 • A ngle cut being em ployed to estab­
lish buccal wall. A pproxim ate figures relative
to nozzle tip distance and nozzle angulation
are indicated
duplicating all o f the functions o f rotary
instruments. Its principal value lies in
the fact that it cuts hard tooth structure
easily and accurately. It is incapable o f
rem oving soft carious dentin or bevel­
ing cavity margins. It is incapable o f
polishing metal o r silicate fillings. O n ce
skill in its use is acquired, the various
cavity preparations m ay be m ade rapidly
and in conform ity with accepted require­
ments. Such preparations require but
little finishing with hand instruments.
T h e general procedure is to:
1. Place the rubber dam.
710 • THE JO U R N A L OF THE A M ERICAN DENTAL A SSO CIA TIO N

2. Use airbrasive for general establish­
ment of the tooth preparation. This in­
cludes establishing outline form, extend­
ing margins to immune areas, following
out all grooves, establishing cavity walls,
and conforming preparation to basic re­
quirements relative to resistance and re­
tention forms.
3. Finish the preparation by means of
hand instruments. Soft carious dentin
should be removed by means of a spoon
excavator. There are instances where the
judicious use of the bur or rotary stone
may be indicated.
The two general methods for estab­
lishing outline form and cavity walls are :
( 1 ) the straight line type of cut and ( 2 )
the angle cut.
Types of cavity preparations for which
airbrasive is indicated arc:
1. Class I and Class II preparations
for amalgam fillings, inlays and gold
foil.
2. Class III preparations for lingual
dovetail inlays, and Class III prepara­
tions for silicate and plastic fillings.
3. Class V preparations for gold foil,
amalgam fillings, silicate fillings and plas­
tic restorations.
4. Three-quarter crown preparations.
5. Jacket crown preparations.
6 . Prophylaxis.

Positivism • During the mid-Nineteenth Century, as a result of the remarkable development

of science which took place in Europe and America, Auguste Comte brought forth the idea that
science had sufficiently advanced to explain the so-called facts of human life. This concept
became popular and had its reflection in medicine. This doctrine, known as Positivism, has a
retarding effect on scientific progress owing to insufficient realization of the limitations of science
as well as to an actually deficient knowledge of physical and biological reality, which did not
permit adequate interdisciplinary correlation of information, had this been considered of much
importance at the time. A critical survey of the medical culture of the past fifty years will
demonstrate that much of the medicine of this period must be considered to be still in the
positivistic stage of development, with characteristic overevaluation of surgical procedures and
dependence on palliative and sedative medications, lack of correlation and integration with
other fields of knowledge, and an insufficient realization and a too rigid interpretation of basic
philosophical postulates. In general it may be said that the positivistic therapeutic viewpoint is
not conducive to the development of true etiological therapies. M aurice N . W alsh, “ Concepts
of T herapy,” Proceedings o f the Staff M eetings of the M ayo Clinic 2 5 :5 4 3 , Septem ber 13, 1950.