There has been a real drive in recent years towards speed increasing handpieces, this was greatly accelerated during the pandemic due to the reduced fallow times that they offered (remember fallow times?!).  The ability to vary speed, the increased precision and torque that they offer is seen by many as a gold standard for preparations.  We are proud to have helped many customers on their path to using speed increasing handpieces in daily practice.  That being said, here are some potential drawbacks for you to understand before embarking on your speed increasing journey.

1. Cost Considerations

One of the most significant downsides of speed-increasing handpieces is their cost. These handpieces are typically more expensive than traditional high-speeds. The higher price point is due to their advanced engineering, the need for compatible electric motors, and the overall precision of the equipment. For dental practices operating on a tight budget, the initial investment can be a deterrent.

2. Weight and Ergonomics

Speed-increasing handpieces are often heavier than traditional high-speed handpieces, primarily because of the additional components (gears) within. This increased weight can lead to hand fatigue, especially during long procedures. 

3. Learning Curve and Adaptation

For many dental professionals who have spent years using traditional high-speed handpieces, switching to a speed-increasing handpiece may come with a steep learning curve. The change in torque, speed, and overall feel can require a period of adaptation. During this time, practitioners may find that procedures take longer or that they struggle to achieve the same level of comfort and efficiency they’re used to with traditional handpieces.

4. Maintenance and Repairs

Speed-increasing handpieces, due to their complexity, require more frequent maintenance and are often more challenging / expensive to repair compared to traditional handpieces. 

5. Potential for Overheating

When bearings fail on a traditional high-speed handpiece, the bur often simply stops spinning, signalling an issue. However, in a speed-increasing handpiece, the increased torque through gearing allows the handpiece to continue running despite bearing failure, which significantly raises the risk of overheating. This can not only damage the handpiece but also pose a risk to patient safety, making it crucial for practitioners to regularly maintain and monitor their equipment. 

Furthermore, when the push button on the head of a high speed is inadvertently depressed during use (which should never be done) either by digits or if resting on soft tissues (which should absolutely never be done), it will usually torque out.  Speed increasing handpieces, due to their increased torque, will continue to spin and can generate high levels of heat very quickly.

Balancing the Downsides with the Pros

Despite these downsides, speed-increasing handpieces offer several compelling advantages that make them a valuable tool in many dental practices:

• Increased Torque: The enhanced torque allows for more efficient cutting, particularly through harder materials like metals and ceramics, improving the quality of work and reducing procedure times.
• Reduced Noise: These handpieces operate more quietly than traditional ones, enhancing the patient experience by reducing anxiety associated with loud dental tools.
• Precision and Control: The ability to operate at lower speeds with higher torque gives practitioners greater control over procedures, leading to more precise and accurate outcomes.  Coupled with a micromotor, they are perfect for refining preps in experienced hands.

Conclusion

While speed-increasing handpieces do come with some notable drawbacks, such as higher initial costs and maintenance demands, their benefits often outweigh these concerns; especially for dentists committed to providing a high standard of care. The improvements in efficiency, precision, and overall quality of work can justify the additional investment, particularly in practices where these factors are prioritized.

Interestingly, a recent conversation I had with a practice owner highlighted a practical approach to integrating these tools into daily practice. He uses traditional high-speed handpieces for the majority of his procedures but switches to speed-increasing handpieces for refinements where speed control is critical and also situations when the increased torque is necessary. This hybrid method not only maximizes the strengths of both types of handpieces but also helps minimize the costs and repairs associated with speed-increasing models.

Ultimately, adopting a balanced approach, leveraging the strengths of both high-speed and speed-increasing handpieces may be the most effective way forward for many practices.