High-speed Rotary Instruments Research Articles

Effect of different parameters utilized for image guided endodontic root canal preparation on temperature changes: an in vitro study

BackgroundNavigated endodontics is a cutting-edge technology becoming increasingly more accessible for dental practitioners. Therefore, it is necessary to clarify the ideal technical parameters of this procedure to prevent collateral damage of the surrounding tissues. There is a limited number of studies available in published scientific literature referencing the possible collateral thermal damage due to high-speed rotary instruments used in guided endodontic drilling. The aim of our study was to investigate the different drilling parameters and their effect upon the temperature elevations measured on the outer surface of teeth during guided endodontic drilling.MethodsIn our in vitro study, 72 teeth with presumably narrow root canals were prepared using a guided endodontic approach through a 3D-printed guide. Teeth were randomly allocated into six different test groups consisting of 12 teeth each, of which, four parameters affecting temperature change were investigated: (a) access cavity preparation prior to endodontic drilling, (b) drill speed, (c) cooling, and (d) cooling fluid temperature. Temperature changes were recorded using a contact thermocouple electrode connected to a digital thermometer.ResultsThe highest temperature elevations (14.62 °C ± 0.60 at 800 rpm and 13.76 °C ± 1.24 at 1000 rpm) were recorded in the groups in which drilling was performed without prior access cavity preparation nor without a significant difference between the different drill speeds (p = 0.243). Access cavity preparation significantly decreased temperature elevations (p < 0.01) while drilling at 800 rpm (8.90 °C ± 0.50) produced significantly less heating of the root surface (p < 0.05) than drilling at 1000 rpm (10.09 °C ± 1.32). Cooling significantly decreased (p < 0.01) temperature elevations at a drill speed of 1000 rpm, and cooling liquid temperatures of 4–6 °C proved significantly (p < 0.01) more beneficial in decreasing temperature elevations (1.60 °C ± 1.17) than when compared with room temperature (21 °C) liquids (4.01 °C ± 0.22).ConclusionsBased on the results of our study, guided endodontic drilling at drill speeds not exceeding 1000 rpm following access cavity preparation, with constant cooling using a fluid cooler than room temperature, provides the best results in avoiding collateral thermal damage during navigated endodontic drilling of root canals.

Tratamiento de caries en época de COVID-19: Protocolos clínicos para el control de generación de aerosoles

La pandemia de la nueva enfermedad llamada COVID-19 requiere cambios importantes en la práctica dental. El coronavirus (SARS-CoV-2) está presente en secreciones de la nasofaringe y en la saliva de los pacientes infectados y las vías de transmisión del virus son por contacto directo con gotículas salivales o por aerosoles . La gran mayoría de los procedimientos dentales convencionales generan aerosoles y son fuente potencial de infección, por lo tanto, los pacientes y los profesionales de la odontología tienen un mayor riesgo de contaminación, especialmente considerando la atención de pacientes que sean portadores asintomáticos o que sean atendidos durante el período de incubación. Le corresponde al equipo odontólogico la misión de mantener un ambiente desinfectado y controlar la transmisión de esta enfermedad altamente contagiosa. En este sentido, además de los cuidados convencionales para todo el consultorio y aquellos recomendados por la Organización Mundial de la Salud contra el coronavirus, se deben implementar procedimientos adicionales a los protocolos de tratamiento diseñados para los pacientes pediátricos. Actualmente, la realización de procedimientos no invasivos, micro y mínimamente invasivos adquiere una connotación importante. Dichos tratamientos tienen en común el hecho de que se basan en los conceptos más modernos para el tratamiento de la caries, con un enfoque conservador y biológico, tienen una eficacia comprobada en el control de la enfermedad y lo más importante para el momento presente es que no requieren el uso de instrumentos rotatorios de alta velocidad o de la jeringa triple (ambas generadoras de bioaerosoles). Los aerosoles producidos por la turbina de alta rotación o por aparatos de ultrasonido pueden contaminar cualquier superficie expuesta del consultorio odontológico y dependiendo del tipo de superficie, la temperatura y la humedad del ambiente, el virus puede permanecer activo durante horas o inclusive días. Por lo tanto, todos los esfuerzos deben ser realizados para evitar los aerosoles.

Aerosols generation using Er,Cr:YSGG laser compared to rotary instruments in conservative dentistry: A preliminary study.

BackgroundIn restorative dentistry, the use of high-speed air turbine, which generates aerosols, can be associated with the transmission of airborne diseases. New laser technologies could be useful in reducing the amount of aerosols, but there is a lack of scientific research on this topic. Material and MethodsThis is a descriptive study to analyze the amount of aerosols produced after class I cavity preparation using high-speed air turbine (group 1) and Er,Cr:YSGG laser with two different parameters (groups 2 and 3). Fluorescein dye was incorporated into the coolant reservoir in order to visualize the production of aerosols during each procedure. Tooth preparation was performed in a typodont with human lower molar tooth under rubber dam isolation. The procedure was carried out in a transparent plastic box to avoid aerosols dispersion. Sixteen grade I cellulose filter discs were distributed along the surfaces of the box. The area contaminated with aerosols in the filters was measured using ultraviolet illumination. ResultsIn group 1, the contaminated surface area covered with fluorescein dye reached 77.3% (1349 cm2) of the total; in group 2 (laser with 80% water) we observed 7.3% (128 cm2) and in group 3 (laser with 40% water) it was 3.8% (68 cm2). The reduction in water parameter from 80% to 40% coincided with 48% reduction of the contaminated area on the filter discs. Focusing on the surfaces of the box, we noted that the mean contamination on the left side was more than on the right side in all three experimental groups. In group 1 using air turbine, we measured a mean of 102.6[±7.5 SD]cm2 on the left side, compared to 70.6[±32.3 SD]cm2 on the right side. In laser groups 2 and 3, a mean of 12.8[±14.9 SD]cm2 and 6.8 [±5.7SD]cm2, respectively, was described on the left surface versus 0 cm2 of surface contamination on the right surface. ConclusionsThe contaminated area during the procedure of class I cavity preparation, is reduced by 70% using Er,Cr:YSGG laser compared to high-speed turbine. A slightly higher contamination was observed between laser groups with 80% versus 40% water. The use of Er,Cr:YSGG laser in restorative dentistry can be a valid treatment alternative to reduce aerosols production compared to conventional high-speed rotary instruments. Key words:Er,Cr:YSGG laser, Aerosols, SARS-CoV-2, Rotary instruments, conservative dentistry.

Recomendações para o Manejo e a Mitigação do Aerossol Produzido pelo Uso de Instrumentos Rotatórios de Alta Velocidade Durante Epidemia da COVID-19: Revisão Integrativa

Objetivo: sistematizar a produção bibliográfica sobre as recomendações para o manejo e a mitigação do aerossol produzidos por instrumentos rotatórios de alta velocidade em tempos de epidemia pela COVID-19. Método: foi realizada uma busca bibliográfica no em bases bibliográficas eletrônicas brasileiras e internacionais (Lilacs, SciELO, MEDLINE e PubMed). Após aplicados critérios de inclusão e exclusão dos documentos, 21 estudos foram selecionados para a realização da revisão. Resultado: foi construída uma proposta com recomendações para reduzir a contaminação durante procedimentos geradores de aerossol provenientes de instrumentos rotatórios de alta velocidade. Conclusão: recomenda-se a utilização de equipamentos de proteção individual completo, incluindo respiradores N95, PFF2, PFF3 ou similar, o emprego de barreiras mecânicas, a aspiração através de bomba de alta eficiência, a constante renovação do ar ambiente através de sistemas de exaustão ou pressurização da sala de trabalho e a limpeza e desinfecção criteriosa do ambiente de trabalho após cada atendimento

In vivo evaluation of tooth colour alterations during orthodontic retention: A split-mouth cohort study.

To assess in vivo colour alterations of teeth following removal of fixed orthodontic appliances during retention. The Department of Orthodontics at the Aristotle University of Thessaloniki. Forty-eight patients after orthodontic treatment. Debonding and cleaning procedures after orthodontic treatment were performed using two different carbide burs attached to a low or high-speed handpiece, respectively, in a non-blinded cohort study with split-mouth design. Spectrophotometric colour data of teeth were recorded: (a) after debonding, (b) three months later, prior to and following finishing with Soflex discs, and (c) after 1year. The CIE Lab colour parameters were measured for each tooth, and the corresponding ΔΕ differences were calculated. The effect on colour was assessed with 3-way mixed ANOVA and Bonferroni's comparisons test (a<0.05). Orthodontic debonding and cleaning procedures were found to have statistically significant effects on the CIE colour parameters of treated teeth, since the L* values decreased 0.6 units (P<0.001), a* values were stable (0.0 units) and b* values increased 1.4 units (P<0.001), during the first retention year. Finishing temporarily decreased the enamel colour differences. Total ΔΕ differences for all types of teeth measured ranged from 1.4 to 2.1 units. The greatest changes were exhibited during the first 3months in teeth on which high-speed rotary instruments were used (1.6 units). The clinical relevance of this study points out that the colour of natural teeth following removal of fixed orthodontic appliances changes in long-term.

The Dangers of Dental Amalgam

researched mercury poisoning and identified through his research that silver amalgam fillings in the mouth were a source of mercury vapor. More recently, many studies reported that amalgam may constitute potential toxic hazards to patients through mercury release and absorption, surface corrosion, and the reaction of released mercury with residual alloy particles to form additional inter metallic compounds. Furthermore, mercury may migrate gradually from an amalgam restoration into the enamel, dentin, pulp tissues, and adjacent gingival tissue where it accumulates [1]. Increased mercury levels in the gingiva adjacent to sub gingival amalgam restorations have been reported. In addition, fine amalgam particles may become accidentally embedded in the soft tissues of the mouth, most commonly the gingiva, when they are abraded by high speed rotary instruments, during the removal of the amalgam fillings and preparation of crowns over amalgam cores. Moreover, this can occur when amalgam is used as a retrograde root filling material, and produces tattoo [2]. Examinations of tissue biopsies from both human and experimental animal lesions by light, electron microscopy and energy dispersive x-ray micro-analysis have shown that the small particles of amalgam undergo progressive degradation within phagocytic cells, with a subsequent redistribution of their constituted elements. Fine secondary particles containing silver become widely distributed in tissues, producing the characteristic tattooing, thereafter, mercury is released into surrounding soft tissues [3]. Amalgam debris is able to activate immunologic adaptive reaction where tissue reaction to amalgam tattoo depends on amalgam particles size and composition. While copper and zinc are rapidly lost from the area of the tattoo, mercury and tin are lost more slowly and finally silver remains permanent in the tissues. The residual elements of amalgam tattoo develop a noxious effect within soft tissues, where mercury passes from the tissue fluid into the blood stream and accumulates in the kidneys [4]. Exposure to large amounts of metallic mercury vapor, compared to small amounts released from amalgam fillings, causes certain symptoms that may include cough, fever, skin rashes, tremors, difficulty in muscle coordination and walking, renal abnormalities, and memory loss [5]. Patients allergic to mercury used in dental clinics may experience itching, hives, local soreness, burning, and dryness of throat and mouth. Several studies reported a strong relationship between the total surface areas of amalgam restorations and blood or urine mercury levels [6]. Heintze et al. [7] reported in vitro formation of methyl mercury from a conventional and mixed amalgam by the action of streptococcus sanguis, mutans and mitior in pure cultures, suggesting the possibility of methyl mercury formation in the mouth if amalgam is present. Mercury compounds have high affinity to proteins, amino acids, purine, pyrimidine and nucleic acid [8]. Mercury toxicity was explained by its interaction with these molecules through sulfhydryl groups, and disulfide bonds on cell membrane; thus, mercury compounds alter the selective permeability of cell membranes for ions and nutrients and possibly block more specific membrane transport processes. Fetal exposure may follow previous mercury uptake by a pregnant mother where mercury compounds, as most other substances, may pass through the placenta to the fetal circulation [9]. Fetal toxicity occurs following certain degrees of mercury compounds accumulation within the central nervous system. Although studies shown that little mercury compounds penetrate to fetal tissues, embryopathic effects of these compounds have been demonstrated as growth retardation, subcutaneous edema, exencephaly, anophthalmia, and teratogenic effects, such as cleft lip and palate, ribs fusion and syndactylia and embryopathic death. Therefore, the safety of dental amalgam-released-mercury during pregnancy became questionable. Data from Soussa E [10] study shows a positive correlation between blood mercury levels in mothers and their oral tissue response; however, the negative impact of mercury on oral tissues is regarded to have taken place during pregnancy in relation to elevated blood mercury levels of mothers. Monitoring the blood mercury following dental amalgam restorations during pregnancy is recommended to avoid its harmful effect on the fetus. The World Health Organization (WHO) has stated that there is no safe level of mercury. That means that no amount of mercury is safe, not even one atom. Even if enough mercury hasn’t accumulated to manifest a symptom directly or indirectly related to chronic mercury poisoning, The World Health Organization, O.S.H.A., N.I.O.S.H., etc, all agree that mercury is an environmental poison and have established specific occupational exposure limits. The Environment Protection Agency has declared amalgam removed from teeth to be a toxic waste. Even the American Dental Association warns that amalgam filling material is hazardous to dental office personnel, Editorial

Evaluation of Minimum Required Safe Distance between Two Consecutive Dental Chairs for Optimal Asepsis

Cross infection and self-protection, these two words are like a lurid to the health care professionals. A balance has to be maintained among those two words if not, it’s after affects areunpredictable. It is believed that even after following the code of practice, some elements such as the aerosols that are evolved during the use of high speed rotary instruments such as airotor and scaler are difficult to handle. Aerosols containing microbes from oral cavity of the patient are a risky source of infection. The best way to fight against these aerosols is to keep a distance from them. But it is not known how far these airborne microorganisms spread under various clinical environments. This article emphasizes the safe distance that has to bemaintained around each dental chair to prevent cross contamination.

Esthetic treatment of gingival melanin hyperpigmentation with a Nd:YAG laser and high speed rotary instrument: comparative case report

PurposeThe purpose of this study was to evaluate the clinical effectiveness of and patient's satisfaction with treatment of gingival melanin hyperpigmentation with a Nd:YAG laser and a high speed rotary instrument.MethodsThree patients with melanin hyperpigmentation in the anterior parts of the gingiva were chosen for this case study. Clinical photographs were taken at the preoperative state and three patients were treated under local anesthesia. In the maxilla, the gingival deepithelization was conducted with a high speed diamond bur, whereas, in the mandible with a Nd:YAG laser. Clinical photographs were taken immediately after the procedures and at the 1st, 2nd, and 4th week to evaluate clinical color changes. A week after the procedure, the patients filled out a questionnaire about any pain or discomfort. At the 4th week after the procedure, the patients filled out questionnaires about esthetic aspects of the results of treatment.ResultsIn all cases, both anterior gingival areas were depigmented with satisfaction and the patients did not complain of severe pain or discomfort. At the 1st week of healing, the gingiva showed moderate to fast epithelization. Two weeks after the procedure, clinically, the gingiva showed almost complete healing. Four weeks after the procedure, there was significant improvement in gingival melanin hyperpigmentation.ConclusionsThe Nd:YAG laser and the high speed rotary instruments seem to be effective for the esthetic treatment of gingival melanin hyperpigmentation.

High Incidence of Blood Exposure Due to Imperceptible Contaminated Splatters During Oral Surgery

To evaluate the incidence of blood exposure during outpatient oral surgery from splattering caused by use of high-speed rotary instruments at the Referral and Teaching Center, University Dental Hospital. Twenty-five consecutive patients who had impacted mandibular third molars were selected. The attending surgeon wore an operation gown and visor mask, and carried out the tooth extraction with the regular procedure. We counted the number of bloodstains found on the operation gown and visor mask, and confirmed the presence of diluted and invisible bloodstains using a leucomalachite green presumptive test, which was able to detect dilutions up to 1:4,000. There were 469 separate bloodstains on the gown and visor mask of oral surgeons, which came from 19 (76%) of 25 patients during impacted mandibular third molar surgery. Presumptive tests for invisible bloodstains resulted in 1,206 positive reactions, 2.57-fold greater than the visible stains, from 88% of the cases. All of the surgeons were right-handed and the common areas of staining were the right forearm, face, and thorax regions. Dental procedures with high-speed instruments exposed surgeons to possible blood-borne infections by splashing in nearly 90% of the cases. Greater than 50% of the stains were invisible to the naked eye. Based on our results, strict compliance with barrier precautions, including routine use of an operation gown and visor mask, is recommended whenever oral surgery is carried out with high-speed rotary instruments.

Analysis of Primary and Permanent Molars Prepared with High Speed and Ultrasonic Abrasion Systems

The aim of this study was to compare high speed and ultrasonic systems with regard to both topography and smear layer formation in the cavity preparations of sound primary and permanent molars. Class I occlusal cavities measuring 2.00 x 2.00 x 2.00 mm were performed in 14 molars, equally divided into two groups (GI = 7 primary teeth and GII = 7 permanent teeth). High speed rotary instruments produced regular layers of enamel and dentin, despite the marked presence of grooves and microfractures on enamel surfaces. On the other hand, ultrasonic abrasion yielded more irregular surfaces in enamel and dentin, with a granular and wavy aspect, but without microfractures in enamel. Both types of dental substrates were found to have an intense smear layer formation, partially or even completely obliterating the dentinal tubules (p>0.05), irrespective of the instrument used. No difference was observed in either primary or permanent teeth as regards the amount of smear layer produced by high speed or ultrasonic abrasion instruments (p>0.05). It was concluded that with regard to the topography of cavity preparations, there were differences between the instruments used, irrespective of the dental substrate. Both systems allowed dense smear layer formation, which completely or partially obliterated the dentinal tubules of primary and permanent teeth.

Preliminary experience with polyethylene fibre glove liners in oral and maxillofacial surgery

The poor performance of latex gloves in preventing penetrating injury is well established. Oral and maxillofacial surgeons face the additional problems associated with wiring techniques and high-speed rotary instruments. A pilot study is presented assessing the efficacy of high-strength polyethylene fibre gloves, used in a triple-gloving technique, in preventing inner glove perforation. The results showed that there were fewer perforations of the inner glove in the surgeon wearing the glove liner, but the difference was not significant.

Surface characteristics of finished posterior composite resins

Samples of a large particle-filled posterior composite resin were finished with rotary instruments and alumina polishing pastes for SEM examination. High-speed rotary instruments left a rough surface, which was more a characteristic of the instrument used than the optimum finish that could be achieved. In contrast, alumina pastes produced smooth surfaces free from artifacts. Six different posterior composites were polished with alumina pastes for SEM and profilometer examination. Unlike anterior materials, small particle-filled posterior composites attained smoother surfaces than microfilled resins. Profile tracings and average surface roughness for each material correlated with SEM appearances. Materials with similar roughness values showed very different surface characteristics.

Histologic identification of mast cells in human dental pulp

Previous investigators who attempted to identify mast cells in the dental pulp have used demineralizing or tooth-splitting procedures to obtain their tissue samples. However, Eda and Langeland15 found that the fluorescence of mast cells is destroyed by acid demineralizing agents. On the other hand, tooth splitting may damage the pulp by crushing it with forceps, or cutting and heating it with burs, stones, or discs. In the present study, we used the extirpated pulps from teeth in which endodontic access openings were made by means of high-speed rotary instruments with water spray. Metachromatic staining methods failed to demonstrate mast cells in any of the non-inflamed pulp specimens. Two of the inflamed pulp specimens revealed numerous mast cells which appeared intact and well preserved with no evidence of degranulation. As to the distribution of the mast cells, there was no correlation with the number and types of other inflammatory cells observed. Although several cells present in the specimens examined were suggestive of mast cells, only those cells that revealed definitive metachromasia were included in this study.

Variation of Inlay Cavity Design

With use of high-speed rotary instruments and a recently introduced bur, a variation of the traditional inlay cavity preparation can be achieved. The region to be restored is cut so that the pulpal floor is rounded and the gingival and axial walls of the tooth are hollow-ground. The technique is evaluated on the basis of traditional principles of cavity preparation.

Histologic response of bone to sectioning by high-speed rotary instruments.

SYNOPSIS IN INTERLINGUA RESPONSA HISTOLOGIC DE OSSO AL SECTION AGE PER INSTRUMENTOS ROTATORI DE ALTE VELOCITATE.—Con le utilisation de fluorescentia inducite per tetracyclina, le guarition de defectos ossee in crestas mandibulo- e maxillo-alveolari, in le margine inferior del mandibula, e in le femores de canes esseva studiate comparativemente post le production del defectos per fresas in rotation a velocitates de 200.000 rpm e, in le mesme animales, post lor production per fresas in rotation a velocitates de 5.000 rpm. Le marcage con tetracyclina revelava osso nove in omne le defectos 14 dies post le operation. Quaranta-duo dies post le operation nulle differentias quantitative o qualitative esseva observabile in le natura del responsa reparatori inter le defectos effectuate a basse e a alte rapiditates.

A study of the effects of high-speed rotary instruments on bone repair in dogs

A study of the effects of high-speed rotary instruments on bone repair in dogs

Principles Associated with the Use of High Speed Rotary Instruments

Vibration contributes to the discomfort usually associated with a dental operation. Many factors influence and cause the vibration that is perceived by the patient, but it is known that the major source of vibration is from the equipment and not the cutting instrument. One of the major advantages to the use of higher speeds for rotary instruments is that the intensity of the vibration is decreased as the frequency is increased. Speeds are available that make it possible to increase the frequency of vibration beyond the threshold of perception by the patient. Evidence has been collected, both clinically and in the laboratory, that demonstrates the necessity for using a coolant when speeds of 10,000 rpm or above are used. Air is not a desirable coolant because it fails to control the generation of heat, and it dehydrates exposed dentin. A sufficient volume of water or the air-water spray are the most effective coolants. Water, in copious quantities, is the coolant of choice if an efficient aspirating unit is employed. Carbide burs are most effective for use with higher speeds than are steel burs. In dentin, the initial cutting rate of either carbide or steel burs is about the same, but the efficiency of the steel bur diminishes very rapidly. At the ultra-high speeds of 100,000 rpm and above, carbide burs cut enamel with ease; however, at the lower speeds they should be used primarily in dentin. Design is an important factor in the cutting effectiveness of a bur, and at the present time there is a great variation both in design and in efficiency amongst various manufacturers’ products. Diamond instruments offer conveniences in size and shape that are not afforded by carbide burs. Because of these conveniences diamond instruments are used almost exclusively by some operators even though their efficiency when cutting dentin is not as great as that of the carbide bur. Diamond points are most effectively used in enamel at light pressures and with an adequate amount of coolant. Instruments of inferior quality are a poor economic investment because their functional life at increased speeds of rotation is relatively short. All diamond instruments should not be operated at the same number of revolutions per minute, inasmuch as it is the peripheral speed that is important. A diamond point with a diameter of $$ inch would have to travel three and one-third times as fast as a point with a diameter of 5 / 16 inch in order to cut with the same efficiency. Clinically it is evident that the cutting rate of the smaller diamond instrument is increased tremendously at the ultra-high speeds; however, the cutting rate of opening wheels and other instruments of comparable or larger size appears to be increased only slightly at speeds in excess of 20,000 to 30,000 rpm. As with any new technique, the use of higher speeds for rotary instruments is in a state of flux and transition. Despite all that has been learned about its use during the last five or six years, much investigation and research are still needed, particularly in connection with the use of speeds above 100,000 rpm. The dentist who has not experienced the advantages to be gained by the judicious use of higher speeds of rotation is encouraged to begin by first gaining experience with the technique in the laboratory. Thought should be given to the use of higher speeds only after becoming thoroughly familiar with the characteristics of cutting instruments that are rotating at 10 to 15,000 rpm. There is now available a range of speeds from the conventional to 200,000 rpm. The choice of the highest speed to be used is one of individual concern. Its selection should be based upon sound biologic, physiologic and operative principles, and should offer the patient and the dentist confidence, efficiency and comfort.

High speed rotary instruments in operative dentistry: review of the literature

In the general practice of dentistry, the restoration of carious teeth occupies the greatest percentage of the dentist’s work­ ing day; therefore, it behooves the den­ tist to become as efficient as possible in this field if he is to gain the optimum utilization of his productive hours. Since the early part of the nineteenth century, rotary tools of various types have been used by dentists for the purpose of abrading or cutting away tooth structure. The dental bur in its present form was first introduced in the early part of the last century,1 and since then it has under­ gone little modification or change. Currently, dentistry appears to be mak­ ing important advancements in the de­ velopment of more effective instruments and improved methods for cutting the hard structures of the teeth. Operative dentistry is an expanding field, and some new methods of cavity preparation are being brought forward. Within the recent past, high speed rotary machines have been introduced. There has also been developed a method of tooth tissue abra­ sion by means of a projected particle apparatus (Airdent). At present, the use of ultrasonic waves is being explored. It has become apparent that, within the predictable future, the present method of cavity preparation will be materially changed. Which method will finally emerge as the most acceptable is still problematical. It is the purpose of this paper to review the presently available literature on the status of the high speed rotary method of shaping cavities in the restoration of carious teeth.