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Why we brought in an AquaCare Twin — removing decay without a drill

Doctor’s column · Published 2026.09.13 · Translated from the Korean original · Seongmo Dental Clinic, Seongbuk-gu, Seoul

A column on the AquaCare Twin (Velopex) air-abrasion and air-polishing unit · written by the director, a board-certified specialist in Integrative Dentistry at Seongmo Dental Clinic, Sungshin Women’s University Station

Even with a Plazen root canal unit, a 5-axis mill and a 3D printer in the clinic, one moment still bothered me: reaching for a high-speed handpiece to treat an early lesion the size of a grain of millet found on Q-ray. The bur was larger than the lesion. AquaCare Twin is the unit we brought in to remove that moment.

What is AquaCare Twin, and how does air abrasion differ from a drill?

AquaCare Twin sprays fine powder with air and water to shape the tooth, and air abrasion removes tooth structure using the kinetic energy of those particles rather than rotation.

The first step in treating decay is removing diseased tooth structure. Until now that work has been done almost entirely by the high-speed rotary bur. It is fast and reliable, but the whole surface the blade touches is cut away, and rotational vibration and frictional heat travel through to the nerve inside the tooth. The sound and the sensation patients dislike most in a dental clinic come from here.

Air abrasion was first introduced in the 1940s and drew attention again as adhesive dentistry developed. Fine aluminium-oxide (alumina) particles are carried in compressed air, and as they strike the tooth they lift the surface away a little at a time. Because the cutting is done by kinetic energy, it is also called kinetic cavity preparation. A 2010 review in the Journal of Conservative Dentistry (Hegde and Khatavkar) lists less vibration, heat and noise than rotary instruments, fewer microcracks and conservative removal in early lesions as advantages, and unsuitability for deep decay, amalgam removal and calculus removal, along with the need to manage the powder, as limitations.

AquaCare is made by Medivance Instruments of London under the Velopex brand. To reduce the powder scatter that was the main inconvenience of dry air abrasion, a dedicated solution (AquaSol) is sprayed alongside the powder stream, and the Twin model has two powder chambers, so cutting and polishing powders can be selected on one unit. According to the manufacturer’s instructions for use, the four powders are alumina 53µm (standard cutting), alumina 29µm (fine cutting), sodium bicarbonate (cleaning and polishing) and Sylc bioactive glass (polishing and desensitising). Working pressure is 4.0–5.0 bar for preparation and 2.5–3.0 bar for polishing, the tungsten-carbide nozzles are 0.4, 0.6 and 0.8 mm, and the foot pedal has three stages for dry, rinse and cut.

Why did Seongmo Dental Clinic bring in an AquaCare Twin?

There were three reasons: to cut an early lesion only as much as its own size, to make the first step of bonding a clinic-wide standard, and to have an option for sensitive teeth beyond something painted on.

The first was matching the scale of diagnosis to the scale of treatment. Seongmo Dental Clinic uses a Q-ray quantitative light-induced fluorescence unit to find and record early demineralisation that is invisible to the eye and to radiographs. But if the lesion found is less than a millimetre across while the treatment instrument is a bur larger than that, the precision of the diagnosis is lost at the treatment stage. The 0.4 mm nozzle and 29µm fine alumina of the AquaCare are the tools that close that gap. When only the lesion is removed and composite is placed in that spot, the case can end as a preventive resin restoration instead of an inlay. It is the unit that puts into practice, at the smallest scale of decay, the principle of preserving natural teeth that the clinic has kept: cut only what is needed and leave the rest.

The second was bonding. Seongmo Dental Clinic makes same-day ceramic restorations through Primescan scanning, design by the director and 5-axis wet milling with SpeedFire sintering. Even a well-made restoration will not last if the bond is unreliable. A surface treated with alumina particles is finely rougher than one prepared by acid etching alone, which is favourable for bonding resin and ceramic, and this is noted consistently in the manufacturer’s material and in the adhesive dentistry literature. Preparing the tooth surface before veneer bonding, the fitting surface of a tried-in ceramic inlay and an abutment with temporary cement remaining, all under the same conditions, has become the in-house standard.

The third was tooth sensitivity. For a patient with a worn cervical area, what could be offered until now was fluoride varnish or a desensitising agent, and composite filling. Sylc bioactive-glass air polishing sits between the two. The literature is discussed in the fifth section.

The standard for bringing in new equipment is always the same. If I would not use it when my own family came as a patient, I do not use it on my patients. This time it was the other way round. When I saw an early lesion in the fissure of my child’s molar, I did not want to pick up a drill. I checked the literature first, and because the result pointed in the same direction as the principles of this clinic, we brought it in.

How does air-abrasion treatment of early decay proceed at the clinic?

Q-ray diagnosis, isolation, air-abrasion removal, composite restoration and occlusal check follow in order, and most cases finish within a single visit.

1. 1. Q-ray quantitative fluorescence diagnosis — one full-arch image is taken and analysed under magnification, and the position and extent of the lesion are recorded. This is where a lesion to be treated is separated from one to be watched.
2. 2. Isolation and protection — a rubber dam or high-volume suction keeps powder and water away from other areas, and protective eyewear is fitted.
3. 3. Choosing powder and nozzle — 29 or 53µm alumina and a 0.4 to 0.8 mm nozzle are chosen to match the size of the lesion, and the unit is switched to Prep mode.
4. 4. Air-abrasion removal — using the three-stage foot pedal for cutting and rinsing, only the lesion is removed. Because there is no vibration or heat, small lesions are often treated without anaesthesia, and if it feels sensitive we move straight to stepwise painless anaesthesia including i-JECT computer-controlled injection.
5. 5. Bonding and composite restoration — adhesive and composite are placed on the prepared surface and light-cured. Sealant is applied to the surrounding fissures where needed.
6. 6. Occlusal check and polishing — the bite is checked and the surface is finished. If there is staining, the unit is switched to Prophy mode and the work continues with the same handpiece.

What shortens the appointment is not the cutting itself so much as the time spent waiting for anaesthesia and the pauses taken while bracing against the sound of the drill. Seongmo Dental Clinic ties air-abrasion treatment to Q-ray diagnosis on the same day because the most conservative outcome for early decay is to finish it small, on the day it is found.

Many patients ask, is it over already? They had been waiting for the sound of the drill.

Where is air abrasion used in bonding and prosthetic work?

It is used for surface preparation before bonding veneers and ceramic restorations, in-house repair of chipped ceramic, cleaning up orthodontic bracket adhesive, and cleaning fissures before sealants.

The manufacturer’s instructions list the indications for AquaCare as preparation before pit-and-fissure sealants, resin removal, cavity preparation, cleaning, polishing and stain removal, and surface treatment of enamel, metal and porcelain. Three of these come up most often at Seongmo Dental Clinic.

The first is preparation before bonding same-day ceramic restorations. The fitting surface of a tried-in inlay or crown and the tooth surface are treated with alumina so that bonding conditions match. Residual temporary cement is cleared at the same step. The second is clearing adhesive after orthodontic treatment. Grinding away the adhesive left where a bracket was removed tends to take enamel with it, whereas air abrasion uses the difference in hardness between adhesive and enamel to lift the adhesive first. The third is cleaning fissures before sealants. Stain and debris deep in the occlusal grooves do not come out with a brush and acid etching alone, so the grooves are cleaned with a fine nozzle before the sealant is placed.

What should be clear is the division of roles. Managing supragingival and subgingival biofilm and calculus is the job of the EMS Prophylaxis Master (AIRFLOW), while the AquaCare Twin takes the side of shaping tooth structure and preparing bonding surfaces. The manufacturer’s instructions also state that this unit is not to be used for calculus removal or for cutting amalgam.

What research is there on air abrasion and Sylc polishing?

The conservative nature of air abrasion is covered in a review and in a bioactive-glass cutting study, and the relief of sensitivity by Sylc polishing in a 2020 double-blind randomised clinical trial.

The representative summary of air abrasion itself is the review by Hegde and Khatavkar published in the Journal of Conservative Dentistry in 2010. It sets out as advantages that air abrasion reduces the loss of healthy tooth structure in early lesions, produces less vibration, heat and noise, and creates a surface favourable for bonding, and as limitations that the absence of tactile feedback demands experience in judging depth, and that powder management and isolation are essential.

A 2011 study published in the Journal of Dentistry by a King’s College London team (Banerjee and colleagues) examined in the laboratory whether air abrasion using bioactive-glass powder instead of alumina removes carious tissue selectively compared with healthy enamel and dentine. The study reports that bioactive-glass powder cuts less aggressively than alumina but acts more selectively on carious tissue. This is the basis on which the clinic uses alumina for cutting and Sylc bioactive glass for polishing and desensitising.

On sensitivity there is a double-blind randomised clinical trial published in The Open Dentistry Journal in 2020 (Ahmed and colleagues). Fifty patients with sensitivity from non-carious cervical lesions were divided into a Sylc air-polishing group of 25 and a fluoride varnish group of 25 and followed for one year. The Sylc group showed a statistically significant reduction in pain to evaporative, thermal and tactile stimuli from 3 weeks up to 1 year (P<0.05), while the fluoride varnish group showed a significant reduction only at the 1-week point. As this is a single study and results vary between individuals, the clinic takes the finding as meaning that an option lasting longer than varnish exists, and diagnoses the cause first.

When is AquaCare not the right choice?

For wide decay that has progressed deep into dentine, amalgam removal, calculus removal and respiratory disease where powder inhalation is a concern, other methods come first.

Air abrasion is a tool for early lesions. Removing decay that has spread deep into dentine with particles alone takes a long time and makes depth hard to judge, so in those cases rotary instruments clear the bulk and air abrasion finishes only the margins and the bonding surface. It is not used for amalgam removal, and calculus is handled by the piezo scaler of the EMS Prophylaxis Master.

Some patients are concerned about inhaling the powder. Rubber dam, high-volume suction and water spray reduce scatter, but for patients with severe asthma or chronic respiratory disease we discuss whether to use it at all beforehand. For those advised to follow a low-sodium diet, a powder other than sodium bicarbonate is chosen.

❓ Frequently asked questions

⚕️ This article was written for information purposes in line with Korean medical law and the Ministry of Health and Welfare’s medical advertising standards. Equipment specifications given here come from the manufacturer’s official material and figures on treatment effect are values reported in academic literature; the outcome of treatment and whether anaesthesia is needed vary with the condition of the mouth. Every treatment carries individual variation and the possibility of side effects, so please obtain an accurate diagnosis through an in-person consultation.

This article was written as of September 2026. Equipment specifications and cost-related content are reviewed and updated every three months.