Air abrasion cutting, using particulates accelerated in a controlled compressed gas stream, is currently being reevaluated as a precision tissue removal technique for dental cavity preparation. The minimal vibrations and heat generated during cutting commend the technique for use in the shaping of fragile or brittle materials that are vulnerable to vibrations and thermal stresses. Traditional air abrasion studies have relied solely upon postprocedure imaging, and cutting process details have een inferred from the nature of the residual surface. In this paper, however, a real-time confocal microscopic imaging method is described, which for the first time has allowed prior target structure characterization with subsequent imaging of cutting interactions and substrate failure patterns. Using internally focusing long working distance Hill objective lenses, focusing deep to a protective microscope slide and adhesive interfaces. unhindered remote image sampling within the bulk of specimens such as tooth tissue, acrylic and brittle ceramics was possible. Moreover, areas of active cutting and inactive regions were identified within air abraded cavities during their creation. The characteristics of the finished cut surfaces were demonstrated and confirmed the findings of previous SEM studies. The method allowed direct control over all the known variables influencing cutting with particulate streams.