Clinical Practice Guidelines on Sterilization of Endodontic Instruments

 

Sowjanyaa J.¹, Dr. Chandana C.S.²

¹Postgraduate Student, Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, India

²Reader, Department of Conservative Dentistry and Endodontics, Saveetha Dental College,

Saveetha University, Chennai, India

 

ABSTRACT:

Diseases are transmitted by indirect contact when contaminated dental instruments of one patient are reused for another patient without adequate sterilization or disinfection between uses. The process of sterilization is designed to render instruments free of all microbial life and bacterial spores, which can be very difficult to kill. Resterilization of dental instruments for use on another patient happens regularly in all dental practices.  Resterilization is simply the repeated application of a sterilization procedure to an instrument or device to remove contamination, allowing for its use in treating multiple patients. Endodontic files and dental burs are commonly treated in this way. It is important to ensure sterility and minimize any associated risk of cross-contamination of patients with dangerous pathogens. Clinical Practice Guidelines are useful for delivering the best care possible in an efficient manner.

 

 

 

INTRODUCTION:

Microorganisms in the human body induce a variety of infectious diseases. A major topic of concern in medical and dental health care settings is infection control. Direct or indirect contamination leads to transmission of infectious agents (1). One of the major concerns of health practitioners is the prevention of cross-contamination of infectious diseases among dental staff and patients. Spread of infectious diseases is prevented by sterilization. In dentistry, it relates to processing reusable instruments to prevent cross-infection (2).

 

As microorganisms are a major cause of endodontic disease, aseptic technique is essential for endodontic success (3). The reasons for endodontic success are elimination of patient cross-contamination and increased endodontic success (4).

 

Precleaning and sterilization of some instruments is difficult due to the complex architecture and small size (5). Endodontic files used for cleaning and shaping of the root canals during endodontic treatment are slender, tapered instrument with intricate topography and spiral cutting edges (6). Dental burs come in a variety of sizes and shapes with detailed and complex surface features (7).

 

Endodontic Instrument Sterilization:

Files must be sterilized before use. Recommendations of ANSI/ADA Specification 28 include:

·        Scrub the instruments with soap and warm water.

·        Rinse thoroughly with deionized or distilled water.

·        Instruments are allowed to air dry.

·        Instruments are unwrapped and placed in the autoclave tray.

·        Steam Autoclave at 136°C ± 2°C for 20 minutes.

·        All rotary files are ideal for single patient use.

 

Recommended File Disposal: Place used files in a Biohazard Sharps container.

 

 

Ultrasonic Tips Sterilization:

Temperature of 136°C (277°F) is maintained for a minimum of 20 minutes as per USP recommendations.

 

Post Decontamination:

Wipe the post with alcohol and allow the post to air dry for 30 seconds before use.

 

Ultrasonic Irrigation Needle:

Wipe the needle and tubing with 70% isopropyl alcohol.

 

Post Drills Sterilization Procedure:

Using deionized or distilled water, unwrapped instruments are subjected to a pressure of 220 kPa (2.2 bar) for 20 minutes at a temperature of (136 ± 2)°C, or placed in a dry heat sterilizer at (180 ± 5)°C for 120 minutes.

 

Endodontic Electric Motor Systems:

Hand pieces:

Wipe with an alcohol gauze. Clean and lubricate handpieces with a cleaner/ lubricant after each use and before autoclaving. This ensures proper operation and a long service life forthe handpiece. Cleaner/ lubricant should not be used after autoclaving and only used before sterilization.

 

Motors:

The entire motor and cord assembly supplied should be surface sterilized by autoclave. Prevacuum sterilize at 132°C (270°F) for 3 minutes after installing the autoclaving plug into the motor and motor connector.

 

Console:

Wiping with a soft cloth moistened with mild detergent or disinfecting solution cleans the exterior of the console.

 

Dental Burs:

Pre-soak carbide burs in soapy water to loosen debris. Ultrasonic systems are used to loosen debris in burs. Burs are separated in a bur block during immersion to prevent damage. Burs can be protected during autoclave by keeping them submerged in a small amount of 2% sodium nitrite solution, 1cm above the burs. Preparation of solution is by adding 20gms of crystal to 1 liter of water in perforated beaker containing burs (8).

 

Sterilization Methods:

Sterilization of instruments is done by three major methods: Dry heat, Steam under pressure (autoclave), and Chemiclave. Lasers have also been used as a method for sterilization. Various modes have been adopted for sterilizing endodontic instruments but out of them steam autoclaving and glass-bead sterilizers are commonly recommended. Boyd stated that moist heat generally kills microorganisms by coagulation of proteins (9). However, coagulation of proteins occurs only when overkill conditions are attained. Before the coagulation occurs, fewer changes such as changes in nucleic acids, inactivation of enzymes, and alteration of cytoplasmic membrane which probably kills the microorganisms are observed. Damaging alterations of proteins by dry heat are the result of desiccation, oxidation and changes in osmotic pressure owing to evaporation of moisture. Dry heat requires temperatures higher than those used in moist heat sterilization and is a slow process. Effective of sterilization by a glass-bead sterilizer is 90% and total sterility cannot be found even after sterilizing for 45 seconds at 240°C (10).

 

CONCLUSION:

Rigid implementation of evidence based infection control measures should be strictly followed in dental practice as it is vital for mutual health safety of patient and health care professionals.

 

REFERENCES:

1.       CH Miller. Infection control and office safety sterilization: Disciplined microbial control. Den Clin North Am. 1991; 35:339–355.

2.       K Rajkumar, L Lakshminarayanan. The Effectiveness of two commonly used methods of Sterilizing Endodontics. J Indian Dent Assoc. 2001; 72:245–248.

3.       Kakehashi S, Stanley HR, Fitzgerald R. Effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol1965; 20:340-9.

4.       Craig A. Hurtt and Louis E. Rossman. The sterilization of endodontic hand files. J Endod. 1996; Vol 22, No 6.

5.       Whitworth CL, Martin MV, Gallagher M, Worthington HV. A comparison of decomtamination methods used for dental burs. Br Dent J 2004; 197(10): 635-40.

6.       Smith A, Dickson M, Aitken J, Bagg J. Contaminated dental instruments. J Hosp Infect 2002; 51(3): 233-5.

7.       JCDA. www.cda-adc.ca/jcda. Feb 2009, Vol. 75, No 1.

8.       Operative dentistry - Short hand book: Concise approach to operative dentistry, Dr. Moiz Khan

9.       RF Boyd, BG Hoeri. Basic Medical Microbiology, 3 rd edition. USA:Little Brown and Company. 1996:120–124.

10.     Raju TBVG, Garapati S, Agrawal R, Reddy S, Razdan A, Kumar SK. Sterilizing Endodontic Files by four different sterilization methods to prevent cross-infection - An In-vitro Study. Journal of International Oral Health : JIOH. 2013; 5(6):108-112.

 

 

 

 

 

 

Received on 29.10.2017         Modified on 24.11.2017

Accepted on 06.12.2017      © RJPT All right reserved