Dentists routinely come across situations where they need to perform surgical procedures on their patients to treat different dental problems. Therefore, it is the responsibility of all dental professionals to implement strict cross-infection control procedures at their workplaces. One of the best methods to prevent cross-infection is to use disposable instruments. However, this is not always possible and dentists also have to rely on non-disposable instruments. Keeping this in view, the center for disease control (CDC) has developed various guidelines to ensure proper cleaning and sterilization of all types of dental instruments.
Sterilization of dental instruments is performed to kill all the bacteria and other harmful organisms attached to them. However, complete and thorough sterilization requires that all the surfaces of the instruments should be completely clean and free of debris. Here we discuss some of the methods used for the cleaning of dental instruments prior to their sterilization:
Manual Cleaning
Scrubbing dental instruments with hands is the most primitive method of instrument cleaning. However, this procedure is quite dangerous since there are chances of injury and cross-infection during the cleaning process. Therefore, this type of cleaning method is only reserved for those instruments such as a dental hand piece, that is hard to clean with other methods.
Ultrasonic Cleaning
The biggest advantage of ultrasonic cleaning machines is the reduced contact with contaminated instruments and chances of cross-infection. An ultrasonic machine generates heavy turbulence inside the ultrasonic cleaning liquid, which creates billions of continuously imploding bubbles. The vibration generated due to these bubbles results in an effective removal of all debris from the instruments. Another advantage of ultrasonic cleaning machines is that they can clean both loose instruments as well as those secured in sterilization cassettes.
Instrument Washers
Instrument washers are also available for cleaning dental instruments. After the instruments have been placed inside the washer, they are first exposed to a spray of a mixture of a water-detergent solution. Afterwards, they are thoroughly cleaned by using a pressurized stream of a cleaning liquid. An advantage of using instrument washers is their capacity to clean a lot of instruments at a time.
Preparing Dental Instruments for Sterilization
After putting the instruments through a cleaning cycle, they are thoroughly rinsed and then dried completely. This process can be accelerated by shaking the instruments, while taking care not to damage their working ends. At this stage, instruments are also examined for defects, and damaged instruments are either discarded or sent for repairs. Some hinged instruments also require lubrication before they are sterilized.
Packaging of Instruments
Packaging of instruments, such as sterilization pouches or sterilization cassettes (see further below), serves two purposes; one is to prevent them from re-contamination after they have been sterilized. Secondly, packaging can also be used to organize instruments. For example, instruments that are frequently used during routine examination are packed and sterilized together.
Sterilization Techniques for Dental Instruments
Autoclaving using Pressurized Steam
This method uses an autoclave chamber that is filled with pressurized steam for an appropriate duration. Complete sterilization of the instruments is only possible when the air inside the autoclave is completely evacuated, which can be undertaken by two methods. Either the steam displaces the air already present inside the chamber (gravity displacement), or the air is evacuated through vacuum and then the steam is introduced.
After the sterilization cycle has been completed, the packages containing the sterilized instruments are allowed to dry completely before they are taken out of the autoclave. The instruments are now ready for use.
Caring for the Instruments During Cleaning and Sterilization
Regardless of the method used for the sterilization of dental instruments, problems regarding their organization and protection are frequently encountered at dental practices. Most dental instruments have very sharp working ends, which can cause serious harm to dental professionals in case a contaminated instrument injures a member of the dental team during cleaning and sterilization. So, what is the best method to ensure safety of the dental team and time-efficient organization of the dental instruments? Most dental practices have now started using sterilization cassettes for washing and sterilization of instruments that are to be used for a specific dental procedure.
Dental Sterilization Cassettes; A Promising Concept!
Sterilization cassettes are simply metallic boxes that contain customized slots for the placement of various dental instruments. These slots are prepared while keeping in view the size, length, thickness, and type of working ends of different dental instruments. Initially, sterilization cassettes were initially used by hospitals for the sterilization of surgical instruments used in medical procedures. However, recent years have marked a significant increase in the use of these cassettes for dental purposes as well.
Perhaps the biggest advantage of using sterilization cassettes is the excellent organization of instruments before, during and after sterilization. In fact, after the instruments required for a specific procedure have been sterilized, they can be kept inside the same cassette and used when the procedure is performed. In this way, your assistant will not have to look for instruments when you are performing surgery, thereby improving the efficiency and productivity of your dental team.
Dentalytec offers various types of sterilization cassettes that can be customized for different types of dental procedures like, restorative, surgical, periodontal and surgical. You can use the following cassettes for organizing your instruments for a specific dental procedure:
1. Scaling and Root Planning
For sterilization, packaging and organization of instruments used for scaling and root planning, Dentalytec recommends using the Slim M Cassette. Not only is this cassette specifically designed for such a procedure, but it is also very compact and takes up very less space. Therefore, it will not take much space when it is used for storage of instruments following sterilization. You can sterilize the following instruments with the Slim M cassette:
- Sickle
- Jacquette
- Hoes
- Mirror
- Probe
- Scaler tips
The Slim M cassette can be used to sterilize up to ten instruments at a time.
2. Instruments Used for Minor Surgical Procedures
With the Vision+ M cassette offered by Dentalytec, you can prepare your own customized minor oral surgical instrument kit which can consist of the following:
- Blade holder
- Periodontal elevator
- Surgical forceps
- Needle holder
- Retractor
- Dental Mirror
- Periodontal probe
The Vision+ Medium sized cassette has been specifically designed to protect the dental staff, as well as the working ends of the surgical instruments. You can sterilize up to 10 instruments using the Vision+ M cassette.
3. Instrument Kit for Main Surgical Procedures
We recommend the Classic L sterilization cassette for instruments used in implantology and other main surgical procedures. The Classic L is the largest cassette offered by Dentalytec, and it can hold up to 20 large surgical instruments. The cassette has an open lid design, which helps in arranging surgical instruments for a procedure. The following instruments can be used with the Classic L cassette:
- Blade holder
- Periodontal elevator
- Forceps
- Extraction forceps
- Needle holder
- Retractors
- Dental mirror
- Periodontal probe
4. Instruments Used for Restorative Dental Procedures
The Clip Cassette M contains a clip which allows for conveniently opening or closing of the cassette, as well as securing the instruments during cleaning and sterilization. The cassette has been designed for the placement of non-sharp instruments that do not need to be placed in a closed cassette system. The Clip Cassette M can be used to sterilize the following restorative dentistry instruments:
- Pluggers
- Plastic instrument
- Burnisher
- Excavator
- Tweezers
- Carvers
- Mirrors
- Periodontal probe
5. Suturing Kit
The ideal sterilization cassette for instruments used in suturing is the Vision+ M. Slots within this cassette are specifically designed to securely accommodate sharp surgical instruments. The Vision+ M can be used to sterilize up to 10 instruments at a time. Some of the instruments which can be used with the Vision + M, are:
- Tweezers
- Needle holders
- Scissors
6. Instruments Used for Root Canal Treatment
Plugin 6H40 – Mostly small and sharp instruments are used during root canal procedures. Keeping this in view, Dentalytec recommends the use of Plugin 6H40 for sterilization and organization of endodontic files and burs. The Plugin 6H40 can be used for sterilization of all types and sizes of endodontic files Plugin 6H30 – this plugin system can be ideally used for sterilization of up to 6 burs of the 4, 8, 12, 16, 30 heights. The Plugin 6H30 can perfectly fit burs used during endodontic procedures. Plugin 6H60 – like the other plugin systems offered by Dentalytec, this plugin can be used for sterilization of different types of burs that are used in surgical procedure. The height of this plugin is 60mm, which can be used to accommodate longer surgical burs.
Although I have provided you with a list of sterilization cassettes which are recommended for a specific dental procedure, it is no way definite. Rather, you can use any cassette which you and your team feel comfortable with. I believe that by using the sterilization cassettes, not only will you reduce chances of cross-infection, but you will also feel a visible improvement in your practice’s efficiency and productivity.