FAQs about sterile instruments

1. Why are endodontic instruments re-used?

In a nutshell... to save costs. Material costs are indeed reduced by re-using endodontic instruments. If, however, the costs for singleuse instruments are compared to the additional costs arising from re-use, such as costs for instrument reprocessing, sterile storage and keeping proper records, the anticipated saving shrinks to a minimum that bears no relation to the possible drawbacks of multiple instrument use.

Current discussions are focussing more and more on the topic of multiple-use. Looking at the mandatory quality management and the extended infection control requirements for dental practices, it can be assumed that this subject will gain even more importance in the near future and that the re-use of endodontic instruments will be questioned even more critically.

The aim of this brochure is to discuss the pros and cons of instrument re-processing and re-use and to help the dentist in making a decision. This brochure is based on German and European statutory and formal requirements for infection control and quality management in a dental practice.

2. Why has the multiple use of endodontic instruments attracted so much attention lately?

Current recommendations by the Robert Koch Institute(RKI) dating from 2001 and 2006 (on “Infection ControlRequirements for Re-processing Medical Devices;Infection Prevention in Dentistry – Infection ControlRequirements1,2”) classify endodontic instruments as critical B. This means that stricter requirements apply to the re-processing of such instruments. Only clean medical devices can be efficiently sterilised, which means that cleaning is a particularly important step in the re-processing cycle of a medical device. Therefore, an efficient cleaning procedure which avoids possible cross-contamination needs to be carried out. Blood, secretion or tissue remnants need to be removed or the subsequent cleaning, disinfection and sterilisation will be impeded.

The minimum requirement is that no residue is visible to the naked eye (without magnification) on any partof the medical device after cleaning / disinfection. This implies a comprehensive inspection of every single instrument before sterilisation. It is difficult enough to safely and comprehensively adhere to these requirements in daily practice, including all consequences which might arise, as well as to document all steps in compliance with legal requirements. To complicate matters further, endodontic instruments come into direct contact with nerve tissue which, in the case of Creutzfeldt-Jakob Disease, can potentially be infectious. Even if it has not yet been possible to detect prions in the pulp tissue of patients with CJD yet, animal experiments have shown the possibility of dental transmission 3.

Moreover, by using the current disinfection and sterilisation procedures, it cannot be 100 % guaranteed that prions are completely destroyed. That is why, for example, the British Spongiform Encephalopathy Advisory Committee (SEAC) has recommended single-use of endodontic instruments as an infection control measure since May 2006.4 In April 2007, the British Department of Health went one step further and issued a clear directive for single use.5

In cases where these recommendations are not followed and an endodontic instrument is re-used on another patient, a stringent re-processing protocol needs to be followed in order to eliminate or minimise the risk of cross-contamination between patients as efficiently as possible.

3. As a basic principle, instruments should be cleaned and desinfected mechanically rather than manually

Manual procedures, even in combination with an ultrasonic bath, should only be used in cases where mechanical methods are not available, as they are considerably less efficient and their results are not as consistent. Irrespective of whether a mechanical or manual procedure is carried out, all instruments need to be pre-cleaned.7

Let’s take a closer look at the (most commonly applied) cleaning and re-processing procedure for endodontic instruments in dental practices. Reprocessing of a contaminated, potentially infectious endodontic instrument should ideally be carried out as shown in the grey box. During manual cleaning, remnants are manually removed by means of small, soft wire brushes. This harbours potential risks such as injuries resulting in an entire chain of compulsory procedures (see needle-stick injuries9).

In the case of NiTi instruments, plastic brushes are recommended to avoid unnecessary roughening of the instrument’s surface.

4. Based on the before mentioned facts, single-use of ready to use, industrially cleaned and pre-sterilised endodontic instruments is recommended.

For the following reasons:

  • Protection of patient, practitioner and practice personnel
  • Supports fulfilment of all legal requirements, guidelines and recommendations
  • Safety in case of potential legal disputes
  • Simplified workflow in the dental practice with regard to quality management measures and infection control requirements

Since the 1980s, VDW has been manufacturing and distributing sterile endodontic instruments in many countries around the world. Today, as an
experienced manufacturer of sterile endodontic instruments, VDW offers almost a complete assortment of industrially cleaned and gamma-sterilised
endodontic stainless steel and nickel-titanium instruments as well as obturation accessories.