Sterilization in Orthodontics


Published on

It is a presentation on four different methods of sterilization of Orthodontic pliers.

Published in: Health & Medicine, Business
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Sterilization in Orthodontics

  1. 1. A very good morning 1
  2. 2. A comparison of four different methods for sterilizing orthodontic pliers - George Kyritis, jco, June 2012 volume issue 6 - 2
  4. 4. INTRODUCTION On a daily basis, the practising dentist and his personal are at risk of being exposed to a wide range of patients with blood borne diseases such as HIV/AIDS, hepatitis B,C and air borne diseases such as tuberculosis. Because of repeated exposure to micro- organisms in blood and saliva, incidence of certain infectious disease has been significantly higher among dental professionals than observed for general population. 4
  5. 5. INTRODUCTION  Orthodontists do not perform oral surgery, but come in contact with blood and oral fluids of healthy patients or infectious patients when doing the orthodontic treatment. Of all the Dental health care personal(DHCP), the rate of infection among orthodontists, is very high, second only to oral surgery specialists, as saliva is as infectious as blood. 5
  6. 6. HISTORY LOUIS PASTEUR (1822-95) was the first scientist to show clearly that bacteria never generate spontaneously and that no growth of any kind occurs in the sterilized media. Dr. Joseph Lister (1827-1912) Discovered the effectiveness of 'carbolic acid,‘ which was used in controlling typhoid. Using carbolic acid, Lister was able to keep his hospital ward in Glasgow free of infection for nine months. 6
  7. 7. carbolic spray, copper, brass with wood handle Carbolic acid spray being used at the time of a surgery 7
  8. 8. Despite the fact that the germ theory of disease had been established in 1877, it was not universally accepted until 1882 when Koch presented his masterly paper on ‘The etiology to tuberculosis’ giving details of the isolation of the tubercle bacillus. 8
  9. 9. DEFINITIONS STERILIZATION It is defined as the process by which an article, surface, or medium is freed of all microorganisms either in vegetative or spore state. (Panikar) Denoting the use of physical or chemical agents to eliminate all viable microbes, including all bacteria, viruses and spores. (Jerry R. Mc Ghee) The process of completely eliminating microbial viability (J.C.O. 1993) 9
  10. 10. DISINFECTION: Disinfection means the destruction of all pathogenic organisms or organisms capable of giving rise to infection. (Panikar) ASEPSIS The absence of infection or infectious materials or agents. (Miller) 10
  11. 11. CATEGORIZATION OF INSTRUMENTS Critical instruments If an instrument will be used to penetrate tissue or to touch bone it must be sterilized. 11
  12. 12. Semi-critical instruments Semi-critical instruments: mirror, probe, and tweezers. If an instrument will touch mucous membranes, but will not be used to penetrate tissue or to touch bone, it should be sterilized if at all possible or,. If the instrument is susceptible to heat damage, it should be subjected to high-level disinfection. 12
  13. 13. Non-critical instruments  These are defined as equipment and surfaces which contact only intact skin, such as mixing slabs and spatulas. Work surfaces are decontaminated by using intermediate- level disinfection 13
  14. 14. DIFFERENT METHODS OF STERILIZATION Dry heat sterilization Flaming Hot air oven Glass bead sterilizer Autoclaving Ethylene oxide sterilization Chemical immersion/cold sterilization Alcohol Laser 14
  15. 15. IN THE PRESENT ARTICLE The author has basically tired to compare four different methods of sterilizing the orthodontic pliers and their efficiency. Wrapped cassettes in M11 ultraclave V- shaped pouches in M11 ultraclave Wrapped cassettes in statim 5000 V shaped pouches in statim 5000 STATI STATIUM M 5000 M 11 ULTRACLAVE 15
  16. 16. Following the CDC guidelines 1.After cleaning , instruments should be bagged in a pouch of appropriate size or placed in a cassette that is subsequently wrapped 2. Hinged instruments, including pliers should be processed in open position. 3. A chemical indicator should be placed inside each pack. 4. The sterilizer should be loaded as instructed by the manufacturer and pouches and cassettes should be separated 5. Sufficient drying time is necessary after sterilization, because wet pouches and wrapping are permeable to microorganisms. 16
  17. 17. Materials and methods 17
  18. 18. Successful decontamination involves four steps:  Pre- sterilization cleaning Packaging Sterilization Adequate storage 18
  19. 19.  50 othodontic pliers were collected and 5 handpieces. -10 weingart pliers - 8 matheiu pliers - 5 ligature cutters - 8 distal end cutters - 4 three prong pliers -5 bird beak pliers pouches for sterilization -5 tweeds pliers -3 braceket removing pliers -2 posterior band removers -5 handpieces 19
  20. 20. IMS double decker cassettes were chosen for the cassette sterilization cycle because of there ability to hold pliers in open position. V shaped pouches especially designed for the hinged instruments were used for the pouched instrument cycle. 20
  21. 21. A fully loaded M11 ultraclave sterilizer could accommodate eight cassettes and five pouched handpieces. A statim sterilizer could hold one cassette and three pouched hand pieces. 21
  22. 22.  In the cycles using V-shaped instrument pouches, the M11 Ultraclave sterilizer held a maximum of 42 pouches and the Statim 50 only 16 pouches.  A Class 5 steam sterilization integrator was placed inside each pouch and in the middle of each cassette to verify the sterilization. 22
  23. 23. Both machines were fully automatic sterilizers equipped with microprocessor controls and LCD panels. The sterilization cycle was set at 132 ͦ-135 ͦ C and 5- 6 minute sterilization time. The test was repeated three times by two different operators and the average time for each step was calculated 23
  24. 24. RESULTS 24
  25. 25.  To evaluate the efficiency of each sterilization method, the average total time processing time per instrument was calculated. 25
  26. 26. By measurment the most efficient method was the M11 ultraclave with V pouches.  The least efficient was statim 5000 with cassettes. These results suggest that smaller sterilizers are less efficient than the large capacity sterilizers when pliers are wrapped and autoclaved in accordance with CDC guidelines. 26
  27. 27. DISCUSSION 27
  28. 28. Advantages……  This study follows the CDC recommendations on wrapping and packing of instruments prior to sterilization. V shaped pouches specifically designed for hinged instruments wee used for the pouch sterilization cycle. Integrated Class 5 chemical indicator was used which allowed the dentist and the staff to verify that the instruments were properly sterilized. 28
  29. 29. Shortcomings..  There has been no comparison between dry heat sterilization. Since these days pliers are manufactured with the medical grade stainless steel with carbide burs. So, corrosion and dulling associated is no longer an issue.  The bagging and wrapping prior to sterilization , can be a challenge for a busy orthodontic office because of large number of pliers used everyday. 29
  30. 30. Shortcomings..  It is important to use a sterilization method that not only ensures patient safety by following CDC guidelines but also allows rapid instrument turnover in the clinic. The amount of time , material and energy wasted in reprocessing unused instruments was not addressed in this study.  Further investigations are needed to allow better appraisal of all currently available sterilization methods and equipments. 30
  31. 31. Supporting articles 31
  32. 32. Effective disinfection of orthodontic pliers. J Orofac Orthop. 2006 Sep;67(5):316-36. Wichelhaus A, Bader F, Sander FG, Krieger D Mertens T. It should be possible to disinfect lipophilic viruses and the usual bacterial infections adequately with all methods, provided that the use of sprays and through disinfection is preceded by cleaning with brush and water, followed by drying. With hydrophilic viruses, however, the spray and trough disinfection methods are limited in their efficacy and cannot be considered adequate. Exclusively chemical methods are therefore less effective than thermal or physical-chemical methods. The ultrasound bath and thermal disinfection can therefore be recommended for the disinfection of orthodontic pliers. 32
  33. 33. Effect of steam versus dry-heat sterilization on the wear of orthodontic ligature-cutting pliers. Am J Orthod Dentofacial Orthop. 2002May;121(5):467-71. There was no significant difference in the mean wear at the tip of the pliers between the 2groups. It appears that there is no need to maintain both sterilization systems, dry heat and steam autoclave, in the orthodontic office. Steam autoclave sterilization can be used with no deleterious effects on the pliers if they are manufactured with stainless steel inserts. 33
  34. 34. Corrosion of orthodontic pliers using different sterilization procedures. J Orofac Orthop. 2004 Nov;65(6):501-11. This study showed that heat sterilization leads to less corrosion than cold disinfection. Corroded pliers can be restored to a useable condition by re- polishing, though it is important that the instructions for their care be strictly adhered to. 34
  35. 35. The effect of routine steam autoclaving on orthodontic pliers. Eur J Orthod. 1993 Aug;15(4):281-90. It is likely that the most important factor, when setting up this type of sterilizing method for orthodontic instruments, is to establish a careful and meticulous routine for cleaning, lubricating, and steam autoclaving pliers. 35
  36. 36. Glass bead sterilization of orthodontic pliers J Dent Assoc Thai. 1990 Jul-Aug;40(4):177-84. The result showed that after the pliers were scrubbed with alcohol and sterilized for 3 minutes with glass bead sterilizer, all vegetative cells and bacterial spores were killed in every test. This study indicated that glass bead sterilizer is capable of sterilizing orthodontic pliers and can be a useful adjunct when rapid chair side sterilization is desired. 36
  37. 37. Microbiological evaluation of elastomeric chains. Giovana R. Casaccia et al, Angle Orthod,Vol 77,No.5,2007 No evidence of any biological contamination due to their manufacturing processes .During clinical use care should be taken to avoid contamination by pathogenic organisms. Precut lengths of the chains would greatly reduce the risk of any biological contamination.
  38. 38. An initial assessment of the effect on orthodontic pliers of various sterilization/disinfection regimes. No statistical evidence was found of routine autoclaving causing more damage to pliers than cold disinfection; in fact, the data suggested the contrary. Chrome plated pliers appeared more resistant to damage and maintained their appearance better than stainless steel pliers. 38
  39. 39. CONCLUSION 39
  40. 40.  The packaging and sterilization methods described in this study comply with all CDC recommendations pertaining to the need to sterilize hinged instruments in open position.  For both sterilizers V- shaped sterilization pouches allowed more pliers than popular cassette system. 40
  41. 41. The study also indicates that sterilizers with smaller chambers are less efficient than large capacity sterilizers in processing wrapped orthodontic instruments. Because of the heightened public awareness of the dangers of cross- contamination and the increased media attention paid to the rise of new infectious agents and the treatment-resistant organisms, orthodontists should expect CDC guidelines to become mandatory. As they already have in California and part of Europe. 41
  42. 42. As the age old saying goes “prevention is better than cure” but precaution is best and must.  so we as orthodontist hold a great responsibility towards the society to not only eradicate diseases but also prevent their spread by following simple sterilization protocols. It might be a little time consuming but then we all know that a “health is wealth” and that a “healthy mind stays in an healthy body” 42
  43. 43. References Text book of microbiology -R.Ananthnarayan & C.K.J.Paniker Glass bead sterilization of orthodontic bands AJODO; Sept 1986 -Gerald.E.Smith An initial assessment of the effect on orthodontic pliers of various sterilization/disinfection regimes.  Microbiological evaluation of elastomeric chains. Giovana R. Casaccia et al, Angle Orthod,Vol 77,No.5,2007 43
  44. 44. Effect of steam versus dry-heat sterilization on the wear of orthodontic ligature-cutting pliers. Am J Orthod Dentofacial Orthop. 2002May;121(5):467-71. Microbiological evaluation of elastomeric chains.Giovana R. Casaccia et al, Angle Orthod,Vol 77,No.5,2007 44
  45. 45. Thank you - Sneh Kalgotra 1st year PG. 45