Sterile Endo Instruments - Vdw-dental.com

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PreambleShould Endodontic Instruments beRe-Used or Not?Why are endodontic instruments re-used?In a nutshell... to save costs.Material costs are indeed reduced by re-using endodonticinstruments. If, however, the costs for singleuseinstruments are compared to the additional costsarising from re-use, such as costs for instrument reprocessing,sterile storage and keeping proper records,the anticipated saving shrinks to a minimum that bearsno relation to the possible drawbacks of multiple instrumentuse.Current discussions are focussing more and more onthe topic of multiple-use. Looking at the mandatoryquality management and the extended infectioncontrol requirements for dental practices, it can beassumed that this subject will gain even more importancein the near future and that the re-use ofendodontic instruments will be questioned evenmore critically.The aim of this brochure is to discuss the pros andcons of instrument re-processing and re-use and tohelp the dentist in making a decision. This brochureis based on German and European statutory andformal requirements for infection control and qualitymanagement in a dental practice.InformationShould Endodontic Instruments be Re-Used or Not? 2Infection Control and Quality Management in the Dental Practice 3Pre-Cleaning, Disinfection, Cleaning andSterilisation of Endodontic Instruments 4The Alternative: Single-Use of Industrially Cleanedand Pre-Sterilised Endodontic Instruments 5Advantages and Benefits of Industrially Cleaned and Gamma-SterilisedEndodontic Instruments by VDW 6Product Overview 7Information on Studies/Papers, Sources of Information, Bibliography 14-15
Infection Control and Quality Managementin the Dental PracticeSterile3Why has the multiple-use of endodontic instrumentsattracted 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 ControlRequirements 1,2 ”) classify endodontic instruments ascritical B. This means that stricter requirements applyto the re-processing of such instruments. Only cleanmedical devices can be efficiently sterilised, whichmeans that cleaning is a particularly important step inthe re-processing cycle of a medical device. Therefore,an efficient cleaning procedure which avoids possiblecross-contamination needs to be carried out. Blood,secretion or tissue remnants need to be removed orthe subsequent cleaning, disinfection and sterilisationwill be impeded.The minimum requirement is that no residue is visibleto the naked eye (without magnification) on any partof the medical device after cleaning/disinfection. Thisimplies a comprehensive inspection of every singleinstrument before sterilisation.It is difficult enough to safely and comprehensivelyadhere to these requirements in daily practice, includingall consequences which might arise, as well asto document all steps in compliance with legal requirements.To complicate matters further, endodonticinstruments come into direct contact with nervetissue which, in the case of Creutzfeldt-JakobDisease, can potentially be infectious. Even if it has notyet been possible to detect prions in the pulp tissue ofpatients with CJD yet, animal experiments have shownthe possibility of dental transmission 3 .Moreover, by using the current disinfection and sterilisationprocedures, it cannot be 100 % guaranteed thatprions are completely destroyed.That is why, for example, the British SpongiformEncephalopathy Advisory Committee (SEAC) hasrecommended single-use of endodontic instrumentsas an infection control measure since May 2006. 4In April 2007, the British Department of Health wentone step further and issued a clear directive forsingle use. 5In cases where these recommendations are notfollowed and an endodontic instrument is re-usedon another patient, a stringent re-processing protocolneeds to be followed in order to eliminate or minimisethe risk of cross-contamination betweenpatients as efficiently as possible.
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