|Year : 2022 | Volume
| Issue : 2 | Page : 83-90
An update on sterilization and disinfection of endodontic instruments
Vaishnavi Satish Borse, Varsha Sanjay Pandit, Ashwini A Gaikwad, Aishwarya N Handa, Abhijit B Jadhav, Ruchira K Bhamare
Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India
|Date of Submission||14-Aug-2022|
|Date of Decision||25-Oct-2022|
|Date of Acceptance||01-Nov-2022|
|Date of Web Publication||29-Dec-2022|
Dr. Vaishnavi Satish Borse
122 Navasahiyadri Hsg Soc, Karwe Nagar, Pune - 411 052, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Infection control is a term used to describe the precautions, policies, and procedures undertaken in a healthcare setting in order to minimize the risk of spreading an infection. It helps prevent the transmission of disease-producing agents such as bacteria, viruses, and fungi from one patient to another, from the dental practitioner and dental staff to patients, and from patients to dental practitioner or other dental staff. Among the many aspects of infection control, sterilization and disinfection of instruments and associated appliances play a crucial role for any infection control regimen to be successful in a health-care setting. Sterilization and disinfection of instruments can be described in general as decontamination procedures for treating instruments, enabling their safe usage. Failure to adhere to recommended sterilization guidelines and protocols can lead to serious cross-infection causing a disease which could be far more incapacitating than what the patient was originally suffering from. It also increases the chances of persistence of the infection. In either case, treatment outcomes are drastically reduced, rendering the entire treatment unfruitful. Sterilization and disinfection of instruments are of particular significance in the field of endodontics due to the intrinsic nature of the various procedures involved as part of the field and the type of instruments that are used. Routine decontamination procedures are usually not effective due to the complex, intricate, and minute design of various endodontic instruments. In addition, it is very important to take into account the effect of various sterilization protocols on the material of the instrument. This review article aims to describe the various sterilization and disinfection procedures for endodontic instruments in a concise manner, taking into consideration the potential effects that the sterilization/disinfection procedure might have on the instrument to be sterilized. Hopefully, it will make it easier for clinicians to choose the most suited/appropriate sterilization and disinfection procedure for any given endodontic instrument.
Keywords: Disinfection, endodontic, instrument, sterilization
|How to cite this article:|
Borse VS, Pandit VS, Gaikwad AA, Handa AN, Jadhav AB, Bhamare RK. An update on sterilization and disinfection of endodontic instruments. J Int Clin Dent Res Organ 2022;14:83-90
|How to cite this URL:|
Borse VS, Pandit VS, Gaikwad AA, Handa AN, Jadhav AB, Bhamare RK. An update on sterilization and disinfection of endodontic instruments. J Int Clin Dent Res Organ [serial online] 2022 [cited 2023 Mar 23];14:83-90. Available from: https://www.jicdro.org/text.asp?2022/14/2/83/365840
| Introduction|| |
Disinfection and sterilization are both decontamination processes crucial for any health-care facility and form one of the most important aspects of infection control.
Failure to adequately sterilize and disinfect dental operative instruments can lead to extensive cross-infection and at times can prove to be extremely fatal to the mankind.,
Sterilization is of great significance especially in the field of endodontics due to the complexity of design that various instruments possess and the intrinsic nature of the endodontic procedures.,
Hence, it is very important for every endodontist to have a thorough knowledge of the concepts of sterilization and disinfection. This would not only minimize the chances of cross-infection but will also drastically improve the outcome of any endodontic treatment.
| Sterilization and Disinfection are decontamination processes which can be explained as following:|| |
A process of complete elimination or destruction of all forms of microbial life including both vegetative and spore forms. Technically, there is a reduction of ≥106 log colony-forming units (CFU) of the most resistant spores achieved at the half-time of a regular cycle.
- Chemical sterilization: Chemicals are used for a longer duration (3–12 h) to destroy all forms of microbes, e.g., peracetic acid (0.2%), glutaraldehyde (≥2.4%), and hydrogen peroxide (7.5%)
- Physical sterilization: Physical procedures autoclaving, chemiclaving, and dry heat sterilization.
Involves complete elimination of vegetative forms of microorganisms except the bacterial spores from inanimate objects. Technically, there is a reduction of ≥103 log CFU of microorganisms by this method without spores. It can be further classified as:
Used for shorter duration and able to kill 106 log microorganisms except spores, e.g., glutaraldehyde (≥2.0%), hydrogen peroxide (7.5%), and hypochlorite (650–675 ppm).
Intermediate level disinfectant
Mainly used for noncritical items contaminated with blood/body fluids. e.g., alcohols, chlorine based agents etc.
Used to remove the vegetative form of bacteria, few fungi, and some enveloped viruses from the noncritical items, e.g., 3% hydrogen peroxide, quaternary ammonium compound, diluted glutaraldehyde, and phenols.
Decontamination and cleaning
Decontamination is the process of removal of pathogenic microorganisms from objects, so that they are safe to handle. Cleaning is defined as removal of visible soil (e.g., organic and inorganic materials) from the surfaces and objects. Technically, it achieves minimum reduction of ≥1 log CFU of microorganisms.
Patient-care items (dental instruments and equipment) can be categorized depending on the potential risk for infection associated with their intended use as proposed in Spaulding's Classification of Surfaces:,
They are used to penetrate soft tissue or bone. They have the greatest risk of transmitting infection. Hence, they should always be sterilized using heat or disposable instruments should be chosen, e.g., pressure heating (autoclaving), dry heat, or heat/chemical vapor. These include endodontic files and probes, matrix bands, forceps, scalpels, bone chisels, and surgical burs.
These come in contact with mucous membranes or skin which may or may not be intact. Hence have a lower risk of transmission. If a semicritical item is heat-sensitive, it should be replaced with a heat-tolerant or disposable alternative. High-level disinfection should be chosen as the last alternative.
These include mouth mirrors, condensers, ultrasonic tip, impression tray, radiographic sensor etc.
They come in contact only with intact skin and hence pose the least risk of cross-infection. In the majority of cases, cleaning followed by disinfection with an Food and Drug Administration-registered hospital disinfectant is adequate. Protecting these surfaces with disposable barriers is advised. e.g.-Apex locator, curing lamps, radiograph head etc.
We must remember that it is important to remove the visible debris (saliva/blood/hard or soft tissue) adhering to the object by manual scrubbing before appropriate disinfection, as debris can shield the microbes and render any further disinfection/sterilization procedures ineffective [Figure 1].,
|Figure 1: gives a general outline for the different steps involved in sterilization and disinfection of any object|
Click here to view
Preferred method of sterilization/disinfection
Although most burs can be reused, it is advisable to use them as single use objects whenever possible as it can get difficult for steam to penetrate into the irregularities present in the bur and at the same time the chances for corrosion increase. As corrosion occurs, it helps in harboring microbes.
The following are some of the commonly used burs in endodontics:
Stainless steel burs
They become easily blunt and corrode after multiple uses and hence must be discarded into the sharps waste sooner. This is commonly seen after the third or fourth cycle of use, particularly when a corrosion inhibitor is not used during reprocessing. They are also more difficult to clean as compared to other types of burs. Hence, it is recommended to use lower cost stainless steel burs as single-use items.
They are designed for reprocessing. However, the resin carrier for the diamond does degrade with multiple sterilization cycles. Some brands employ chrome cobalt alloy as a matrix for the diamond particles, which is long lasting.
Are commonly used for dentoalveolar surgery and are designed for reprocessing. They are made of materials such as tungsten carbide that minimally degrades under steam sterilization. Likewise, silicon nitride burs are also designed for reprocessing.
The following sterilization/disinfection methods were compared for their efficacy in different articles-manual scrubbing, hot air oven, glass bead sterilization, ultrasonic cleaner, autoclave, chemiclave and various chemical disinfectants.,,
From almost all the articles, it is evident that steam sterilization (autoclaving) continues to be more efficacious than other methods evaluated, followed closely by dry heat sterilization. The reason for this mainly is that moist heat has better penetrative potential as compared to dry heat. However, steam sterilization did not lead to complete sterility of the burs in any of the articles. From most of the articles it was concluded that steam sterilization (autoclaving) was successful in reducing bacterial threshold only by 75% to 85%. This strongly indicates that whenever possible, burs should be disposed after a single use.,,
It is important to note that presoaking of burs in soapy water/disinfectant is crucial to loosen the debris that is adhering on the burs. Ultrasonic systems can also be used for enhanced debridement.
A study evaluated the following sterilization methods on the cutting efficacy and durability of burs-dry heat, autoclave, microwave irradiation, and glutaraldehyde. From this study, it was evident that dry heat sterilization had the least deteriorating effect on the burs. Autoclaving and chemical sterilization had corrosive effects on the bur.
An alternative to keep the burs protected from deteriorating during autoclaving is to submerge them in 2% sodium nitrite solution.,
Hand operated endodontic files
Most hand files are typically labeled as single-use items. Sterilizing them is both ineffective and unsafe as it can result into sharps injury. Protocols with proven effectiveness for cleaning rotary nickel titanium files have limited effectiveness in removing bioburden from hand files made from either stainless steel or nickel titanium alloy. Besides this the complex structure of endodontic files with their microscopic crevices left behind by the manufacturing process retains more debris to which prions adhere becoming impervious to most of the decontamination and sterilization methods. Prions are highly heat resistant and have been known to cause a variety of neurodegenerative disorders. The WHO guidelines suggest the following procedures for inactivating prions: Immersion in sodium hypochlorite (20,000 ppm of available chlorine) for 1 h and heating with 1 M sodium hydroxide for 1 h, or autoclaving under vacuum at 121°C for 30–90 min in the presence of sodium hydroxide. These procedures are inappropriate to be used on endodontic files as they can cause corrosion and deterioration of mechanical properties of the instruments. Besides this, the timing is not suitable for outpatient activity. Hence, it is recommended that whenever possible, hand files should not be reused.,,,
The Department of Health of the United Kingdom recommended in 2007 that either endodontic files be considered as disposable instruments or that the most effective sterilization method available be employed.
Although first preference continues to be to use hand files as single use items, various studies compared different sterilization and disinfection protocols to sterilize hand files. Through these, it can be concluded that appropriate disinfection followed by autoclaving continues to be the most efficacious method compared to the rest of the methods (hot air oven, glass bead sterilization, ultrasonic cleaner, autoclave, chemiclave and various chemical disinfectants) tested.,,,
From studies, it is also evident that although glass bead/salt sterilizers have been intended for this purpose and require less time, they do not effectively sterilize files as they are based on dry heat sterilization which has poor penetration potential. Furthermore, the handle portion of files continues to be unsterilized.,,,
Further using an endodontic box instead of plastic packaging for autoclaving gave marginally better results.
A study indicates that enzymatic disinfection (immersing the files in an enzymatic disinfecting solution) in an ultrasonic bath before autoclaving was highly efficacious. Enzymatic solutions contain various proteinases and collagenases which help break down pulpal tissue adherent to files.
Furthermore, mechanical debridement (scrubbing) with appropriate brush and soap water prior to immersing in a disinfecting solution and subsequent autoclaving is crucial to eliminate the bulk of the pulpal remnants.,,,
Rotary NiTi files
When using rotary files, it is not economical to discard the files after a single use. Besides this, sterilizing Niti files is more efficacious than sterilizing stainless steel files due to the difference in their surface characteristics.,
However, physical and mechanical properties of Niti instruments recover only partially following autoclaving. Hence, it is recommended that they should not be used for more than five cycles.
When NiTi endodontic rotary files are reprocessed, the presterilizing cleaning process must be validated as being effective. A verifiable process has been described below:
- Immediately after use remove stoppers and insert the files into a scouring sponge soaked with chlorhexidine gluconate aqueous solution
- Clean the files by using 10 vigorous in-and-out strokes in the sponge
- Place the files in a wire mesh basket and immerse in a suitable enzymatic cleaning solution for 30 min
- Follow this by 15 min ultrasonification in the enzymatic cleaning solution;
- Drain and rinse in running water for 20s
- Proceed to steam sterilization.
Adverse effects of sterilization/disinfection on Niti files can be summarized as follows:
- Disinfecting agents such as sodium hypochlorite and autoclaving are known to increase surface roughness of the metal and initiate micropitting type of corrosion.,
- A reduction in the cutting efficacy of NiTi files occurs in alloys which are not treated during the hot making process (twisted file with the M-wire alloy) has been noticed. The researchers have predicted that the corrosive effect after autoclaving produced a reduction in the cutting capacity of 20% of the instruments tested after seven autoclave cycles. Data from another study reported that there is a 1%–12% reduction in the cutting capacity after 5–10 autoclave cycles.,
- Partial recovery of cyclic fatigue suffered by NiTi instruments (majority but not all studies) in an autoclave – recently, manufacturers of endodontic instruments have made nickel-titanium alloys which through a thermomechanical production process, produce a superelastic NiTi alloy that is capable of maintaining a stable martensitic phase during clinical use. These instruments have the ability to undergo an additional thermal treatment during the sterilization phase which increases their flexibility.,,,
- Varying results have been obtained while studying the influence of autoclaving on torsional stress (resistance) with some suggesting an improvement with autoclaving while others suggesting that it may have no effect or is detrimental.,,,
Hence, taking into consideration the abovementioned effects, we can clearly see that although rotary endodontic instruments are reusable, their reuse should be limited to only a few cycles of autoclave. This will help in maintaining adequate clinical efficacy and prevent chances of instrument separation.
Although the sterilization protocol may differ based on the manufacturing company, most of the ultrasonic tips are autoclavable.
The post can be wiped with alcohol and then allowed to air dry before use.
However there seems to be a lack of evidence about the effect of contaminated dental post on success of endodontic treatment. Furthermore, as such there is no verifiable process for the disinfection and sterilization of all types of dental posts.
Gutta-percha cones and resin points (root filling materials)
The synthesis of the cones occurs under aseptic conditions, but from various studies it has been noticed that they get colonized by bacteria subsequently. Although gutta-percha cones contain a certain amount of zinc which can partly inhibit the growth of microorganisms, the proliferative action of bacteria occurs anyways.,
Hence, from these studies, it is evident that they require disinfection prior to use even if they are aseptically removed from a new packet.
Sterilization by heat would alter the cones, so autoclaving is not suggested. Following are some of the methods that have been tested and compared:
- Sodium hypochlorite in concentrations of 0.5%–5%
- Chlorhexidine, 2%
- Hydrogen peroxide, 3%
- Rosmarinus officinalis extract
- Quaternary ammonium
Among all the above methods, sodium hypochlorite immersion with concentrations ranging from 2% to 5.25% for a minimum time of 5–10 min, continues to be the most commonly followed method. This can be attributed to the fact that sodium hypochlorite is extremely efficacious, easily available in the dental office, inexpensive and has a quick action. Alternatively, chlorhexidine can be used in a concentration equal to 2% for a shorter period (1–2 min).,,,
Other agents which demonstrated disinfecting capacity similar to sodium hypochlorite and chlorhexidine were hydrogen peroxide, glutaraldehyde and quaternary ammonium compounds. However, it was observed that all these disinfectants required prolonged immersion time of at least 10 min to achieve comparable results.,,,
Rosmarinus officinalis extract derived from the plant rosemary with its bactericidal and a fungicidal properties has also showed great promise. It contains carnosic acid and carnosol, which may disturb the bacterial cell membrane.
The physical alterations caused on the cones of gutta-percha and resin by the various disinfectants can be summarized as follows: ,,
- Alterations of the surface due to the action of hypochlorite, MTAD and chlorhexidine
- The formation of cuboidal crystals on the surface due to precipitation of hypochlorite
- A reduction of tensile strength following prolonged exposure to sodium hypochlorite.
Hence to minimize the above mentioned effects, it is recommended that prolonged immersion times should avoided and the disinfectants should be completely rinsed off. Rinsing with distilled water has been strongly recommended after disinfection procedures.
Absorbent paper points
Studies indicate that absorbent paper points just like gutta-percha cones can be contaminated with bacteria. This indicates that it is important for us to sterilize them prior to use.,
A study also indicates that absorbent paper points maintain their sterility only for a maximum duration of 1 week and hence require resterilization after that.
Both dry and wet heat can be used for sterilization of paper points without significantly affecting their absorption capacity.
All dental hand pieces must be cleaned and lubricated in accordance with the manufacturer's instructions and must be sterilized after each patient. Debate continues about the most effective decontamination method for hand piece. Some of the methods compared in past are dry heat, moist heat and ethylene oxide gas. Among these, according to most of the studies, moist heat and ethylene oxide gas have shown the best results. This can be attributed to their excellent penetration capacity into the intricate parts of the dental hand piece. However, ethylene oxide gas is preferred over moist heat as it does not cause corrosion.,
The following steps have been recommended for sterilizing hand piece: 
- Clean the outside of the handpiece with detergent and water–never clean or immerse the handpiece in disinfectant solutions or the ultrasonic cleaner
- Lubricate the handpiece with pressurized oil for the recommended period
- Clean off excess oil
- Sterilize in a steam sterilizer or by using other suitable sterilization method
- Run the handpiece briefly before use to clear excess lubricant that might be there.
Curing light tips are regarded as semicritical pieces of equipment. The curing tips should be either heat sterilized or have an appropriate barrier placed over the tip for each patient. However, it is not possible to heat sterilize all curing tips and hence high level disinfectants can be used, provided a barrier was placed.
It is recommended to use heat-tolerant or disposable intraoral radiograph devices (unless digital radiography is utilized) wherever possible and semicritical items (e.g. film-holding and positioning devices) must be either heat sterilized or barrier protected before use on subsequent patients. Use of protective barriers should always be done where possible on the developing equipment and when surfaces become contaminated, they must be cleaned using an appropriate disinfectant.
Specialized intraoral equipment and devices
Commonly used ones endodontics include air abrasion unit, intraoral cameras, lasers, apex locators, endomotors, occlusal analyzers, and electrosurgery units. Some of them come in direct contact with the oral mucosa and hence are considered as semicritical items. Most of them are heat sensitive. Hence, high level disinfection in conjunction with disposable barriers should be carried out. It is advisable to first read the manufacturer's instructions pertaining to their disinfection as some may not be tolerant to high level disinfectants, e.g.-lenses of intraoral cameras.
These are items which need to be discarded after they have been used once a patient. Whenever possible, they should be used as they reduce the chances of cross-contamination. These include disposable triple-syringe tips, plastic evacuator tips, prophylaxis cups, microbrushes, plastic dappen dishes, disposable impression trays, local anesthetic needles, cartridges, sutures, and scalpel blades. For common simple triple-syringe designs, disposable ones are preferred due to difficulty of cleaning and challenges in removal of air for steam penetration during autoclaving.
Very small or sharp instruments with minute complex designs are difficult to clean and should be considered single use. This is very relevant to matrix bands, wedges, reamers, and broaches. There is currently no validated cleaning method for such items.
To conclude, the method chosen for sterilization and disinfection largely depends on the object that is undergoing the procedure. At same time, it is also important to take into consideration, the implications that the chosen method is going to have on the object which would be undergoing the sterilization/disinfection procedure.
Financial support and sponsorship
Self-supported (Contributor 1).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Redd JT, Baumbach J, Kohn W, Nainan O, Khristova M, Williams I. Patient-to-patient transmission of hepatitis B virus associated with oral surgery. J Infect Dis 2007;195:1311-4.
Radcliffe RA, Bixler D, Moorman A, Hogan VA, Greenfield VS, Gaviria DM, et al
. Hepatitis B virus transmissions associated with a portable dental clinic, West Virginia, 2009. J Am Dent Assoc 2013;144:1110-8.
Morrison A, Conrod S. Dental burs and endodontic files: Are routine sterilization procedures effective? J Can Dent Assoc 2009;75:39.
Parashos P, Linsuwanont P, Messer HH. A cleaning protocol for rotary nickel-titanium endodontic instruments. Aust Dent J 2004;49:20-7.
Mohapatra S. Sterilization and disinfection. Essent Neuroanesth 2017:929-44.
Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2016.
Garg N, Garg A. Textbook of Endodontics. 2nd
ed. New Delhi, India: Jaypee Brothers Medical Publishers; 2010. p. 108.
Rick Olive AM. ADA's Guidelines for Infection Control. 3rd
ed.St Leonards, Australia: Australian Dental Association; 2015. p. 15.
Sajjanshetty S, Hugar D, Hugar S, Ranjan S, Kadani M. Decontamination methods used for dental burs – A comparative study. J Clin Diagn Res 2014;8:ZC39-41.
Mathivanan A, Saisadan D, Manimaran P, Kumar CD, Sasikala K, Kattack A. Evaluation of efficiency of different decontamination methods of dental burs: An in vivo
study. J Pharm Bioallied Sci 2017;9:S37-40.
Al-Jandan BA, Ahmed MG, Al-Khalifa KS, Farooq I. Should surgical burs be used as single-use devices to avoid cross infection? A case-control study. Med Princ Pract 2016;25:159-62.
Fais LM, Pinelli LA, Adabo GL, Silva RH, Marcelo CC, Guaglianoni DG. Influence of microwave sterilization on the cutting capacity of carbide burs. J Appl Oral Sci 2009;17:584-9.
Bertolotti RL, Hurst V. Inhibition of corrosion during autoclave sterilization of carbon steel dental instruments. J Am Dent Assoc 1978;97:628-32.
Sowjanyaa J, Chandana CS. Clinical practice guidelines on sterilization of endodontic instruments. Res J Pharm Tech 2018;11:1039-40.
Ferreira MM, Michelotto AL, Alexandre AR, Morganho R, Carrilho EV. Endodontic files: Sterilize or discard? Dent Press Endod 2012;2:46-51.
Van Eldik DA, Zilm PS, Rogers AH, Marin PD. A SEM evaluation of debris removal from endodontic files after cleaning and steam sterilization procedures. Aust Dent J 2004;49:128-35.
Walker JT, Dickinson J, Sutton JM, Raven ND, Marsh PD. Cleanability of dental instruments – Implications of residual protein and risks from Creutzfeldt-Jakob disease. Br Dent J 2007;203:395-401.
Bourgeois D, Dussart C, Saliasi I, Laforest L, Tramini P, Carrouel F. Observance of sterilization protocol guideline procedures of critical instruments for preventing iatrogenic transmission of Creutzfeldt-Jakob disease in dental practice in France, 2017. Int J Environ Res Public Health 2018;15:853.
Cockcroft B. Advice for Dentists on the Re-Use of Endodontic Instruments and Variant Creutzfeldt-Jakob Disease (vCJD). Gateway Approval Reference Number 8100. London: Department of Health; 2007.
Yenni M, Bandi S, Avula SS, Margana PG, Kakarla P, Amrutavalli A. Comparative evaluation of four different sterilization methods on contaminated endodontic files. CHRISMED J Health Res 2017;4:194-7. [Full text]
Hooks TW, Adrian JC, Gross A, Bernier WE. Use of the carbon dioxide laser in sterilization of endodontic reamers. Oral Surg Oral Med Oral Pathol 1980;49:263-5.
Zadik Y, Peretz A. The effectiveness of glass bead sterilizer in the dental practice. Refuat Hapeh Vehashinayim (1993). 2008;25:36-9,75.
Venkatasubramanian R, Jayanthi, Das UM, Bhatnagar S. Comparison of the effectiveness of sterilizing endodontic files by 4 different methods: An in vitro study. J Indian Soc Pedod Prev Dent 2010;28:2-5.
] [Full text]
Al-Jamell D. The effectiveness of three different methods for sterilization of the endodontic files (an in vitro
study). Adv Life Sci Technol 2014;27:1-6.
Wu CD, Sung PH, Fang TH. Study of deformation and shape recovery of NiTi nanowires under torsion. J Mol Model 2013;19:1883-90.
Olive R. ADA's Guidelines for Infection Control. 3rd
ed. St Leonards, Australia: Australian Dental Association; 2015. p. 11-2.
Nair AS, Tilakchand M, Naik BD. The effect of multiple autoclave cycles on the surface of rotary nickel-titanium endodontic files: An in vitro
atomic force microscopy investigation. J Conserv Dent 2015;18:218-22.
] [Full text]
Haïkel Y, Serfaty R, Bleicher P, Lwin TT, Allemann C. Effects of cleaning, disinfection, and sterilization procedures on the cutting efficiency of endodontic files. J Endod 1996;22:657-61.
Rapisarda E, Bonaccorso A, Tripi TR, Condorelli GG. Effect of sterilization on the cutting efficiency of rotary nickel-titanium endodontic files. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:343-7.
Plotino G, Costanzo A, Grande NM, Petrovic R, Testarelli L, Gambarini G. Experimental evaluation on the influence of autoclave sterilization on the cyclic fatigue of new nickel-titanium rotary instruments. J Endod 2012;38:222-5.
Zinelis S, Darabara M, Takase T, Ogane K, Papadimitriou GD. The effect of thermal treatment on the resistance of nickel-titanium rotary files in cyclic fatigue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:843-7.
Alfoqom Alazemi M, Bryant ST, Dummer PM. Deformation of HyFlex CM instruments and their shape recovery following heat sterilization. Int Endod J 2015;48:593-601.
Viana AC, Gonzalez BM, Buono VT, Bahia MG. Influence of sterilization on mechanical properties and fatigue resistance of nickel-titanium rotary endodontic instruments. Int Endod J 2006;39:709-15.
Casper RB, Roberts HW, Roberts MD, Himel VT, Bergeron BE. Comparison of autoclaving effects on torsional deformation and fracture resistance of three innovative endodontic file systems. J Endod 2011;37:1572-5.
Hilt BR, Cunningham CJ, Shen C, Richards N. Torsional properties of stainless-steel and nickel-titanium files after multiple autoclave sterilizations. J Endod 2000;26:76-80.
Mize SB, Clement DJ, Pruett JP, Carnes DL Jr. Effect of sterilization on cyclic fatigue of rotary nickel-titanium endodontic instruments. J Endod 1998;24:843-7.
Canalda-Sahli C, Brau-Aguadé E, Sentís-Vilalta J. The effect of sterilization on bending and torsional properties of K-files manufactured with different metallic alloys. Int Endod J 1998;31:48-52.
Alamri H, Mustafa M. Contaminated dental posts and methods of disinfection: A systematic review. Int J Med Res Health Sci 2019;8:135-8.
Pang NS, Jung IY, Bae KS, Baek SH, Lee WC, Kum KY. Effects of short-term chemical disinfection of gutta-percha cones: Identification of affected microbes and alterations in surface texture and physical properties. J Endod 2007;33:594-8.
Dioguardi M, Sovereto D, Illuzzi G, Laneve E, Raddato B, Arena C, et al
. Management of instrument sterilization workflow in endodontics: A systematic review and meta-analysis. Int J Dent 2020;2020:5824369.
Dioguardi M, Gioia GD, Illuzzi G, Laneve E, Cocco A, Troiano G. Endodontic irrigants: Different methods to improve efficacy and related problems. Eur J Dent 2018;12:459-66.
] [Full text]
Royal MJ, Williamson AE, Drake DR. Comparison of 5.25% sodium hypochlorite, MTAD, and 2% chlorhexidine in the rapid disinfection of polycaprolactone-based root canal filling material. J Endod 2007;33:42-4.
Ozalp N, Okte Z, Ozcelik B. The rapid sterilization of gutta-percha cones with sodium hypochlorite and glutaraldehyde. J Endod 2006;32:1202-4.
Costa DM, Lopes LK, Hu H, Tipple AF, Vickery K. Alcohol fixation of bacteria to surgical instruments increases cleaning difficulty and may contribute to sterilization inefficacy. Am J Infect Control 2017;45:e81-6.
Prado M, Gusman H, Gomes BP, Simão RA. The importance of final rinse after disinfection of gutta-percha and Resilon cones. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e21-4.
Linke HA, Chohayeb AA. Effective surface sterilization of gutta-percha points. Oral Surg Oral Med Oral Pathol 1983;55:73-7.
Brito-Júnior M, Nobre SA, Freitas JC, Camilo CC, Faria-e-Silva AL. Antibacterial activity of a plant extract and its potential for disinfecting gutta-percha cones. Acta Odontol Latinoam 2012;25:9-13.
Sossi G. Rapid sterilization of the hands using quaternary ammonium disinfectants. Minerva Stomatol 1965;14:109-10.
Short RD, Dorn SO, Kuttler S. The crystallization of sodium hypochlorite on gutta-percha cones after the rapid-sterilization technique: An SEM study. J Endod 2003;29:670-3.
Pessoa de Andrade L, Chacon de Oliveira Conde N, Sponchiado Junior EC, Franco Marques AA, Pereira JV, Garcia LF. Contamination of absorbent paper points in clinical practice: A critical approach. Gen Dent 2014;62:e38-40.
Abu-Melha AS, Zakirulla M, Alqisi AY, Khawshal AA. Evaluation of cell pack paper points before and after sterilization: A microbiological study. Int J Med Dent 2018;8:38-42.
Aguiar C, Torres T, Mendes D, Farias B, Câmara A. Effect of sterilization methods on the absorption capacity of absorbent paper points. Braz Dent Sci 2012;15:27-32.
Sasaki JI, Imazato S. Autoclave sterilization of dental handpieces: A literature review. J Prosthodont Res 2020;64:239-42.
Parker HH 4th
, Johnson RB. Effectiveness of ethylene oxide for sterilization of dental handpieces. J Dent 1995;23:113-5.
Olive R. ADA's Guidelines for Infection Control. 3rd
ed. St Leonards, Australia: Australian Dental Association; 2015. p. 30-45.
Palenik CJ. Infection control practices for dental radiography. Dent Today 2004;23:52-5.
Puttaiah R, Cederberg R, Youngblood D. A pragmatic approach towards single-use-disposable devices in dentistry. Bull Group Int Rech Sci Stomatol Odontol 2006;47:18-26.