STERILIZATION AND

DISINFECTION IN
PROSTHODONTICS

Presented by:
Dr. Jehan Dordi
I year MDS
1
Contents
• Introduction
• Terminologies
• Need for Sterilization and Disinfection
• Difference between Sterilization and Disinfection
• Sterilization
• Methods of Sterilization
• Recent Advances
• Test for sterilization
• Disinfectants
• Methods of disinfection
• Levels of disinfection
• Spaulding's Classification
• Unit Dose Concept
2
• Sterilization in Prosthodontic practice
• Disinfectants in Prosthodontic practice
• Management of Infectious Patient
• Management of Implant room/Operation Theatres.
• Review of literature
• References

3
INTRODUCTION

4
 Terminologies
• Sterilization: It is defined as a process by which article, surface or medium is freed of all living
micro-organisms either in vegetative or spore state.

• Disinfection: The destruction or removal of all pathogenic organisms, or organisms capable of

giving rise to infection.

• Asepsis: It is the state of complete absence of viable pathogenic microorganisms in any

environment.

5
• Antiseptics: They are agents that can be safely applied on the skin or mucous membrane to
prevent infection by inhibiting the growth of bacteria.

• Bactericidal agent/ germicides: They are substances that can kill bacteria.

• Bacteriostatic agents: They prevent the multiplication of bacteria which may, however, remain
alive.

• Decontamination: It is the process of rendering an article or area free of contaminants, including

microbial, chemical, radioactive and other hazardous materials from an area, object or body
surface.
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 Need for Sterilization and Disinfection

• Micro-organisms are ubiquitous.

• They are found in the surroundings, on inanimate objects and on the surface of the human body.

• Since they cause contamination, infection and decay, it becomes necessary to remove or destroy
them.

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• All hospitals need to sterilize their equipment and supplies. Even the smallest private clinic
requires sterile surgical instruments for minor procedures, and sterile dressing materials.

• If a hospital has a full surgical unit, the sterilization of surgical instruments and linen, together
with dressing materials for the wards and operating theatre, plays a key role in infection control.

• Henceforth to prevent cross-contamination between patient to patient or between patient and

operator and to run a safe sterile practice sterilization and disinfection of instruments and
materials is very necessary

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 Disinfection Sterilization

This technique minimizes the number of This technique is the elimination of all the
microorganisms but does not eliminate them microorganisms.
completely.

This method does not eliminate bacterial spores This method kills bacteria as well as vegetative
spores
It is not an absolute condition It is an absolute condition

Disinfection method is used for Sterilization process is used for

decontamination of surfaces and air. decontamination of food, surgical equipment's,
instruments and several medicines

Disinfectants are commonly used in daily life Sterilization is used in surgical operations and
various labs where sterile conditions are pre-
requisite. 9
 Disinfection Sterilization

Disinfection process do not require a strict The sterilization process are well laid down and
guidelines to be followed follow a strict protocol to completely kill the
pathogens.

Disinfected objects have less number of micro- No viable organisms present on sterilized items
organism

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STERILIZATION

11
 Methods of Sterilization
Chemical agents
Physical agents
1. Alcohols: ethyl, isopropyl, trichlorobutanol
1. Sunlight
2. Aldehydes: formaldehyde, glutaraldehyde
2. Drying
Orthophthalaldehyde
3. Dry heat: By flaming, incineration
3. Peracetic acid,
or using hot air
4. Hydrogen peroxide
4. Moist heat: By boiling, steam at
atmospheric pressure, steam above 5. Hypochlorous acid
atmospheric pressure 6. Dyes
5. Filtration: Using candles, asbestos 7. Halogens
pads, membranes
8. Phenols
6. Radiation
9. Surface-active agents
7. Ultrasonic and sonic vibrators
10. Metallic salts
11. Gases: ethylene oxide, formaldehyde, beta
12
propiolactone
 PHYSICAL AGENTS
• Sunlight: Active germicidal effect due to combined effect of Ultraviolet rays and heat rays.

• Drying: 4/5th of weight of bacterial cell consist of water and hence drying has a deleterious
effect on many bacteria.

• Heat: The killing effect of heat is due to protein denaturation, damage by oxidising molecules,
destroying cell constituents and the toxic effect of elevated levels of electrolyte.

• There are 2 types of heating method: Dry and moist heat

13
 Dry Heat

• Flaming: An inoculating loop or wire, the tip of forceps

and searing spatulas can be sterilized by holding them
over a Bunsen flame till they become red hot. Inoculation
loops carrying infective material may be dipped in a
disinfectant before flaming to prevent spattering.

• Incineration: This is an excellent method for terminal

sterilization for destroying biomedical waste.

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• Hot air oven: This is the most widely used method of sterilization by dry heat. Sterilization is
achieved by conduction.

• The heat is absorbed by the surface of the item to be sterilized, which then penetrates to the
centre, until the entire item reaches the desired temperature.

• A holding period of 160 degree for 2 hours is necessary to sterilise glassware, forceps, scissors,
scalpels, all glass syringe, swabs.

• Glass-wares should be perfectly dry before placing in oven.

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External and Internal view of Hot air oven

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 Sterilisation control for hot air oven:

Physical:

• Temperature monitoring by thermocouples

can be carried out.

Chemical:

• A Browne's tube (green spot) is used- A

green color is produced after 60 minutes at
160°C or 115 minutes at 150°C, suggesting
complete - sterilization.
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• Biological: Heat-resistant spores of a non-
toxigenic strain of Clostridium tetani or
Bacillus subtilis are used to indicate
efficiency of dry heat sterilisation.

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Moist heat

Temperatures below 100 C

• Pasteurization of milk: The milk is heated at

either 63°C for 30 minutes or 72°C for 15-20
seconds, followed by cooling quickly to 13 °C or
lower.

• By these process, all non sporing pathogens such as

mycobacteria, Brucella and salmonellae are
destroyed.

• Coxiella burnetii is relatively heat-resistant and

may survive the holder method.
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• Inspissation: Media such as Lowenstein-
Jensen and Loeffler's serum are rendered
sterile by heating at 80- 85°C for half an
hour/on three successive days in an
inspissator.

20
Temperature at 100°C

• Boiling: Vegetative bacteria are killed

immediately at 90-100°C but bacterial spores
can withstand long periods of boiling. In
cases where boiling is considered adequate,
the material should be immersed in the water
and boiled for 10-30 minutes.

• Boiling is not recommended for sterilization

of instruments used for surgical procedures.

21
 Steam at atmospheric pressure (100°):

• An atmosphere of free steam is used to

sterilize culture media which may decompose
if subjected to higher temperatures.

• A Koch or Arnold steamer is usually used .

22
 Tyndallisation or Intermittent Sterilisation:

• It is a method used for media containing sugars or

gelatin.

• An exposure to 100°C for 20 minutes on three

successive days is used.

• The principle is that the first exposure kills all

vegetative bacteria, and the spores, since they are in a
favorable medium, will germinate and be killed on
subsequent exposure to 100 °C for 20 minutes. 23
 Steam under pressure:
• The equipment used is an autoclave.

Principle:

• The principle of the autoclave or steam sterilizer

is that when water boils, its vapor pressure
equals that of the surrounding atmosphere.

• Hence, when pressure inside a closed vessel

increases, the temperature at which water boils
also increases, generating steam.
24
• When steam comes into contact with a cooler surface, it condenses and transmits its latent heat
to that surface (1600 ml steam at 100°C and at atmospheric pressure condenses into 1 ml of
water at 100°C and releases 518 calories of heat) .

• The large reduction in volume sucks in more steam and the process continues till the
temperature of that surface equalizes with that of steam. Condensed water ensures moist heat for
killing the microbes present on the material.

25
Types of autoclaves

• Vacuum autoclaves in which air is evacuated from a

metal chamber by vacuum pump are now becoming
popular in dentistry. In center sterile supply units in
hospitals they are sometimes referred to as porous load
autoclaves.

• These vacuum autoclaves are more desirable for routine

dentistry than the gravity displacement type for the
sterilization of hollow devices such as dental handpieces.

26
• Gravity displacement autoclaves are small,
automatic bench-top autoclaves. They work
on the principle of downward displacement
of air as a consequence of steam entering at
the top of the chamber.

• For Gravity displacement autoclaves, a

sterilization cycle of 134°C for 3–4 min at
207 kPa is recommended for both wrapped
and unwrapped dental instruments.
27
 Autoclaves used in dentistry

• Type N: air removal in type N sterilizers is achieved by passive displacement with steam. They
are non-vacuum sterilizers designed for non-wrapped solid instruments.

• Type B (vacuum): these sterilizers incorporate a vacuum stage and are designed to reprocess
load types such as hollow, air-retentive and packaged loads. A number of different cycles may
be provided.

• Each cycle should be fully validated and used in accordance with instructions provided by both
the sterilizer manufacturer and the instrument manufacturer(s).

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The sterilization cycle

• The sterilization cycle can be divided into three periods: the heating-up period, the holding
period and the cooling period.

• For the N-type non-vacuum bench-top autoclave (routinely used in dentistry), this entails:

• 1. Removal of air by a vacuum pump or downward displacement of air by incoming steam while
the chamber is heated to the selected temperature.

• 2. Holding the load, which is sterilized, for the appropriate period at the selected temperature
and pressure.
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• 3. Drying the load to its original condition by a partial vacuum (this is assisted by the heat from
the jacket)

• 4. Restoration of the chamber to atmospheric pressure by rapid exhaustion of steam.

Method Temperature (C) Holding time (in Chamber pressure

minutes)

Autoclave 121 15 15 lbs per square

inch

126 10 20 lbs per square

inch

133 03 30 lbs per square

inch
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Sterilization control:

• Sterilization control is similar to that of dry heat sterilization as described earlier except for the
use of Geobacillus stearothermophilus, which is used as the test organism for checking
sterilization by steam under pressure.

• This is a thermophilic organism with an optimum growth temperature of 55- 60°C and its spores
require an exposure of 12 minutes at 121 °C to be killed.

• Biological indicators are the only process indicators that directly monitor the lethality of a given
sterilization process.
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Test for Sterilization

• A bowie dick tape is used for testing of sterilization.

• Bowie Dick tape is applied to articles begin autoclaved.

• If the process has been satisfactory, the strip will change its color completely.

32
Filtration
Types of filters

• Candle filters are manufactured in different

grades of porosity and have been used widely
for the purification of water for industrial and
drinking purposes.

• They are of two types

1. Unglazed ceramic filters (for example,

(chamberland and Daulton) and

2. Diatomaceous earth filter; (for example,

berkefeld and mandler). 33
Sintered glass filters

• They are prepared by heat fusing finely

powdered glass particles of graded sizes.
They have low absorptive property and can
be cleaned easily but are brittle and
expensive.

34
Membrane filters

• They are made of cellulose esters or other polymers

and have largely replaced other types of filters. They
are routinely used in water purification and analysis,
sterilization and sterility testing, and for the
preparation of solutions for parenteral use.

• They come in a wide range of average pore diameters

the size being the 0.22mm most wide used for
sterilisation
35
Radiation
• Two types of radiation are used for sterilization.

1. Non ionizing and

2. Ionizing.

• Infrared and ultraviolet rays are of the non-ionizing, low-energy type, while gamma rays and
high-energy electrons are the ionizing, high energy type.

36
Non-ionizing radiation:

• Here, electromagnetic rays with wavelengths longer

than those of visible light are used.

• These are, to a large extent, absorbed as heat. Infrared

radiation is used for rapid mass sterilization of
prepacked items such as syringes and catheters.

• Ultraviolet radiation is used for disinfecting enclosed

areas such as biosafety cabinets in laboratories,
entryways, operation theatres and laboratories.

37
Ionizing radiation:

• X-rays, gamma rays and cosmic rays are highly lethal

to DNA and other vital constituents.

• They have very high penetrative power. Since there is

no appreciable increase in temperature in this method,
it is referred to as cold sterilization.

• Commercial plants use gamma radiation for sterilizing

items like plastics, syringes, swabs, catheters, animal
feeds, fabric and metal foils 38
Ultrasonic Vibrators:
• Used instruments are soaked into a container containing 70%
isopropyl alcohol for removal of organic debris. After removing
instruments rinse thoroughly in warm water to remove all
chemicals.

• As a final step insert the instruments into the ultrasonic vibrator

and operate for 30 minutes, after which sterile instruments are
rendered.

• Ultrasonic vibrators are generally used for non-critical items. 39

Recent advances in sterilization
• Plasma sterilization: Plasma is known as the fourth state of matter
and consists of ions, electrons or neutral particles. A radio frequency
energy is applied to create an electromagnetic field.

• Into this, hydrogen peroxide vapors are introduced which generates a

state of plasma containing free radicals of hydrogen and oxygen.

• This state renders the articles sterile by denaturing all

microorganisms. Arthroscopes, urethroscopes, etc., are sterilized by
plasma sterilization. 40
Flash sterilization:

• Flash sterilization was originally defined by Underwood and Perkins as sterilization of an

unwrapped object at 1320°C for 3 minutes at 27-28 lbs. of pressure in a gravity displacement
sterilizer.

• Flash sterilization is considered acceptable for processing cleaned patient-care items that cannot
be packaged, sterilized, and stored before use.

• It also is used when there is insufficient time to sterilize an item by the preferred package
method.

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Effects of sterilization on periodontal instruments, JOP, vol 53, no:7, 2011.
DISINFECTANTS

42
 CHEMICAL AGENTS

An ideal antiseptic or disinfectant should:

1. Have a wide spectrum of activity and be effective against all organisms.

2. Be active in the presence of organic matter

3. Be effective in acid as well as alkaline media

4. Have speedy action

5. Have high penetrating power

6. Be stable

43
 Mode of action of chemical agents:

1. By protein coagulation

2. By disruption of the cell membrane resulting in exposure, damage or loss of contents

3. By removal of free sulfhydryl groups essential for the functioning of the enzymes

4. By substrate competition of enzymes necessary for the metabolism of the cell

44
Alcohols
• Ethyl alcohol (ethanol) and isopropyl alcohol are the
most frequently used. They are used mainly as skin
antiseptics at a concentration of 60- 90% in water.

• They act by denaturing bacterial proteins. They have

no action on spores

• Methyl alcohol is effective against fungal spores and is

used for cleaning cabinets and incubators.

• A pad moistened with methanol and a dish of water (to

ensure high humidity) are kept inside the chamber
which is left at working temperature for several hours. 45
Aldehydes
• Formaldehyde is active against the amino group in the
protein molecule. In aqueous solutions it is markedly
bactericidal, sporicidal and virucidal.

• It is used to preserve anatomical specimens, and for

destroying anthrax spores in hair and wool. 10% formalin
containing 0.5% sodium tetraborate is used to sterilize
clean metal instruments.

• Formaldehyde gas is used for sterilizing instruments, heat-

sensitive catheters and for fumigating wards, isolation rooms
and laboratories.
46
Glutaraldehyde

• Has an action similar to that of formaldehyde.

• It is especially effective against the tubercle bacilli, fungi

and viruses. It has no deleterious effect on cement or
lenses of instruments.

• Hence, it is used to sterilise cystoscopes, bronchoscopes,

rubber anaesthetic tubes, plastic endotracheal tubes and
polythene tubing. It can also be used for metal
instruments.
47
 Orthophthalaldehyde
• Has bactericidal activity.
• It is used to cleanse endoscopes
between patients as it is quick,
effective and safe.

48
• Peracetic acid has a good sterilization effect on
bacteria, particularly common antibiotic-resistant
bacteria such as methicillin-resistant Staphylococcus
aureus, vancomycin-resistant Enterococcus and
Clostridium difficile.

• Hypochlorous acid is generated from the reverse

reaction of sodium hypochlorite and hydrogen
peroxide. It has bactericidal activity against common
pathogenic organisms. It is active against biofilms and
microorganisms within the biofilms.
49
Dyes
• The aniline dyes include brilliant green,
malachite green and crystal violet. They do not
act against tubercle bacilli. Hence, malachite
green is used in the Lowenstein-Jensen
medium as a selective agent.

• The are non-irritant and non-toxic to the

tissues. They are inhibited by organic material.
Lethal effects on bacteria are believed to be
due to their reaction with the acid groups in the
cell.
50
 Acridine dyes

• They are not as selective as the aniline dyes. They are

minimally affected by the presence of organic matter.

• Important dyes in this group are proflavine,

acriflavine, euflavine and aminacrine. They impair the
DNA complexes of the organisms and prevent
replication.

51
Halogens
• Iodine in an aqueous and alcoholic solution
has been widely used as a skin disinfectant.
It is bactericidal, with moderate action
against spores. It is active against the
tubercle bacteria and viruses.

• Compounds of iodine with non-ionic

wetting or surface-active agents known as
iodophores have better action than aqueous
or alcoholic solutions of iodine.

52
• Chlorine and its compound hypochlorite
have been used as disinfectants over time.
They are markedly bactericidal and virucidal.

• Town water supplies, swimming pools, food

and dairy industries use chlorine for
disinfection. The organic chloramines are
used as antiseptics for dressing wounds.

53
Phenols
• These compounds are obtained by distillation of
coal tar between temperatures of 170°C and 270°C.

• Bactericidal effect of phenols is due their capacity

to cause cell membrane damage, inactivation of
membrane-bound oxidases and dehydrogenases
leading to lysis and death of the microorganism.
Low concentrations of phenol precpitate proteins.

54
• Phenols is widely used as disinfectants in hospital.
Commonly used compounds are Lysol and cresol
They are not readily inactivated by the presence of
organic matter; hence, they are good general
disinfectants

• Chlorhexidine (Hibitane) is a relatively non-toxic

skin antiseptic and wound dressing. They are active
against most Gram-positive organisms and fairly
effective against Gram-negative bacteria.

55
Commonly used disinfectants & their concentrations

56
Gases
• Ethylene oxide: This is a colorless liquid with a
boiling point of 10.7C and highly penetrating at
normal temperature and pressure.

• It has a sweet, ethereal smell and is highly

inflammable. It is highly explosive at
concentrations greater than 3%. Combination with
10% carbon dioxide or nitrogen makes it less
explosive.

57
• It acts by alkylating the amino, carboxyl, hydroxyl and sulfhydryl groups in protein molecules
within the microbes and spores. It also reacts with DNA and RNA (rendering them virucidal). It
is potentially toxic to human beings, causing mutagenicity and carcinogenicity.

• It diffuses through many types of porous materials and readily penetrates some plastics.

• It is especially used for sterilizing heat-sensitive equipment like heart-lung machines,

respirators, suture materials, dental equipment, books and clothing.

• It has a wide application within and outside the hospital. It is unsuitable for fumigating rooms
because of its explosive property.
58
 Formaldehyde gas:

• This is employed for fumigation of operation

theatres and other rooms.

• The sealed room is left unopened for 48 hours

after fumigation;. The gas is neutralized with
ammonia(300 ml for every liter of formaldehyde
used) .

• Fumigation of operation theatres is no longer

preferred.

59
• Betapropiolactone: This is a condensation
product of ketane and formaldehyde. It is no
longer used for fumigation as it is
carcinogenic.

• Hydrogen peroxide fogging: Bactericidal

action is by oxidizing the cell wall of the
organism. This has replaced fumigation. It has
the advantage of short cycle time and is non-
toxic.

60
Surface-active agents

• They are substances that alter the energy

relationship at interfaces, producing a
reduction in surface tension. They are
widely used as wetting agents,
detergents and emulsifiers.

61
 Mechanism:

• These act on the phosphate groups of the cell membrane and also enter the cell. The membrane
loses its semi-permeability and the cell proteins are denatured. They act on bacteria, but have no
action on spores, tubercle bacilli and most viruses.

62
Metallic salts

• Though all salts have a certain amount of

germicidal action, salts of heavy metals have
greater action. Silver, copper and mercury salts are
used as disinfectants.

• They are protein coagulants and have the capacity

to combine with free sulfhydryl groups of cell
enzymes.

63
• Thimerosal, phenyl mercury nitrate and mercurochrome are less toxic and are used as mild
antiseptics and have marked bacteriostatic but weak bactericidal and limited fungicidal action.

• Copper salts are used as fungicides.

64
LEVELS OF DISINFECTION

65
• High-level disinfectant: This is a chemical that kills all microbial pathogens except large
numbers of spores. It may have some activity against a smaller number of spores if the contact
time is increased.

• For example, glutaraldehyde and hydrogen peroxide.

• Uses: They are active against Gram-positive and Gram-negative bacteria, spores and M.
tuberculosis

66
• Intermediate-level disinfectant: A chemical that kills all microbial pathogens including
mycobacteria and non-enveloped viruses except spores.

• For example, alcohol, phenolic compounds and iodophores.

• Uses: Destroys M. tuberculosis, vegetative bacteria, most viruses and fungi.

67
• Low-level disinfectant: A chemical that kills only vegetative bacteria, fungi and lipid-
enveloped viruses.

• For example, quaternary ammonium compound.

• Uses: Kill most bacteria and most fungi, but not M. tuberculosis or spores

68
INSTRUMENT CLASSIFICATION BASED
ON POTENTIAL TO SPREAD INFECTION
(Spaulding's classification)

69
• In 1968, Dr. E. H. Spaulding classified medical/surgical instruments as
• Critical,
• Semi-critical and
• Non-critical based on their potential to spread infections.
• The classification helps to decide how to proceed with the instruments.

70
Critical items

• Critical items are those which enter sterile tissue or the

vascular system and pose a high risk of infection if the
article is contaminated.

• They must be sterilized by autoclaving if heat-stable or with

ethylene oxide or hydrogen peroxide gas plasma if heat-
sensitive.

• For e.g. Surgical instruments, scalers, scissors, dental burs,

scalpel blades, forceps, cardiac catheters, implants, etc.
71
Semi-critical items
• Articles which come in contact with mucous membranes or non-
intact skin are called semi-critical items. They require high-level
disinfection.

• Glutaraldehyde is the most commonly used high-level

disinfectant. Endoscopes and bronchoscopes undergo high-level
disinfection prior to and between patients.

• Some semi-critical items like thermometers and blood pressure

cuffs for neonates require only intermediate level disinfection.
This is done by disinfecting with alcohol as the articles may not
be compatible with glutaraldehyde.

• For e.g. Mouth mirror, impression trays, hand-pieces, probe,

72
tweezers, amalgam condensers
Non-critical items

• These items come in contact with intact skin but not

mucous membranes.

• They can be cleaned or treated with low-level

disinfectants as they carry no risk of transmitting
microorganisms to the patients directly.

• For e.g. X-ray tubes, light handles, radiograph

head/cone, blood pressure cuff, face bow
73
 Unit Dose Concept

• Unit dose concept was introduced with purpose- to minimize cross contamination.

• Refers to dispensing of amount of materials sufficient to accomplish a particular procedure,

prior to patient contact.

• Dispose of excess material at completion of procedure

74
STERILIZATION IN PROSTHODONTIC
PRACTICE

75
Sterilization of Diagnostic Instruments (Mouth mirror, Probe, Explorer)

• Dry the diagnostic instrument with help of wipes. Only absolutely dry instruments must be
placed in the sterilizer, in order to avoid calciferous deposits and/or water spots. Instruments are
autoclaved at 121° C.

• In order to prevent staining and corrosion, the steam must be free of particles. When several
instruments are sterilized, the maximum capacity of the sterilizer must not be exceeded.

• After sterilization instruments must be stored and transported in the rooms and containers
designated by the practice. The instruments should be processed as soon as possible after use.
76
Sterilization of Impression Trays

• After the impression has been removed from the metallic impression trays the trays are washed
with running water and are made free from the particles adhering to it.

• The trays are the properly dried and placed in autoclave for sterilization at 121° C.

77
Sterilization of Handpiece

• Several ways to control the spread of contaminating matter between two patients have been
recommended.

• The most common methods of asepsis control are as follows: Protection from any contact with
the fluids present within the oral environment, Chemical disinfection, Thermal sterilization
Disinfection using microwaves, Disinfection via irrigation, Single use hand-pieces.

• Among the above techniques, moist heat using saturated water vapor's (autoclave) offers the
best results as regards the sterilization of handpieces in the short time.
78
• Step 1. After the end of the dental procedure the handpiece must be operated for 5-10 seconds
over the wash basin or a similar container while ejecting water and air.

• Step 2. Then, after being detached from the tubing's and connections with the unit, it must be
meticulously washed and brushed under running water.

• Step 3. Then, it must be dried with an absorbent paper.

• Step 4. After external cleaning, the handpiece is reconnected to the tubing's and operated for 3-5
seconds only with air so that any water residues are removed from the interior of the tubing.
79
• Step 5. Then, the handpiece is lubricated with the lubricant recommended by the manufacturer
and operated again for 10-20 seconds only with air so that the lubricant is properly distributed
throughout the sensitive areas of the head of the handpiece.

• Step 6. After the end of this procedure, the handpiece along with the bur extractor are enclosed
in a special pouch which is made airtight with either a self-adhesive tape or a thermosealer.

• Step 7. The handpiece and the bur extractors are placed in the autoclave, taking care not to
over-pack the pouches and ensuring that the air can pass unhampered.

80
• Depending on the manufacturer's indications, the autoclave is programmed to operate at 121C
for 20 minutes or at 134 C for 13 minutes.

• After these cycles have finished, the handpieces and the bur extractors are sterilized and are
ready to be used.

• Step 8. Just before re-use, some handpieces must be lubricated again with an appropriate
lubricant.

81
82
83
84
Sterilization of Burs
• Burs should be sterilized independently of their type or the area of the mouth in which they have
been used.

• Step 1. A necessary step prior to sterilizing a bur is meticulous cleaning to remove tooth debris,
residues of dental materials, blood clots or a paste-like mixture with saliva of all the above.

• The most widely accepted cleaning method for burs and other micro instruments are ultrasonic
devices (baths) using suitable solutions and with the addition of enzymes with a proteolytic
action.
85
• In these baths using suitable solutions at a temperature of about 60°C, burs vibrate at a
frequency of 60-80 kHz for at least 15 minutes. After the end of this procedure, burs are free
from foreign matter as well as oxides which are very often deposited on their shank.

• Step 2. After removal from the ultrasonic bath, burs must be dried using absorbent paper and hot
air.

• Step 3. They must then be placed in an appropriate device for sterilization, depending on the
material they are made of.
• More specifically:
1) Burs made of common carbon steel should not be placed in the autoclave because they will
undergo oxidation.

2) Burs made of stainless steel or tungsten carbide are not so affected.

86
3) Dry heat ovens, ovens for chemical vapor sterilization and ethylene oxide ovens are suitable for
sterilizing all types of burs. However, dry heat ovens, due to prolonged heating involved, may
seriously damage the cutting edge of the burs.

4) Using various aldehydes and phenols for at least 30 minutes offers adequate sterilization while
after 10 hours chemical sterilization is achieved. Nevertheless, they may damage the integrity of
rotating cutting instruments.

87
88
89
Sterilization of Facebows & Bite forks
• Parts of facebow which are made of metal can be sterilized in autoclave.

• It is important to note that earpieces of facebow be removed before sterilization.

• Before facebow and bite fork is kept in autoclave it is necessary to wipe it with dry cloth.

• Facebow and bite fork can be autoclaved at 121 C.

90
Sterilization of Dental Implants.

• The following products are delivered non sterile:

• Transfers, Analogs, Drivers, Overdenture, Abutments, Transfer screws, Drill Extension, Parallel
Pin, Transfer Screws and plastic handle.

• It is recommended to sterilize the components and instruments prior to placing in oral cavity.

• If modification has been made to the components and instruments clean prior to sterilization.

• Dental implants and components are pre-cleaned prior to sterilization.

91
Steps in Pre-cleaning of components:
• Remove the debris in lukewarm water (<40 C) and immerse devices in cleaning solution

• Scrub devices with soft bristled nylon brush

• Flush re-useable devices with channels/lumina using cleaning solution.

• Rinse with water.

• Load devices into washer/disinfector

• Run cleaning and disinfection cycles

• Run drying cycle

• Dry with compressed air or wipes

92
Removal of residual tissue or bone debris by
immersing the instruments in lukewarm water.
Pre-cleaning in an ultrasonic bath is
recommended.

Immerse the instruments in enzymatic cleaning

solution (enzymatic detergent with pH between 7-
10) with lukewarm water temperature not more
than 40 C.

93
Scrub the component with nylon brush
until visible soil and all debris are
removed.

Flush the internal channel/lumina with 20ml

cleaning solution using the irrigation needle
connected to a 20ml syringe

94
Components are loaded in a instrument tray before
placing in washer/ disinfector.

Kit boxes are disassembled before cleaning and

disinfection

95
Sterilization of implant components
• Inspection: Before sterilization visual inspection for cleanliness should be performed with
magnifying glasses.

• Packaging of instruments: Place instruments in sterilization pouches.

• Sterilization: Steam sterilize the device in a sterilization pouch for 4 mins at 132 C. Dry the
device for 20 mins

96
DISINFECTION IN PROSTHODONTIC
PRACTICE

97
Methods Of Disinfecting Impressions

1. Spraying
2. Immersion

98
Different Impressions

• Disinfection of Alginate Impressions

can be done with 0.5% sodium
hypochlorite.
• Iodophores Immersion disinfection for
prolonged periods will cause distortion
due to imbibition.

Beyerle, M.P., Hensley, D.M., Bradley Jr, D.V., Schwartz, R.S. and Hilton, T.J., . Immersion disinfection of irreversible hydrocolloid impressions with sodium hypochlorite. Part I: Microbiology.
99 Int J
Prosthodont.2014, 7(3),234-8
• Agar- Reversible Hydrocolloid: Found to be stable when immersed in 1:10 dilution sodium
hypochlorite or 1:2 iodophor.

• Recommended immersion time is 10 minutes.

100
Giblin, J., Podesta, R. and White, J., Dimensional stability of impression materials immersed in an iodophor disinfectant. Int J Prosthodont. 2010, 3(1). 72-7
 Zinc Oxide Eugenol Immersion

• It can be disinfected in 2% glutaraldehyde

Iodophores or Chlorine compounds.

• Adverse effect have been reported on ZOE

immersed for 16 hours in diluted
hypochlorite.

Olsson, S., Bergman, B. and Bergman,M., Zinc oxide-eugenol impression materials. Dimensional stability and surface detail sharpness following treatment with disinfection solutions
101 Swed
Dent J.2012, 6(4),177.
 Impression Compound
• Immersion in 1:10 dilution
sodium hypochlorite or
iodophor for specified time
period has been found to
be useful for disinfecting
impression compound
impressions.

102
Bhat, V.S., Shetty, M.S. and Shenoy, K.K., Infection control in the prosthodontic laboratory. J Indian Prosthodont Soc 2007, 7(2),62.
Elastomeric Impression Materials

• Polysulphide and Addition

Silicone: Glutaraldehyde, Iodophor,
0.5% sodium hypochlorite should be
used for its disinfection.

103
Thouati, A., Deveaux, E., Iost, A. and Behin, P., Dimensional stability of seven elastomeric impression materials immersed in disinfectants. J Prosthet Dent. 2016, 76(1),8-14.
Polyether:
• Spraying in iodophor, 0.5% Sodium
hypochlorite should be used.

• Prolonged immersion causes distortion.

• Polyether shows dimensional changes on

immersion in 2% glutaraldehyde.

Drennon, D.G. and Johnson, G.H., The effect of immersion disinfection of elastomeric impressions on the surface detail reproduction of improved104
gypsum
casts. J Prosthet Dent. 2012, 63(2),233-241.
Disinfection Of Wax Bites & Wax Rims
• Wax rims and wax bites should be disinfected by the
spray wipe spray method using an iodophor. Rinse &
spray may be more appropriate for wax bites.

• For adequate disinfection these should remain for longer

time in tuberculocidal disinfection.

• After the second spray, they can be enclosed in a sealed

plaster bag for the recommended time. These items
probably should be rinsed again after disinfection to
remove any residual disinfectant.

105
Disinfection Of Bite Registrations
• Bite registrations made of various materials or compound can
be handled in the same manner as impressions of the same
materials.

• These registrations also can be disinfected, using the rinse

spray rinse technique, with most EPA registered hospital level
tuberculocidal disinfectants used as sprays (chlorine
compounds should not be applied to ZOE).

• After disinfection, the registration should be rinsed again to

remove residual disinfectant. 106
Disinfection of Casts

• ADA recommends that stone casts be disinfected by the

spraying until wet or immersing in a 1:10 dilution of
sodium hypochlorite or an iodophor.

• Casts to be disinfected should be fully set (i.e. stored for at

least 24 hours).

• Microwave irradiation of casts for 5 mins at 900W gives

high level disinfection of the gypsum casts

107
Disinfection Of Custom acrylic resin impression trays

• Custom acrylic resin impression trays

should be disinfected by spraying with
surface disinfectants or immersing in either
1:2 iodophor or 1:10 sodium hypochlorite.

• They should be rinsed thoroughly to

remove any residual disinfectant and
allowed to dry fully before use. After use in
the mouth custom trays should be
discarded.

108
Dental Prosthesis and Appliances

• The ADA recommends disinfection by

immersion in iodophors or chlorine
compounds.

• Although both of these disinfectants are

somewhat corrosive, studies have shown little
effect on chrome cobalt alloy with short-term
exposure (10 minutes) to iodophors or 1:10
hypochlorite.

109
• Damage of heat cured denture base resin has been shown to occur after only 10 minutes of
immersion in a glutaraldehyde with phenol buffer, although immersion in 2% alkaline
glutaraldehyde did not damage the acrylic surfaces.

• Given the tissue toxicity of glutaraldehyde's and phenolic, however iodophors or chlorine
compounds are preferred for disinfection of acrylic appliances.

• Prostheses never should be stored in a disinfectant before insertion. After disinfection and
thorough rinsing, acrylic items can be stored in diluted mouthwash until inserted.

110
• Cast partial dentures are disinfected
using iodophors solution or 2%
glutaraldehyde solution for 10
minutes.

• Damage of heat cured denture base

resin has been shown to occur after
only 10 minutes of immersion in
glutaraldehyde.

111
• Fixed metal/porcelain prosthesis may be disinfected by
immersion in glutaraldehyde's for the time
recommended for tuberculocidal inactivation by the
disinfectant manufacturer.

• In addition several clinical services have confirmed that

fixed prosthesis can be disinfected by short immersion in
diluted hypochlorite without apparent harm to the
device.

112
• The higher the content of noble metal, the less the likelihood of adverse effects on the metal
core should be taken to minimize the exposure times of metals to potentially corrosive
chemicals.

• Unglazed porcelain should not be exposed to any disinfectant and (porcelain firing/ glazing will
suffice), fixed metal prostheses can be sterilized with ethylene oxide or even by autoclaving if
desired.

• Any device that has been immersed in a disinfectant should be rinsed thoroughly before
delivery to the patient.
113
• Prostheses or appliances that have been worn by patients should be cleaned thoroughly before
disinfection by scrubbing with a brush and an antiseptic hand wash or by cleaning in an
ultrasonic unit.

• Dentures or other acrylic appliances that have been worn by patients and require repair should
be disinfected, after cleaning and before handling should be handled (i.e. with gloves) as
contaminated even after disinfection.

• The porous nature of acrylic makes such devices difficult to disinfect adequately.

114
• Robert J. Boylan et al used UV light with a wavelength of 254nm as a mode of sterilizing
complete dentures, partial dentures and a rubber base impression contaminated with fine known
species of microorganisms.

• The results showed that killing of microorganisms with greater than 98% within 15 seconds and
99% either 30 seconds and 100% in 2 minutes.

• They also concluded that UV light cannot be used as a sole means of disinfecting the
impressions because of shadowing effect that allows the survival of microorganisms unexposed
to UV light.
115
Disinfection of Dentures with Soft liners

• Disinfection of dentures with soft

liners can be done by soaking the
dentures in 2% alkaline
glutaraldehyde solution for 10
minutes or by soaking in 5%
sodium hypochlorite solution for
10 minutes.
• After disinfection is done the
dentures are washed with water
before re-inserting.

116
Protective eye wear:
• It may be in the form of glasses and / or a facemask. It
should prevent trauma to the eye tissue from flying
droplets / aerosols.

• Protective glasses should be washed with soap first,

these rinsed with water and wiped with an appropriate
surface disinfectant.

• Plastic safety lenses can also be immersed in alkaline

glutaraldehyde solution and should be thoroughly
rinsed to avoid possible irritation to skin and eyes. 117
Management of instruments after use:
• They should be cleaned and dried, lubricated if necessary and packaged before loading into the
autoclave.

• Cleaning involves an initial presoaking with detergent solution containing disinfectants to soften
organic debris and begin microbial kill. After cleaning the instruments should be dried.

• Surfaces like unit handles, light handle, light switch, chair controls, head rest knob, trolley
handle, trolley and 3-way syringes cannot be disconnected and sterilized and therefore need to
be treated with disinfectants covered with a protective barrier.
118
• However instruments which enter oral cavity and are connected to some of the equipment e.g.
air rotor and surgical handpiece, ultrasonic inserts / tips, airwater syringe tips and light cure
probes / tips should be disconnected, sterilized and rinsed.

• Disinfection of surfaces involves the cleaning of surfaces, after every patient and application of
a disinfectant chemical. These chemicals include alcohol (spirit), iodophor products, synthetic
phenols, glutaraldehyde, chlorines etc.

• The advantages of barriers include ease and speed of insertion, standard sizes and the protection
of equipment from damage by chemicals, blood and fluids.
119
• Spittoons should be flushed with water,
scrubbed and disinfected.

• Waste buckets should be used with disposable

plastic bags as liners to be changed wherever
necessary.

120
Dental Unit Waterlines: Disinfection and management

• Quality of water in dental unit waterlines

(DUWLs) attached to handpieces, ultrasonic
sealers and air/ water syringes has been debated
widely.

• The source of water to the dental unit is either

directly from municipal supply or via water
reservoir bottles usually filled with distilled water
or normal water.
121
• After entering the unit, it passes through a multichannel control
box that distributes the water to hoses (DUWLs) feeding
various attachments such as the high-speed handpiece, the
air/water syringe and the ultrasonic scaler.

• The main risk to dental staff and patient health from DUWL
contamination comes from opportunistic and respiratory
pathogens such as Legionella, non-tuberculous mycobacteria
(NTM) and Pseudomonas.

• These organisms can be amplified in the biofilm to reach

infective concentrations, with the potential for inhalation-
associated respiratory infections or direct contamination of
surgical wounds. 122
• All DUWLs should be flushed for 2 min at the beginning of each day, prior to commencing
treatment and at the end of the day.

• The DUWL should be flushed for 20–30 s between patients to reduce temporarily the microbial
count, as well as to clean the waterline of materials that may have entered from the patient’s
mouth. This includes handpieces, ultrasonic scalers and air/water syringes.

• All DUWLs should be fitted with non-retractable devices, to prevent suck-back (backflow/back-
siphon age) of material into the municipal water supply.

123
• Water from DUWL should never be used as an irrigant in procedures involving breaches of the
mucosa and bone exposure.

• During surgical procedures use sterile solutions or coolant/irrigant administered by an

appropriate delivery device, for example, sterile bulb syringe, sterile tubing that bypasses
DUWLs or sterile single-use devices.

124
Laboratory Asepsis
• Dental practitioners regularly send clinical material to the laboratory: impression material,
dentures sent to the technology laboratory or pathological samples such as pus or biopsy
specimens referred to pathology laboratories.

• The dentist is obliged to deliver all such items in a manner that obviates infectious hazards,
whether during transport or within the laboratory.

• Blood and saliva must be carefully cleaned from the impressions and denture work by washing
under running water and disinfection, and, if appropriate, placed in plastic bags before transport
to the laboratory.

• Proprietary disinfectant soaking solutions are preferred to sprays for decontaminating the
microbes retained on impression surfaces.

125
• The dental laboratory itself should be regarded as a clean (not contaminated) area, and
appropriate protocols for disinfection of surfaces and material, as well as regular and timely
renewal of disinfectant solutions, should be established. Smoking and eating should be
prohibited.

• Microbiological specimens sent to the laboratory should be securely bagged to avoid

contamination of personnel who handle the items. The request form should be separately
enclosed to prevent contamination.

• Biopsy specimens should be put in a sturdy container with a secure lid to prevent leakage during
transport. 126
• Care should be taken when collecting specimens to avoid contamination of the external surface
of the container.

127
Maintenance of Wooden handle spatulas, Blow-torches, Rubber bowls & Shade- guides

• After manipulation chairside wooden handled

spatulas should be cleaned and disinfected.

• Other times such as Blow torches should be

disinfected after use, or the area to be touched should
be covered with a barrier such as plastic wrap to
prevent contamination.

• Rubber bowls should be cleaned and disinfected after

chairside use.

128
• Items such as shade guides should be cleaned and disinfected to avoid cross contamination.

• If iodophors are used on shade guides, they should be wiped with water or alcohol after the
exposure time to remove any residual.

129
Management of Infectious Patients

130
Transmission of Infectious Pathogens like HIV, HBV etc.

• Pathogenic organisms like HIV can be transmitted in dental settings through:

1. Direct contact with blood, oral fluids or patient materials.

2. Indirect contact with contaminated objects.

3. Contact of conjunctiva, nasal or oral mucosa with droplets containing microorganisms

generated from an infected person.

131
Modes of Occupational Exposure

• Patient to DHCP (Dental Health Care Personnel), including dentists, hygienists and assistants.

• From DHCP to patient.

• From patient to patient.

132
Prevention Strategies (Universal Protection Protocol)

• The different prevention protocol includes the following:

1. Personal Protective Equipment's

2. Cubicle preparation

3. Personal protective equipment's

4. Gloves, masks, protective eye wears

5. Puncture resistant gloves and thimbles

6. Double gloves

133
Barriers for Preventing Cross- Contamination of Infection
Gloves:

• After contact with each patient, gloves should be

removed, and hands should be washed and then re-
gloved before treating another patient.

• Exposure to disinfectants or other chemicals often

cause defect in gloves, thereby diminishing their
value

• Latex heavy rubber gloves, also called utility gloves

should be used in management of HIV patients.
134
• Protective clothing's such as gowns, clinic
jackets or similar outer protective garments
which are disposable should be used.

• Masks: Surgical masks or chin length plastic

face shields should be worn to protect the face
and oral and nasal mucosa when a discharge
of body fluids is anticipated

135
• Handling of sharp instruments and needles:
If a patient requires multiple injection over
time then the needle should be recapped
between each use to avoid needle stick
injury.

• Disposable syringes, needles, scalpel

blades, and other sharp items should be
discarded in puncture resistant biohazard
container that are easily acceptable.
136
Cubicle Preparation
1. Surface disinfection

2. Disinfecting counter tops

• Any item that cannot be autoclaved should be

disinfected with a fresh iodophor solution and
protective cover should be placed.

• Surfaces can be covered with plastic wrap, aluminium

foil or impervious backed absorbent paper.

• Counter tops should also be disinfected with

appropriate disinfectants. 137
Proper Hand Washing Technique
• The steps included in proper hand washing techniques include:

• Palm to palm

• Right palm over left dorsum and left palm over right dorsum

• Palm to palm finger interlaced

• Fingers to opposite palms

• Rotational rubbing of right thumb clasped over left and vice versa

• Rotational rubbing backwards and forward

138
Hand Washing Techniques

139
Frequently and less frequently missed areas during hand washing

140
141
Bio-medical Waste Segregation

142
143
144
145
Disposal Of Infected Clinical Waste

• All waste from HIV seropositive and AIDS patients must be treated as infected waste.

• Disposable plastic aprons and gloves must be worn when handling infected material.

Dispose off infected items as follows:

• Place into a disposable YELLOW plastic bag and seal.

• Place this inside a second YELLOW plastic bag and seal.

• Affix “STANDARD UNIVERSAL PRECAUTION” label to outside of YELLOW plastic bag in

a prominent position. 146
• Remove protective clothing and dispose of as clinical waste.

• Wash hands.

• Make arrangements for collection and disposal of bagged waste.

• All waste in YELLOW plastic bags should be sent for incineration.

147
Disposal of Contaminated Linen
• All linen from HIV seropositive and AIDS patients
must be treated as infected linen.

• Disposable plastic apron and gloves must be worn

when handling infected linen.

• Grossly contaminated heavily blood soaked linen

must be carried to the sluice area to be bagged.

• It should be placed in the appropriate water-soluble

laundry bag at the bedside and sealed.

• This water-soluble bag is then placed in double

yellow bags and incinerated.
148
• Affix “Standard Universal Precaution” label to the outside of the bag in a prominent position. It
should be sent to the laundry immediately.

• The infected/contaminated linen should not be handled by laundry staff it is kept into the
washing machine with very high temperature 71°C for 25 minutes.

• After placing the linen in the appropriate bags remove the protective clothing and dispose off as
clinical waste.

149
Disposal, Disinfection & Sterilization Of Contaminated Equipment

• Use disposable items whenever possible and dispose of as clinical waste.

• Wear protective clothing when dealing with contaminated equipment.

• Upon completion of procedure dispose of protective clothing as clinical waste.

150
Contaminated Instruments (Stainless steel & polypropylene instruments, bowels,
kidney dishes etc.)
• Clean the instruments with running water and dry.

• Place the instruments in surgical plate. Apply some amount of alcohol over the instruments and
burn it.

• Next place them in an autoclavable disposal bag.

• Secure the neck of the bag for transportation.

• Arrange transportation of contaminated items for decontamination and sterilization.

• Incineration of some instruments is also carried out.

151
STERILIZATION OF IMPLANT ROOM/
OPERATION THEATRE

152
Fumigation of Operation Theatre/ Implant room
• To sterilize the operation theatre formaldehyde
gas (bactericidal & sporicidal, virucidal) is
widely employed as it is cheaper for sterilization
of huge areas like operation theatres.

• Formaldehyde kills the microbes by alkylating

the amino acids and sulfhydryl group of proteins
and purine bases.

• In spite of the gas being hazardous continues to

be used in several developing countries. 153
• Fumigation usually involves the following phases:

1. First the area to be fumigated is usually covered to create a sealed environment.

2. Next the fumigant is released into the space to be fumigated; then, the space is held for a set
period while the fumigant gas percolates through the space and acts on and kills any
infestation in the product.

3. Next the space is ventilated so that the poisonous gases are allowed to escape from the space,
and render it safe for humans to enter.
154
Procedure of Fumigation

• Thoroughly clean windows, doors, floor, walls and all

washable equipment's with soap and water.

• Close windows and ventilators tightly. If any

openings found seal it with cellophane tape or other
material.

• Switch off all lights, A/C and other electrical &

electronic items
155
Personal care during fumigation

• Adequate care must be taken by wearing cap, mask, foot cover, spectacle.

• Formaldehyde is irritant to eye & nose; and it has been recognized as a potential carcinogen.

• So the fumigating employee must be provided with the personal protective equipment's.

156
REVIEW OF LITERATURE

157
Rai R, Anand V, Loushambam P. Disinfection Of Alginate Impression Materials Using Uv
Lights Coated With Candida Albicans. Global Journal For Research Analysis. 2018
Oct30;7(10).

• Rai et al conducted a study to evaluatethe efficacy of ultra-violet light in decreasing the colony
counts of Candida albicans after coating the irreversible hydrocolloid impression material with
Candida albicans colonies.

• A circular master die (dimensions: diameter-30mm, thickness-3mm) was fabricated. Samples

were prepared with alginate impression materials.

• They were coated with Candida albicans colonies with standardization.

158
• Three different tubes were used in ultra-violet light unit corresponding to 8watts, 16watts, and
24watts.

• The times of exposure were 15, 30, 60, 90, 120 and 180 seconds. The results were tabulated and
statistically analysed.

• It was found that ultra-violet light exposure more efficiently decreases the colony counts of
Candida albicans on samples.

159
Sreekumar S, Varghese K, Abraham JP, Jaysa JJ. An in vitro evaluation of the
efficiency of various disinfection and sterilization methods to decontaminate
dental handpieces. J Dent Res Rev 2018;5:50-3.
• Sreekumar et al did a study to evaluate the efficiency of various disinfection and sterilization
methods to decontaminate dental handpieces.

• For the study sixty contaminated handpieces were selected and divided into four groups of 15
handpieces.

• They were then contaminated using a mixture of Streptococcus salivarius, Escherichia coli, and
Candida albicans.

• Sterilization using autoclave and disinfection procedures using a commercially available

disinfectant (Decident™) and 70% isopropyl alcohol was done on each group.

160
• The handpieces were then subjected to manual scrubbing followed by bacteriological culture.

• The study revealed that moist autoclave is the best way to decontaminate the dental handpieces.

• Further, it was shown that proper cleaning of the instrument prior to autoclave, as recommended
by the American Dental Association’s Centers for Disease Control and Prevention (CDC), is
required for 100% efficiency.

• Statistically significant presence of S. salivarius and E. coli was found in samples disinfected
with Decident™ and 70% isopropyl alcohol, respectively.

• The study revealed that moist autoclave, following the procedures recommended by the CDC,
still remains as the gold standard of sterilization of dental handpieces.

161
Farrugia C, Cassar G, Valdramidis V, Camilleri J. Effect Of Sterilization Techniques Prior
To Antimicrobial Testing On Physical Properties Of Dental Restorative Materials. Journal
Of Dentistry. 2015 Jun 1;43(6):703-14.
• Farrugia et al did a study to evaluate Effect Of Sterilization Techniques Prior To Antimicrobial
Testing On Physical Properties Of Dental Restorative Materials.

• The aim of this study was to investigate any changes to the microstructure and surface
properties of selected dental materials after sterilization carried out prior to subjecting them to
antimicrobial testing. Initial microbial contamination on the material, as well as other possible
sources of contamination were also assessed.

• The materials investigated included dentine replacement materials (Chemfil Superior1,

Ionoseal1, Dyract Extra1 and SDR1). The materials were characterized by scanning electron
microscopy (SEM) and energy dispersive spectroscopy (EDS).

• The test materials were sterilized using alcohol, steam, ultraviolet light (UV) and ethylene oxide
and any changes to these materials were then assessed by SEM, microhardness testing and
Fourier transform infrared (FT-IR) spectroscopy. 162
• Material microbial levels before treatments were assessed by plate counting technique and
turbidity tests. Possible contamination through dispensers was assessed by analyzing the
CFU/sample.

• Ethylene oxide affected the microstructure of the Chemfil, Ionoseal and Dyract, resulting in
flattening of the Si–O stretching vibrations and deposition of chlorine and calcium respectively
in Chemfil and Dyract.

• Varied contamination was demonstrated on all materials when incubated in anaerobic

conditions.

• It was concluded that the different sterilization techniques affected the microstructure of the
materials under investigation. Samples of materials produced in sterile conditions could also be
contaminated with bacteria, either from the material itself or through the dispensing apparatus.

163
• Clinical significance: Results of antimicrobial studies cannot be extrapolated
clinically as the material sterilization treatment results in changes to material
chemistry and microstructure, which could in turn affect the materials’
antimicrobial activity.

164
Basso MF, Giampaolo ET, Vergani CE, Pavarina AC, Machado AL, Jorge JH. Occlusal
pressure analysis of complete dentures after microwave disinfection: a clinical study.
Journal of Prosthodontics. 2017 Oct;26(7):606-10.
• Basso et al did a study to evaluat the effect of microwave disinfection protocols on the occlusal
pressure pattern of dentures after microwave disinfection.

• Dentures were constructed for 40 patients and evaluated as follows (n=20).

• Group 1: Patients had the maxillary dentures submitted to microwave disinfection, once a
week, for 4 weeks.
• Group 2: Patients had the maxillary dentures submitted to microwave disinfection, three
times a week, for 4 weeks.

• Occlusal contacts were recorded on five occasions: 30 days after denture insertion and before
first disinfection (baseline or control group); 1 week after disinfection; 2 weeks after
disinfection; 3 weeks after disinfection; 4 weeks after disinfection.

165
• Occlusal contacts were analyzed by T-Scan III. Intergroup analysis was performed using the
Mann-Whitney test and intragroup analysis using the Friedman test with significance of 5%.

• The results showed no significant difference between groups during the periods.

• The data on parameters loss of denture adaptation or complaints showed that patients used their
dentures regularly for eating and expressed comfort and satisfaction in all experimental periods.

• The evaluation of functional occlusion revealed that the distribution of the occlusal contacts
remained unaltered after disinfection.

• Microwave disinfection protocols as studied in this report did not influence occlusal contacts of
the complete dentures.

166
References
• Ananthanarayan And Panikers. Textbook Of Microbiology. 10th Edition. India: Universal Press;
2016.

• Lakshman Samarannayake. Essential Microbiology For Dentistry. 5th Edition. Poland: Elsevier;
2018.

• Baveja C.P. Textbook Of Microbiology. 11th Edition. India; ACP Publishers; 2011.

• Rai R, Anand V, Loushambam P. Disinfection Of Alginate Impression Materials Using Uv

Lights Coated With Candida Albicans. Global Journal For Research Analysis. 2018 Oct
30;7(10).

• Farrugia C, Cassar G, Valdramidis V, Camilleri J. Effect Of Sterilization Techniques Prior To

Antimicrobial Testing On Physical Properties Of Dental Restorative Materials. Journal Of
Dentistry. 2015 Jun 1;43(6):703-14.
167
• Rani L. Sterilization Protocols In Dentistry-a Review. Journal Of Pharmaceutical Sciences And
Research. 2016 Jun 1;8(6):558.

• Brandt R, Coffey J, Baker Ps. Infection Control In A Prosthodontic Residency Program. Journal
Of Prosthodontics. 2013 Mar;2(1):51-5.

• Bhat Vs, Shetty M, Shenoy K. Infection Control In The Prosthodontic Laboratory. The Journal
Of Indian Prosthodontic Society. 2017 Apr 1;7(2):62.

• Sreekumar S, Varghese K, Abraham JP, Jaysa JJ. An in vitro evaluation of the efficiency of
various disinfection and sterilization methods to decontaminate dental handpieces. J Dent Res
Rev 2018;5:50-3.

• Boylan RJ, Goldstein GR, Schulman A. Evaluation of an ultraviolet disinfection unit. Journal of
Prosthetic Dentistry. 1987 Nov 1;58(5):650-4.
168
• Pavan S, Arioli Filho JN, Dos Santos PH, Nogueira SS, Batista AU. Effect of
disinfection treatments on the hardness of soft denture liner materials. Journal of
prosthodontics. 2007 Mar;16(2):101-6.

169
THANK YOU
170