Generalized Instructions for Reprocessing

All instruments supplied by Artman Instruments should be reprocessed. Surgical assemblies, simple assemblies, hinged instruments (surgical or non-surgical), and all those instruments that contain aluminum are indications for reprocessing.

Contraindication

Any instrument or device that is used in a confirmed or a suspected Creutzfeldt-Jakob disease (CJD) is a contraindication of reprocessing. Such instruments must be destroyed due to the inability to completely rule out the risk of contamination.

Considerations before use

Users should ensure the satisfactory performance of all the instruments. Prior to use, all instruments should be inspected to ensure proper functioning and condition.

It is a must to clean instruments before reprocessing. Remove all protective caps and sheaths with utmost care. The instrument must be:

  • cleaned
  • lubricated
  • decontaminated
  • sterilized
  • inspected before use

Impact of Reprocessing on instruments

Repeated reprocessing has minimal effect on the instruments. Proper cleaning and lubrication are necessary for prolonging the working. The end of the life of an instrument is determined by wear and tear.

Handling of instruments

The instruments should be used only by trained professionals and personnel having adequate training and familiarity with techniques of procedure. The instruction guidelines should be thoroughly and carefully read before usage.

Cleaning and Sterilization

It is not a recommended practice to leave the used instruments overnight and leave it for the next day. It promotes bacterial growth, and the smell produced may be detrimental to the environment.

Soil removal

Before sterilizing the instruments, all excess soil clotted blood or dirt should be removed. This should be done as soon as possible with a disposable cloth or a gauze.

Preparation for Sterilization

The instruments should be thoroughly checked for any remaining soil. Instruments with assemblies should be prepared with good care. Disassembly of the different mechanical parts should be carried out without the aid of any mechanical tool. Follow the cleaning instructions below before sterilization.

Classification of Instruments Before Sterilization

Instruments are classified based on the extent of contact with the patients. These are classified as:

Critical instruments

Critical instruments are those instruments that penetrate the soft tissue, contact bone, enter into the bloodstream, or other normally sterile tissues. These instruments are meant to be dealt with utmost care and responsibility as they have the highest risk of transmitting infection.

This category includes Surgical instruments, periodontal scalers, scalpels, surgical burs, bone expanders, crown remover tips, and all those instruments that get contaminated by saliva and/or blood.

The sterilization of critical instruments must be in a steamed autoclave machine. The steam sterilization (autoclave) mostly has two built-in programs.  Instruments should be exposed to pressurized moist heat

in for 17-25 minutes at a temperature of 250/ 121. This procedure is done for packaged instruments that allow penetration of steam. Instruments packed in paper, plastic cloth, and plastic peel pouches should be sterilized in this manner.

For closed metal and glass containers, a cycle of 3-10 minutes at 270132 is recommended.

Semi Critical instruments

The semi-critical instruments have a lower risk of infection transmission because they contact the mucous membranes or non-intact skin, but will not penetrate soft tissue, contact bone, or enter into/contact the bloodstream or other normally sterile tissue.

This category includes Dental mouth mirrors, amalgam condenser, reusable dental impression trays, dental handpiece.

Semi critical items should be cleaned, and heat sterilized (as mentioned above in the critical instruments segment). If the instrument is heat-sensitive, it should, at a minimum, be processed with high-level disinfection. Heat sensitive instruments can be sterilized by immersing them in a liquid chemical germicide registered by the FDA as a sterilant.

Some instruments like “Molar band seaters” and “Mouth gags” fall in this category because of the nylon parts or plastic tubing that they contain. 

High-level disinfection is employed for cleaning heat-sensitive semi-critical instruments. Instruments should be dipped in disinfectants approved by FDA, such as Glutaraldehyde, Hydrogen peroxide, and peracetic acid. The instruments need to be exposed for short periods.

Non-critical instruments

These instruments are at least risk of transmission as they get in contact with intact skin only.

This includes Radiograph holders, cones, blood pressure cuffs, facebow, a pulse oximeter.

Non-critical instruments should be cleaned and disinfected or use disposable barrier protection.

Manual (Required when washer/disinfector method is not used)

 

  • All instruments must be cleaned in the completely open and disassembled (i.e., taken-apart).
  • Prepare a neutral pH enzymatic detergent according to the vendor’s directions. A highly alkaline for aluminum instruments is not recommended.
  • Completely immerse the device in the prepared detergent as per labeling instructions.
  • Allow complete penetration of detergent into the hard to reach areas. This is achieved by actuating all movable parts during soak time.
  • Use a soft-bristled brush to scrub the device. Pay utmost attention to the scrubbing of the movable parts, lumens, and crevices. Carry out scrubbing in hard to reach areas until visible soil has been removed.
  • Rinse all surfaces, crevices, and lumens in running water (RO/DI) for a minimum of 3 minutes to remove any residual detergent/debris.
  • Dry the instruments with a clean, soft cloth.
  • Carefully examine each instrument for cleanliness. If any residual soil is visible, repeat the procedure.

Considerations for Lumen devices and Cannulas.

Additional steps are carried out in the procedure:

  • For lumen devices, use an appropriately sized syringe filled with a minimum of 15ml of detergent. Flush the lumen with the syringe for at least 7 times.
  • Prepare a neutral pH enzymatic detergent in the sonicator and sonicate the instruments for a minimum of 10 minutes. The enzyme solution shall be changed to bloody or turbid color when it becomes grossly contaminated.
  • Flush internal lumens at least 3 times with a minimum of 15 ml of RO/DI running water. Flush ports can also be used if available.

Inspection and testing

  • Check for smooth movement of hinges. The Locking mechanisms should be smooth and free of nicks.
  • Broken, chipped, worn out, or cracked instruments should be kept aside and sent for repair or replacement.
  • The stain should be removed from Stained or discolored instruments by soaking them in Cold Soak stain and rust remover. The instructions from the detergent manufacturer should be followed.
  • Lubricate all the instruments before autoclaving with Insta-Lube or a steam permeable instrument lubricant.

Packaging of instruments

The instruments can be wrapped in a sterilization wrap, as per manufacturer’s instructions.

Autoclave Sterilization

The instruments provided by the Artman Instruments are reusable and meet AAMI standards for sterilization. We guarantee our products to withstand a minimum of 20 sterilization cycles according to the criteria listed.

Sterilization can be performed with different techniques. The Autoclave or ethylene Oxide method is a famous one. The Time and Temperature parameters required for sterilization vary according to the type of sterilizer, the packaging material, and the cycle design.

The steps of Autoclave Sterilization are as follows:

  1. Each healthcare facility should test to ensure the specific configuration of instruments is suitable for sterilization or not.
  2. Do not sterilize the instruments at temperatures beyond 141 ̊C (285 ̊F).
  3. All ring handled instruments must be autoclaved in a fully open position. This is done to prevent cracking of the box lock.
  4. All instruments must be sterilized in an open and disassembled condition/configuration.
  5. All the flush ports should be in a fully open position.
  6. All devices should be positioned to allow steam contact of all surfaces.
  7. All instruments with concave surfaces should be placed so that the surfaces will drain water. The drainage of water is difficult with the concavities of the instrument. Thus,a cautious approach is recommended.
  8. Verify parameters with the instructions from the sterilizer.

Ultrasonic Sterilization

  1. Wear Personal Protective Equipment (PPE), including safety eyewear, facemasks, impermeable socks, and gloves to protect yourself from microbial contamination while cleaning and preparing the instruments.
  2. The biological debris on the instruments (blood and saliva) may dry out. To prevent this, immerse the instruments in an enzymatic presoak or a germicidal soak. PreZyme is a popular enzymatic soak.
  3. An Ultrasonic Cleaning solution such as UltraDose Germicidal should be used that is diluted to 1 oz. Per gallon of water.
  4. Instruments to be cleaned are to be placed in a mesh tray or a basket. The tray is then suspended by its handles into the ultrasonic cleaning solution. A complete immersion of the instruments into the solution should be ensured.
  5. Average cleaning time of 7-10 minutes should be given. The time duration varies according to the load. The temperature is set using the intuitive control panel, and this must be ensured that the temperatures be kept below 107⁰F (42°C).
  6. When the ultrasonic cleaning cycle is completed, rinse the instruments in water to remove solution residue and then move to the disinfecting/sterilizing steps to complete the process as an interim step Barrier Milk can be used to lubricate hinges and prevent corrosion.

Follow the instructions provided by manufacturers of ultrasonic cleaning equipment and solutions.

Storage

After sterilization, the instruments should remain in a sterilization wrap and stored in a clean and dry cabinet. Care must be taken to protect the jaws from damage. Proper sealing of the instrument container should be ensured.

Maintenance and Repair

Apply lubricant only on the connecting elements and moving parts.

To ensure that all repairs are completed according to the manufacturer’s specifications, the precision instrument should be repaired by Artman Instruments only.

Regardless of age, if any instrument needs service, return it to your authorized service center. All instruments must be cleaned and sterilized prior to sending them.

Warranty

We guarantee every instrument to be free of functional defects in workmanship and materials when used normally for its intended purpose. Any instrument proving defective will be replaced or repaired in accordance with our guarantee available online.

Frequently Asked Questions

There are 2 different types of crown removers. The automatic and manual crown remover.

The crown removers comprise the tips and the handpiece. The tips come under critical category, and the handpiece comes under non-critical.

Sterilization of tips

There is clotted blood in the tips most of the time that is advised to clean with the ultrasonic cleaner prior to autoclave. The tip should also be examined if these are blunt or out of shape. If found, then these should be repaired or discarded.

Sterilization of the handpiece

We do not recommend the heat or steam sterilization of the handpiece since it contains the spring that may lose its tension after a few cycles of sterilization.

 If you want to control the power of impulse of the handpiece, you can do it by holding the “tip holding part” with the provided wrench and moving the “power controller” with your fingers in the handpiece. 

Impact of Autoclaving on the loading spring of handpiece

 The other important care for the automatic crown is the checking of the loading spring. If you cannot generate the impulse by pressing the button or lever on it, it means spring is out of order and should be replaced. The recurrent autoclave heat affects the spring, and it loses its power after a certain period.

When dealing with impression trays, the problem of impression materials or plaster getting hardened inside the tray, so it is important to remove the alginate as soon as possible. To remove alginate,the following steps should be followed:

1)            Submerge the trays in a container with water and 4 spoons of white Vinegar for half an hour.

2)             Use 60 ml of Vinegar for every half liter of water. A higher concentration of Vinegar can affect the shine of metallic impression trays.

3)            When it gets softened, remove the material with a plastic scraper from the backside of trays by scraping on the perforations.

4)            Push the wax knife between the tray and impression material at one side and peel it off. Repeat this peeling off on the other side.

5)            Pull out the whole bulk of alginate in one piece.

6)             We suggest an ultrasonic cleaning after this in order to remove the tiny pieces of alginate that are otherwise difficult to remove.

Hard and Soft plaster: The plaster sometimes gets stuck in the perforations and under the molded borders of the tray.

Solution:

1) Submerge the impression trays in water containing EDTA.

2) Use 30 ml of EDTA for every half liter of water.

3) Leave the impression trays submerged for 30 minutes.

4) Now you can scrape off the plaster easily.

5) Ultrasonic cleaning is a good practice after this to get the fresh look of the trays.

Rubber base Impression materials. Follow the following steps:

1)            Scrape off the material from the perforated area at the backside of the trays with a plastic scraper.

2)             Free the materials under the molded border of the tray on all sides with some wax knife.

3)            Leave the tray submerged in hot water for half an hour.

4)            Push the wax knife between the tray and impression material at one side and peel it off. Repeat this peeling off on the other side.

5)            The material should easily get off once you pull it.

Sterilization of impression trays

We recommend the following sterilization procedure for perforated steel and plasma coated impression trays.

1)            After ultrasonic cleaning, make the trays dried with air. You can use a hairdryer if you want quick action.

2)            Pack every pair of trays, upper and lower, in a sterilization pouch and seal it.

3)            Leave all the pouches in a steam autoclave. The usual cycle maintains a temperature of 121° C for at least 30 minutes by using saturated steam under at least 15 psi of pressure.

Scissors fall under the critical, semi-critical, and non-critical category depending upon their use.  Refer to the respective category for sterilization procedure.

Castroviejo Scissors and Needle Holders: These scissors are mainly used for stitch removal, and for other small cuts, they easily lose their sharpness and spring action because of the autoclave procedure. It is recommended to use the chemical sterilization procedures for these.

Lagrange scissors and Goldman fox scissors are mainly used in dissection and come in direct contact with the blood. These can be autoclaved if their cutting part is inserted with tungsten carbide. The scissors without tungsten carbide inserts can lose their sharpness even after a single autoclave cycle. Any scissors used for some other procedure that is not recommended for it will more likely damage its sharpness.

Bandage scissors are used outside the body, to cut the bandages and tubing, these are recommended for chemical sterilization. Most of these scissors have plastic or nylon made handles that are autoclavable, but since heat sterilization can damage its sharpness, we recommend chemical sterilization.

The bandage scissors with the serrated cutting edge stand well in the autoclave and can be autoclaved a few times.We at Artman Instruments sell bandage scissors with serrated cutting edges.

The orthodontic pliers and forceps fall under the Semi critical instrument category. It is preferable to heat sterilize them in an autoclave (see critical instruments for reference).

The orthodontic pliers can be cleaned by high-level disinfection, but the preferred method is autoclaving. Most of the orthodontic pliers are used for wire bending and do not have sharp edges. These can be easily autoclaved. The wire cutters are mostly supplied with the tungsten carbide inserts; they can also be autoclaved.

The dental syringe does not come in direct contact with mucosa or the broken skin, so it falls under the category of Semi critical Instruments.High-level disinfection can be done, but autoclaving is preferred. It is recommended to wrap the syringes in autoclavable pouches before sterilization.

The sterilization of burs is carried out in an autoclave at 121 for 15 minutes at a pressure of 15lbs. The autoclave sterilization tends to rust the burs, so as a protective mechanism, the burs should be kept submerged in 2% Sodium Nitrate Solution.

The diamond and carbide burs should be placed in 0.2% glutaraldehyde and Sodium phenate for at least 10 minutes, then cleaned with a brush or in an ultrasonic bath and then sterilized in the autoclave.

Steel burs,drills, and trephines can be sterilized using a chemical vapor sterilizer at 230 for 20-30 seconds.

The implant-bone expanders should be autoclaved (refer to the sterilization of critical instruments) after cleaning in the ultrasonic cleaner. Ultrasonic vibrations remove the clotted blood in the thread and clean it well. 

Liposuction cannulas and handles must be sterilized before each use.

Cleaning instructions:

  1. Immerse in hot, soapy water.
  2. Carefully scrub internally with a cannula brush and stylet.
  3. Ultrasound and/or pressure water if available.
  4. Dry and Package.
  5. Autoclave at 265-270 degrees, 25 psi for a minimum of 15 minutes.

The photocontrasters can be metallic with the dark color coating or the plastic ones. Plastic photocontrasters are mostly disposable. The metallic photontrast that gets in contact with the oral mucosa is recommended for chemical sterilization.

If these are autoclaved, they may get micro-cracks on the surface after repeated autoclaves since the expansion and contraction of the black coating is different than that of the underlying metal.

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