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

1. A very good morning
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2. A comparison of four different methods for
sterilizing orthodontic pliers
- George Kyritis, jco, June 2012 volume issue 6
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3. CONTENTS
INTRODUCTION
DEFINITIONS
HISTORY
DIFFERENT METHODS
ORTHODONTIC INSTRUMENTS
THE MAIN ARTICLE
RESULTS
DISCUSSION
SUPPORTING ARTICLES
CONCLUSION
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4. INTRODUCTION
On a daily basis, the practising dentist and his
personal are at risk of being exposed to a wide
range of patients with blood borne diseases such
as HIV/AIDS, hepatitis B,C and air borne diseases
such as tuberculosis.
Because of repeated exposure to micro-
organisms in blood and saliva, incidence of
certain infectious disease has been significantly
higher among dental professionals than observed
for general population.
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5. INTRODUCTION
 Orthodontists do not perform oral
surgery, but come in contact with blood and
oral fluids of healthy patients or infectious
patients when doing the orthodontic
treatment.
Of all the Dental health care
personal(DHCP), the rate of infection among
orthodontists, is very high, second only to oral
surgery specialists, as saliva is as infectious as
blood. 5

6. HISTORY
LOUIS PASTEUR (1822-95) was the first
scientist to show clearly that bacteria never
generate spontaneously and that no growth of
any kind occurs in the sterilized media.
Dr. Joseph Lister (1827-1912) Discovered the
effectiveness of 'carbolic acid,‘ which was used
in controlling typhoid. Using carbolic
acid, Lister was able to keep his hospital ward
in Glasgow free of infection for nine months.
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7. carbolic spray, copper, brass with wood
handle
Carbolic acid spray being used at the
time of a surgery
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8. Despite the fact that the germ theory of
disease had been established in 1877, it was
not universally accepted until 1882 when Koch
presented his masterly paper on ‘The etiology
to tuberculosis’ giving details of the isolation
of the tubercle bacillus.
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9. DEFINITIONS
STERILIZATION
It is defined as the process by which an
article, surface, or medium is freed of all
microorganisms either in vegetative or spore
state. (Panikar)
Denoting the use of physical or chemical
agents to eliminate all viable
microbes, including all bacteria, viruses and
spores. (Jerry R. Mc Ghee)
The process of completely eliminating
microbial viability (J.C.O. 1993) 9

10. DISINFECTION:
Disinfection means the destruction of all
pathogenic organisms or organisms capable of
giving rise to infection. (Panikar)
ASEPSIS
The absence of infection or infectious
materials or agents. (Miller)
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11. CATEGORIZATION OF INSTRUMENTS
Critical instruments
If an instrument
will be used to
penetrate tissue or
to touch bone it
must be sterilized.
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12. Semi-critical instruments
Semi-critical instruments:
mirror, probe, and
tweezers.
If an instrument will touch
mucous membranes, but
will not be used to
penetrate tissue or to
touch bone, it should be
sterilized if at all possible
or,. If the instrument is
susceptible to heat
damage, it should be
subjected to high-level
disinfection. 12

13. Non-critical instruments
 These are defined as
equipment and
surfaces which contact
only intact skin, such as
mixing slabs and
spatulas. Work surfaces
are decontaminated by
using intermediate-
level disinfection
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14. DIFFERENT METHODS OF STERILIZATION
Dry heat sterilization
Flaming
Hot air oven
Glass bead sterilizer
Autoclaving
Ethylene oxide sterilization
Chemical immersion/cold sterilization
Alcohol
Laser
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15. IN THE PRESENT ARTICLE
The author has basically tired to compare four
different methods of sterilizing the
orthodontic pliers and their efficiency.
Wrapped cassettes in M11 ultraclave
V- shaped pouches in M11 ultraclave
Wrapped cassettes in statim 5000
V shaped pouches in statim 5000
STATI STATIUM M 5000
M 11 ULTRACLAVE 15

16. Following the CDC guidelines
1.After cleaning , instruments should be bagged in a
pouch of appropriate size or placed in a cassette that is
subsequently wrapped
2. Hinged instruments, including pliers should be
processed in open position.
3. A chemical indicator should be placed inside each pack.
4. The sterilizer should be loaded as instructed by the
manufacturer and pouches and cassettes should be
separated
5. Sufficient drying time is necessary after sterilization,
because wet pouches and wrapping are permeable to
microorganisms.
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17. Materials and methods
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18. Successful decontamination involves four steps:
 Pre- sterilization cleaning
Packaging
Sterilization
Adequate storage
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19.  50 othodontic pliers were collected and 5 handpieces.
-10 weingart pliers
- 8 matheiu pliers
- 5 ligature cutters
- 8 distal end cutters
- 4 three prong pliers
-5 bird beak pliers pouches for sterilization
-5 tweeds pliers
-3 braceket removing pliers
-2 posterior band removers
-5 handpieces
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20. IMS double decker cassettes were chosen for
the cassette sterilization cycle because of
there ability to hold pliers in open position.
V shaped pouches especially designed for the
hinged instruments were used for the
pouched instrument cycle.
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21. A fully loaded M11 ultraclave sterilizer could
accommodate eight cassettes and five
pouched handpieces.
A statim sterilizer could hold one cassette and
three pouched hand pieces.
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22.  In the cycles using V-shaped instrument
pouches, the M11 Ultraclave sterilizer held a
maximum of 42 pouches and the Statim 50
only 16 pouches.
 A Class 5 steam sterilization integrator was
placed inside each pouch and in the middle of
each cassette to verify the sterilization.
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23. Both machines were fully automatic sterilizers
equipped with microprocessor controls and
LCD panels. The sterilization cycle was set at
132 ͦ-135 ͦ C and 5- 6 minute sterilization time.
The test was repeated three times by two
different operators and the average time for
each step was calculated
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24. RESULTS
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25.  To evaluate the efficiency of each sterilization
method, the average total time processing
time per instrument was calculated.
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26. By measurment the most efficient method
was the M11 ultraclave with V pouches.
 The least efficient was statim 5000 with
cassettes.
These results suggest that smaller sterilizers
are less efficient than the large capacity
sterilizers when pliers are wrapped and
autoclaved in accordance with CDC guidelines.
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27. DISCUSSION
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28. Advantages……
 This study follows the CDC recommendations on
wrapping and packing of instruments prior to
sterilization.
V shaped pouches specifically designed for
hinged instruments wee used for the pouch
sterilization cycle.
Integrated Class 5 chemical indicator was used
which allowed the dentist and the staff to verify
that the instruments were properly sterilized.
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29. Shortcomings..
 There has been no comparison between dry
heat sterilization. Since these days pliers are
manufactured with the medical grade
stainless steel with carbide burs. So, corrosion
and dulling associated is no longer an issue.
 The bagging and wrapping prior to
sterilization , can be a challenge for a busy
orthodontic office because of large number of
pliers used everyday.
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30. Shortcomings..
 It is important to use a sterilization method
that not only ensures patient safety by
following CDC guidelines but also allows rapid
instrument turnover in the clinic.
The amount of time , material and energy
wasted in reprocessing unused instruments
was not addressed in this study.
 Further investigations are needed to allow
better appraisal of all currently available
sterilization methods and equipments.
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31. Supporting articles
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32. Effective disinfection of orthodontic pliers.
J Orofac Orthop. 2006 Sep;67(5):316-36.
Wichelhaus A, Bader F, Sander FG, Krieger D Mertens T.
It should be possible to disinfect lipophilic viruses and the usual
bacterial infections adequately with all methods, provided that the
use of sprays and through disinfection is preceded by cleaning with
brush and water, followed by drying. With hydrophilic
viruses, however, the spray and trough disinfection methods are
limited in their efficacy and cannot be considered adequate.
Exclusively chemical methods are therefore less effective than
thermal or physical-chemical methods. The ultrasound bath and
thermal disinfection can therefore be recommended for the
disinfection of orthodontic pliers.
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33. Effect of steam versus dry-heat sterilization on the
wear of orthodontic ligature-cutting pliers.
Am J Orthod Dentofacial Orthop.
2002May;121(5):467-71.
There was no significant difference in the mean
wear at the tip of the pliers between the 2groups.
It appears that there is no need to maintain both
sterilization systems, dry heat and steam
autoclave, in the orthodontic office. Steam
autoclave sterilization can be used with no
deleterious effects on the pliers if they are
manufactured with stainless steel inserts.
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34. Corrosion of orthodontic pliers using different
sterilization procedures.
J Orofac Orthop. 2004 Nov;65(6):501-11.
This study showed that heat sterilization leads to
less corrosion than cold disinfection. Corroded
pliers can be restored to a useable condition by re-
polishing, though it is important that the
instructions for their care be strictly adhered to.
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35. The effect of routine steam autoclaving on
orthodontic pliers.
Eur J Orthod. 1993 Aug;15(4):281-90.
It is likely that the most important
factor, when setting up this type of sterilizing
method for orthodontic instruments, is to
establish a careful and meticulous routine for
cleaning, lubricating, and steam autoclaving
pliers. 35

36. Glass bead sterilization of orthodontic pliers
J Dent Assoc Thai. 1990 Jul-Aug;40(4):177-84.
The result showed that after the pliers were
scrubbed with alcohol and sterilized for 3 minutes
with glass bead sterilizer, all vegetative cells and
bacterial spores were killed in every test. This
study indicated that glass bead sterilizer is
capable of sterilizing orthodontic pliers and can
be a useful adjunct when rapid chair side
sterilization is desired.
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37. Microbiological evaluation of elastomeric chains.
Giovana R. Casaccia et al, Angle Orthod,Vol
77,No.5,2007
No evidence of any biological contamination due to
their manufacturing processes .During clinical use
care should be taken to avoid contamination by
pathogenic organisms. Precut lengths of the chains
would greatly reduce the risk of any biological
contamination.

38. An initial assessment of the effect on
orthodontic pliers of various
sterilization/disinfection regimes.
No statistical evidence was found of routine
autoclaving causing more damage to pliers
than cold disinfection; in fact, the data
suggested the contrary. Chrome plated pliers
appeared more resistant to damage and
maintained their appearance better than
stainless steel pliers.
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39. CONCLUSION
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40.  The packaging and sterilization methods
described in this study comply with all CDC
recommendations pertaining to the need to
sterilize hinged instruments in open position.
 For both sterilizers V- shaped sterilization
pouches allowed more pliers than popular
cassette system.
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41. The study also indicates that sterilizers with
smaller chambers are less efficient than large
capacity sterilizers in processing wrapped
orthodontic instruments.
Because of the heightened public awareness of
the dangers of cross- contamination and the
increased media attention paid to the rise of new
infectious agents and the treatment-resistant
organisms, orthodontists should expect CDC
guidelines to become mandatory. As they already
have in California and part of Europe.
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42. As the age old saying goes “prevention is
better than cure” but precaution is best and
must.
 so we as orthodontist hold a great
responsibility towards the society to not only
eradicate diseases but also prevent their
spread by following simple sterilization
protocols.
It might be a little time consuming but then
we all know that a “health is wealth” and
that a “healthy mind stays in an healthy body”
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43. References
Text book of microbiology
-R.Ananthnarayan & C.K.J.Paniker
Glass bead sterilization of orthodontic bands
AJODO; Sept 1986 -Gerald.E.Smith
An initial assessment of the effect on orthodontic
pliers of various sterilization/disinfection regimes.
 Microbiological evaluation of elastomeric
chains. Giovana R. Casaccia et al, Angle
Orthod,Vol 77,No.5,2007
43

44. Effect of steam versus dry-heat sterilization on
the wear of orthodontic ligature-cutting pliers.
Am J Orthod Dentofacial Orthop.
2002May;121(5):467-71.
Microbiological evaluation of elastomeric
chains.Giovana R. Casaccia et al, Angle
Orthod,Vol 77,No.5,2007
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45. Thank you
- Sneh Kalgotra
1st year PG.
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