The cleaning of dental diamond burs

Decontamination methods used for dental burs - a comparative study

AIMS AND OBJECTIVES

Infection control and modes of sterilizations are the key factors to avoid cross transmission of infection in the field of dentistry. Transmission of disease or infection is noted with improper sterilization of reused instruments. Dental burs are the most important tool in any endodontic or conservative procedures of teeth involving tooth contouring, restorative filling procedures and endodontic procedures. Hence, the present study is undertaken to assess the efficacy of different methods of sterilization or decontamination which are routinely used in dental clinics.

MATERIALS AND METHODS

For the present study 96 round diamond burs were selected and divided into 6 groups. These burs were used for the access cavity preparation to get contamination and subjected for bacteriological culture. After getting base line date burs were subjected to manual scrubbing, hot air oven, glass bead sterilizer, ultrasonic cleaner and autoclave to get post decontamination data.

RESULTS

The study revealed that mean colony forming units/ml of Streptococcus mutans decreased maximum for autoclave with 80% reduction, for Lactobacilli 76% reduction and for Candida albicans maximum reduction seen for glass bead sterilizer with 74%.

CONCLUSION

Findings of our study revealed that none of the methods used were found to be absolutely efficacious in the decontamination of dental burs. However, among the experimental groups used in the present study, autoclave was found to be the relatively best method.

Changes in the cutting efficiency of different types of dental diamond rotary instrument with repeated cuts and disinfection

STATEMENT OF PROBLEM

Cutting efficiency is one of the most important factors to consider when a specific dental diamond rotary instrument is selected. However, the selection of a dental diamond rotary instrument is based on clinical experience rather than any scientific evidence.

PURPOSE

The purpose of this study was to identify how the cutting efficiency of different types of dental diamond rotary instrument changed with repeated cuts and disinfection.

MATERIAL AND METHODS

Four types of diamond rotary instrument from 2 dental manufacturers (Shofu, Jin Dental) were investigated with a high-speed air-turbine handpiece. The groups were as follows: S cham group (n=10): chamfer design from Shofu; J cham group (n=10): chamfer design from Jin Dental; S thin group (n=10): thin tapered design from Shofu; J thin group (n=10): thin tapered design from Jin Dental. Changes in the cutting efficiency of diamond rotary instruments on glass ceramic blocks were measured after repeated cuts. Changes in cutting efficiency also were measured for 30 diamond rotary instruments, the same type as those used in group J cham after disinfection with ethylene oxide gas, immersion in solution, or autoclaving. One-way ANOVA, 2-way ANOVA, and repeated-measures ANOVA were used to identify differences in cutting efficiency, in total cutting efficiency, and change trend in cutting efficiency (α=.05). The Tukey honestly significant difference method was used for the post hoc tests. The principal metal components of the diamond rotary instruments were detected with x-ray spectrometry.

RESULTS

The mean (standard deviation [SD]) total cutting efficiency after 10 cuts in the 4 groups was in the following order: J cham group (0.210 ± 0.064 g/min) > S cham group (0.170 ± 0.064 g/min) > J thin group (0.130 ± 0.042 g/min) > S thin group (0.010 ± 0.040 g/min) (P<.05).The decrease in the cutting efficiency was greatest after the first cut. The cutting efficiency was not influenced by repeated disinfection.

CONCLUSION

The cutting efficiencies of diamond rotary instruments with different designs and particle sizes showed a decreasing trend after repeated cuts but did not show any change after various disinfecting procedures.

Relationships between tissue properties and operational parameters of a dental handpiece during simulated cavity preparation

A preliminary study was conducted on the development of an intelligent dental handpiece with functionality to detect subtle changes in mechanical properties of tooth tissue during milling. Such equipment would be able to adopt changes in cutting parameters and make real-time measurements to avoid tooth tissue damage caused by overexertion and overextension of the cutting tool. A modified dental handpiece, instrumented with strain gauges, microphone, displacement sensor, and air pressure sensor, was mounted to a linear movement table and used to mill three to four cavities in >50 bovine teeth. Extracted sound frequency and density were analyzed along with force, air pressure, and displacement for correlations and trends. Experimental results showed a high correlation (coefficient close to 0.7) between the feed force, the rotational frequency, and the averaged gray scale. These results could form the basis of a feedback control system to improve the safety of dental cutting procedures. This article is written in memory of Dr Hongyan Sun, who passed away in 2011 at a young age of 37.

Decontamination of viable Streptococcus mutans from orthodontic tungsten carbide debonding burs. An in vitro microbiological study

OBJECTIVES

To investigate the effectiveness of currently recommended decontamination procedures on tungsten carbide debonding burs (TCDBs).

DESIGN

In vitro microbiological study.

SETTING

St George's Hospital NHS Trust, UK.

MATERIALS AND METHODS

A total of 240 extracted tooth surfaces were bonded with orthodontic brackets, debonded to leave residual composite and artificially contaminated with Streptococcus mutans.

INTERVENTION

Sterilized TCDBs in a slow handpiece were used to remove this composite before random allocation into one of six different decontamination groups of 40 burs each. These included a control group that was not decontaminated and a further five that underwent different methods of presterilization cleaning within the decontamination process (none, manual, ultrasonic, washer disinfector and enzyme soak) followed by sterilization in a vacuum phase autoclave at 134 degrees C for 3 min.

MAIN OUTCOME MEASURES

The burs were placed in brain heart infusion (BHI) broths, incubated for 48 h. Following this the broths were inspected for turbidity and microbiological analysis was carried out to detect viable bacterial growth. Data were analysed using the Kruskal-Wallis test for single ordered data.

RESULTS

S. mutans was recovered from 39 out of 40 burs in the control group and no burs from the decontamination groups, which was statistically significant (P = 0.001). No differences were found between decontamination groups (P = 0.271). However, skin flora contamination was noted in 17 broths.

CONCLUSIONS

The five methods of decontaminating TCDBs investigated in this study were effective in removing viable S. mutans. Other investigations are required to determine if TCDBs can be successfully cleaned of blood and protein residue prior reuse.

A comparison of decontamination methods used for dental burs

OBJECTIVES

This study investigated the bacterial and fungal contamination of used dental burs. A novel assay system for comparison of efficacy of pre-sterilisation cleaning techniques for dental burs was used to evaluate manual scrubbing, enzymic agents and washer-disinfectors.

METHODS

Thirty dental burs contaminated during cavity preparation were analysed for micro-biological total viable counts and species of bacteria and fungi present. To simulate clinically contaminated burs, a culture of Streptococcus sanguis NCTC 7863 was used to inoculate unused dental burs, alone and combined with blood, saliva or a mixture of blood and saliva. Contaminated burs were subjected to six pre-sterilisation cleaning techniques and the log reduction in contamination achieved by each method was assessed.

RESULTS

The microbial count from used dental burs ranged from 0 to 6.92 x 10(4) CFU ml(-1). Many potentially pathogenic species were identified. The decontamination assay demonstrated that autoclaving alone was not sufficient to sterilise dental burs. Manual scrubbing in air was less efficacious than manual scrubbing under water (p<0.001). The most effective method of pre-sterilisation cleaning for dental burs was a washer-disinfector.

CONCLUSIONS

Enzymic agents are suitable for soaking contaminated dental burs immediately after use. Washer-disinfectors are recommended as the method of choice for pre-sterilisation cleaning of contaminated dental burs.

The magnitude of cutting forces at high speed

STATEMENT OF THE PROBLEM

Previous research has used a range of cutting forces for preparing teeth, but there are no data available on the forces actually imposed while cutting teeth with high-speed handpieces.

PURPOSE

The purpose of this study was to measure the forces imposed while cutting teeth with tungsten carbide burs used in high-speed handpieces.

MATERIAL AND METHODS

Thirty-one dentists each cut 8 conventional class II MO and DO preparations in intact extracted third molars, by use of 2 different air turbine handpieces with different torque-speed characteristics. Two different flat fissure, plain and cross-cut tungsten carbide burs, cutting wet and dry in each handpiece/bur combination. The teeth were mounted in a custom-made transducer unit that displayed the forces imposed by the bur. Data were analysed with a 1-way ANOVA (alpha =.05) and Spearman correlation test.

RESULTS

The results showed that there was no significant difference in the applied force between plain and cross-cut burs, cutting wet or cutting dry, but there was a significant difference between the high and the lower torque handpieces. The higher torque handpiece was used at a mean cutting force of 1.44 N and the lower torque handpiece at 1.20 N (P<.002). The overall general mean force observed was 1.30 N.

CONCLUSION

It was concluded that the forces used in cutting teeth with the tungsten carbide burs tested related both to the type of the handpiece and to the forces chosen by clinical operators. There was no difference between the plain and cross-cut burs, there was no difference between the cutting wet or dry, and the higher torque handpiece required a higher mean cutting force.

Variant Creutzfeldt-Jakob disease--a problem for general dental practitioners?

Over a hundred deaths from variant Creutzfeldt-Jakob disease (vCJD) have now been recorded. The incubation period for vCJD may be up to 40 years and the number of asymptomatic carriers in the population could be as many as 100,000. Confirmed iatrogenic transmission of other human transmissible spongiform encephalopathies raises the possibility of cross-infection from apparently healthy persons who are incubating vCJD. Decontamination techniques routinely used in general dental practice are incapable of inactivating the infective protein responsible for transmitting the disease. So far, no evidence exists to preclude the risk of iatrogenic infection occurring during dental procedures. The author reviews present knowledge of the infective agent, its transmissibility, its origins, current guidelines and the implications for dental practice.

Disinfection of dental diamond burs contaminated with hepatitis B virus

STATEMENT OF PROBLEM

Hepatitis B infection (HBV) is a significant hazard in the dental environment because the virus may be transmitted through contaminated dental instruments.

PURPOSE

This study determined whether cold disinfectants can inactivate HBV DNA and HBV surface antigens on diamond burs contaminated with HBV and whether ultrasonication can increase the antiviral properties of these agents.

MATERIAL AND METHODS

Sterile dental diamond burs were contaminated with serum from a patient who tested positive for HBV surface antigen and hepatitis B viral DNA. The burs were air dried and placed in solutions containing either Cidex, Asepsys, TBS, Rotagerm, Virkon disinfectants, or a control phosphate buffered saline. Burs were divided into 2 groups and disinfected for 15 minutes. The first group was ultrasonicated; the second group was not ultrasonicated during disinfection. All the burs were transferred to phosphate buffered saline and ultrasonicated to remove any remaining viral particles. The ultrasonicate was tested for the presence of HBV surface antigen with a microparticle enzyme immunoassay and for hepatitis B viral DNA with a chemiluminescent molecular hybridization assay.

RESULTS

TBS did not require ultrasonication to inactivate viral DNA and surface antigen. Rotagerm and Virkon inactivated surface antigen and viral DNA only with ultrasonication. Cidex and Asepsys inactivated viral DNA but not surface antigen with ultrasonication.

CONCLUSION

The chlorine containing compound TBS was the most active disinfectant tested and did not require ultrasonication to destroy HBV. The remaining disinfectants should be used with ultrasonication to inactivate HBV.

Dental diamond burs made with a new technology

STATEMENT OF PROBLEM

Conventional diamond burs show several limitations such as the heterogeneity of grain shapes, the difficulty of automation during fabrication, the decrease of cutting effectiveness due to repeated sterilization, and short lifetime. An additional shortcoming may be represented by the potential release of Ni+2 ions from the metallic binder into the body fluids.

PURPOSE

This study investigated a new diamond rotative instrument made of a continuous diamond film obtained by chemical vapor deposition (CVD). This bur, characterized by a pure diamond cutting surface without metallic binder between crystals, was compared with a conventional diamond bur.

MATERIAL AND METHODS

Cutting tests were followed by SEM examination and electron microprobe analysis (EMA) to trace metallic residues both at the surface of the bur and the substrate.

RESULTS

EMA demonstrated that the metals Ni, Cr, Si, and Fe were present in the metallic binder matrix of the conventional bur and could be smeared on the surface of the substrate during cutting. SEM showed that significant loss of diamond particles occurred during cutting. On the other hand, no discrete particles sheared off the CVD bur. The smearing of the metallic binder cannot occur using the new bur.

CONCLUSION

The new CVD bur not only proves to be more efficient in its cutting ability and longevity, but also excludes the risk of metal contamination. This last aspect concerns both the pollution of the oral environment and the contamination of the ceramic during the laboratory manufacturing of dental restorations.

Dental cutting: the historical development of diamond burs

This brief history of the dental diamond bur is intended to provide both a historical perspective and an evaluation of the current state of bur technology. An understanding of the origins of dental diamonds and the issues facing manufacturers transforms the dentist from a simple user into an informed consumer. The author contends that this can improve dental care and enable the dentist to collaborate with manufacturers in developing improved dental burs.

Dental air turbine handpiece performance testing

Air turbine handpieces are expected to continue to be widely used as the main means of carrying out dental cutting work and scope exists for further design improvements. An understanding of the theoretical principles governing the performance of these devices seems essential for the systematic development of better handpiece designs and methods of specification. Furthermore, for experimental work on cutting behaviour with air turbine equipment, this knowledge is required for appropriate characterization of the performance of the particular handpiece used with respect to actual rates of energy disposition. The literature relating to air turbine handpiece performance is critically reviewed to assess currently available methods of measuring important variables such as speed, torque, and power. In this, consideration is given to the current state of knowledge of the influence on these variables of air pressure, flow and turbine design features. It is apparent that, although various measurement methods have been described and data for individual handpieces published, no attempt has yet been made to explore the functional relationships that exist between the variables. It is concluded that there is a need to identify the factors influencing turbine performance, to develop measurement systems which would provide adequate accuracy and precision and then to investigate the functional relationships between these relevant variables.

The present status of dental rotary cutting performance tests

Appropriate methods of assessing the cutting ability of handpiece and rotary cutting instrument combinations are needed for research into the processes involved in dental cutting. They are also required for the development of improved devices and recommendations on operation as well as for equipment specification and standards testing. In reviewing the literature on dental rotary cutting performance testing to evaluate available methods, the factors which may influence clinical cutting behaviour are identified as those related to characteristics of the operator, handpiece, rotary cutting instrument, coolant/lubricant used and workpiece material. Existing industrial cutting theory is of limited help in understanding dental cutting in view of the differences between the control of relevant variables in the two cases. Consideration is given to the ways in which the important variables have (or have not) been controlled in past studies of dental cutting and thus the clinical relevance of available methods evaluated. Serious problems such as the lack of suitable test workpiece materials, as well as deficiencies in current knowledge of operator behaviour, handpiece characteristics and effects of coolant/lubricant application are noted. It is concluded that before improved, clinically relevant tests can be developed, further fundamental research in these areas is essential and that until this is done, further work under arbitrary experimental conditions would be of little value.

Cutting effectiveness of diamond instruments subjected to cyclic sterilization methods

The effect of repeated sterilization on the cutting effectiveness of one brand of rotary dental diamond cutting instruments was measured. Four groups of five diamond burs were sterilized by four methods: (1) sterilization with a chemical agent (Sporicidin); (2) steam under pressure (autoclave); (3) dry heat (Dri-Clave); or (4) chemical vapor (Chemiclave). Each group of diamond instruments made a timed cut in a ceramic block. This cut and all subsequent cuts were measured and were used to determine a baseline cutting effectiveness. Each group of diamond burs was then ultrasonically cleaned, sterilized, and another cut was made. At the end of 10 cycles there was no difference in cutting efficiency of the dental diamond instruments. However, there are differences in the cutting efficiency of individual diamond instruments. The SEM evaluation made prior to cutting and at the end of the 10 cycles of sterilization demonstrated that diamond wear was similar in all groups and that little diamond particle loss occurred in any group.

An evaluation by scanning electron microscopy of small dental cutting instruments through use and cleaning

The progressive status of some selected small dental cutting instruments was examined from the time of their unpackaging through routine institutionalized cleaning and sterilizing procedures both before and after first and subsequent use. The cleaning protocol in place at the time involved a phosphoric acid based detergent and ultrasonic cleaning. All assessments were made by scanning electron microscopy. It was found that new burs as unpackaged are unacceptable for use without first being subjected to a cleaning process and that the cleaning procedure utilized was ineffective and unsuitable. Also observed was the potential for gross contamination; the need for subsequent ultrasonic cleaning; and the different rate and nature of deterioration, with use, of the three bur types studied. This study has led to the introduction of modified procedures for the physical cleaning of small cutting instruments in our institution and confirms the usefulness of the scanning electron microscope in the ongoing practice of quality assurance.