Sterilization of reusable implant components: a pilot study

Contemporary Sterilization Protocols of Healing Abutments for Reusability: A Systematic Review

INTRODUCTION

Although healing abutments are designated for single use by most implant manufacturers, it is common practice for clinicians to reuse healing abutments. However, there is a lack of adequate references that describe detailed sterilization protocols for reuse of healing abutments.

OBJECTIVES

The purpose of this systematic review was to compile, organize, and describe the most common techniques for the sterilization of healing abutments and their efficiency in eliminating traces of microorganisms.

METHODS

An electronic search in 5 different databases was performed, including the National Library of Medicine (MEDLINE via PubMed), Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar from January 2000 to December 2020. Search variables included were dental implant, healing abutment, contaminate, contamination, reuse, and sterilization. Studies reporting with a minimum sample size of 10 healing abutments (5 per group) published in the English language were evaluated. Risk of bias assessment was elaborated for included investigations.

RESULTS

In total, 812 articles were identified, of which 8 were included in the analysis. Steam autoclave was the most widely used form of resterilization. Not a single protocol, however, was able to achieve 100% virgin surface of the healing abutments.

CONCLUSION

Although reuse of dental implant healing abutments is a cost-effective measure in dental practice, thorough surface decontamination followed by resterilization is highly recommended before reuse.

KNOWLEDGE TRANSFER STATEMENT

With consideration of cost and patient preference, results of this review would be useful in knowing various sterilization protocols for reusing healing abutments that could lead to more appropriate therapeutic decisions.

Evaluation of residual contamination on reused healing abutments

OBJECTIVES

The purpose of this study is to evaluate residual contamination of healing abutments sterilized by dealers of dental implant companies.

MATERIAL AND METHODS

Healing abutments collected from dealers of different implant companies were randomly numbered, and they were examined for visible deformation and contamination on the abutment surface, packaging errors, and presence of a sterilization indicator. The healing abutments were stained with a dye solution for contamination detection and evaluated by dividing into different regions. The presence of residual contamination was examined through photographic images taken from the healing abutments and the data obtained were recorded. Pearson's chi-square analysis was used to evaluate the relation between implant brands and contamination status. Significance was evaluated as p <0.05.

RESULTS

Visible residual contamination was detected in approximately 31% of the healing abutments. After the staining procedure, in the visual assessment of the stained surfaces, residual contamination was found in at least one region of all healing abutments except one (n=176, 99.4%). The most intense staining was seen in the screw driver hole (n=172, 97.1%), body (n=113, 63.8%), occlusal (n=107, 60.4%), screw (n=79, 44.6%), and connector (n=72, 40.6%) regions, respectively. A significant relationship was found between the brands and the contamination status (p <0.05).

CONCLUSION

The reuse of healing abutments is not suitable, as it does not ensure optimum cleaning and sterilization, and it is not possible to eliminate contaminants completely.

CLINICAL RELEVANCE

Despite the economic benefits of multiple use of healing abutments, disadvantages should be carefully evaluated by clinicians.