This systematic review evaluated the influence of autoclave sterilization procedures on the cyclic fatigue resistance of heat-treated nickel-titanium (NiTi) instruments.
A systematic search without restrictions was conducted in the following electronic databases: PubMed, Scopus, Web of Science, ScienceDirect, Cochrane, and Open Grey. The hand search was also performed in the main endodontic journals. The eligible studies were submitted to the methodological assessment and data extraction.
From 203 abstracts, a total of 10 articles matched the eligible criteria. After reading the full articles, 2 were excluded because of the absence of the heat-treated instruments in the experimental design and 3 due to the lack of a control group using heat-treated instruments without autoclave sterilization. From the 5 included studies, 1 presented a low risk of bias, 3 presented moderate and 1 high risk. It was observed heterogeneous findings in the included studies, with autoclave sterilization cycles increasing, decreasing or not affecting the cyclic fatigue life of heat-treated NiTi instruments. However, the retrieved studies evaluating the cyclic fatigue resistance of endodontic instruments presented different protocols and assessing outcomes, this variability makes the findings less comparable within and also between groups and preclude the establishment of an unbiased scientific evidence base.
Considering the little scientific evidence and considerable risk of bias, it is still possible to conclude that autoclave sterilization procedures appear to influence the cyclic fatigue resistance of heat-treated NiTi instruments.
When curing the composite restorations with light curing units, the light guides are often in direct contact with oral tissues, therefore contamination of light guides is inevitable. Curing light guides fall into the "semicritical" instrument category according to the Centers for Disease Control and Prevention (CDC) and must be heat or vapor-sterilized or at a minimum, these semicritical instruments must be sterilized in a liquid chemical agent. Currently, most common methods of maintaining sterility of the light guides are wiping the guide with a disinfectant, such as glutaraldehyde, after each patient use; using autoclavable guides; using presterilized, single-use plastic guides; and using translucent disposable barriers to cover the guide.
The purpose of this study was to determine the effect of sodium hypochlorite and steam autoclaving on the cyclic fatigue of nickel-titanium endodontic files.
Two types of files with a .06 taper and #30 were used, K3® (SybronEndo, Glendora, California, USA) and Hero642®(Micro-Mega, Besançon, France).
The files were divided into 6 experimental groups containing 10 files each group depending the soaking time in 6% sodium hypochlorite solution and number of cycles of steam autoclave. After sterilization, a cyclic fatigue test was performed on each file, and the fracture time was recorded in seconds. The control group underwent the cyclic fatigue test only. After the test, the surface characteristics of the files were observed using scanning electron microscopy (SEM).
All groups containing the Hero 642® files showed a similar cyclic fatigue fracture time. However, the cyclic fatigue fracture time with the K3® files was significantly shorter in groups which were treated with sodium hypochlorite than in the control group (P < 0.05). SEM revealed both Hero642® and K3® files to have significant corrosion on the file surface in groups treated with sodium hypochlorite, compared with the sharp and regular blades of the control group. K3® files showed more corrosion than the Hero642® files. Bluntness of the blades of the K3® file was observed in groups treated with steam autoclave. Although there was no obvious destruction on the surface of steam autoclaved Hero642® files, slight bluntness was observed.
Sterilizing with a steam autoclave is much less destructive to K3® files than sodium hypochlorite. The longer time exposed to sodium hypochlorite, the more destructive pattern was shown on the blades of the files. Therefore, when using sodium hypochlorite solution, the exposure time should be as short as possible in order to prevent corrosion and increase the cyclic fatigue fracture time.
A variety files made of stainless steel (S-S) or nickel-titanium (Ni-Ti) are used during endodontic treatment. The purpose of this study was to evaluate the corrosion susceptibility of S-S and Ni-Ti endodontic files. Three brands of files were used for this study: K-flex® S-S files (Maillefer, USA), Profile® Ni-Ti files (Maillefer, USA), K-3® Ni-Ti files (SybronEndo, USA). 120 files of each brands (21mm, ISO size #20) were divided into 12 groups according to 1) sterilization methods using Autoclave or Ethylene Oxide (E-O) gas, 2) Irrigation solutions using 5.25 % NaOCl or Saline, 3) the number of sterilization (1, 5, 10 times). After above procedures, each of the files was inspected by three examiners with a light microscope and camera at X25. Each file was judged and ranked according to the following criteria: 0; no corrosion, 1; mild corrosion, 2; moderate corrosion, and 3; severe corrosion. The files of high score were examined under the Scanning Electron Microscope.
Data were statistically analyzed with the Kruskal-Wallis test (p < 0.05). Most of the ten time-autoclaved files had showed mild to moderate corrosion. But, one or five time-autoclaved files did not show corrosive surface. NaOCl treatment and E-O gas sterilization did not influence on corrosion. There was a significant difference in corrosion susceptibility between sterilization methods and the number of autoclaving. However, there was no significant difference between brands and file materials.