The Effects of Sterilization Procedures on the Cutting Efficiency of Endodontic Instruments: A Systematic Review and Network Meta-Analysis

Abstract

Sterilization processes guarantee the sterility of dental instruments but can negatively affect instrument features by altering their physical and mechanical properties. The endodontic instrumentation can undergo a series of alterations, ranging from corrosion to variation in the cutting angle and then changes in the torsional properties and torsional fatigue resistance. This systematic literature review and meta-analysis aims to investigate alterations to the cutting efficiency of endodontic instruments that are induced by procedures for their disinfection and sterilization. Methodologies adopted for this investigation follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The following were used as search terms on PubMed and Scopus: “endodontic sterilization”, “endodontic autoclave”, “cyclic fatigue”, “torsional”, “cutting efficiency”, “sterilization”, “surface characteristics”, and “corrosion”. At the end of the selection process, 36 articles were identified, and seven of them are included in this systematic review. The results of a meta-analysis conducted for the use of 10 autoclaving cycles shows a standardized mean difference (SMD) of 0.80 with a p-value equal to 0.04 with respect to effect on cutting efficiency. The network meta-analysis, through direct and indirect comparison between the different autoclave cycles (0, 1, 5, 10, and 15 cycles), revealed that treatment involving 15 autoclave cycles produced the most robust results in terms of having the greatest effects in terms of altered cutting efficiency with a probability of 57.7% and a SUCRA (surface under the cumulative ranking) of 80%. The alterations in the effects on cutting efficiency appear to be triggered after five cycles of sterilization by heat (autoclave). In conclusion, the meta-analysis of the data indicates that the autoclave sterilization protocol must not be repeated more than five times to preserve cutting efficiency. Within the limitations of this review, we can therefore establish that sterilization by autoclaving alone results in steel and NiTi instruments becoming less efficient in cutting after five cycles, as measured by a reduction in cutting efficiency.

Influence of sterilization procedures on the physical and mechanical properties of rotating endodontic instruments: a systematic review and network meta-analysis

“…First outcome: Khabiri et The entire selection and screening procedure, as described in Table 2 (Ref. [7,40,41,[87][88][89][90]), is presented in the flowchart in Fig. 1.…”

Sterilization of New Endodontic Hand Files Stored in Dental Office Inventory: An In Vitro Study

“…A study has concluded that the adoption of a combination of mechanical, chemical, and ultrasonic cleaning methods as a standard protocol can provide complete cleaning of biological debris from endodontic instruments. All the endodontic files should be cleaned ultrasonically to remove the surface residue followed by autoclave procedures, which are considered gold standard sterilization procedures, and packed and stored to prevent cross-contamination by pathogenic bacterial species [5][6][12][13][14].…”

Evaluating the shortest and most efficacious decontaminating method for endodontic files in Pediatric dentistry

“…In today's scenario, this is the major hurdle in establishing a dental home where children are vulnerable for corona virus infections 13 . A systematic review and network meta-analysis by Dioguardi M et al, 2021 concluded that autoclave sterilization protocol must not be repeated more than 5 cycles as it reduces the cutting efficiency of steel and NiTi instruments 14 . Various studies prove that autoclaving may lead to fracture of the rotary instruments due to cyclic fatigue.…”