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News Bulletin : ADA News Bulletin April 2011
37 APRIL 2011 The next program commences in February 2012. This is a three year full-time program embracing all aspects of the specialty. The course is based at Westmead Centre for Oral Health. Candidates progress through a Graduate Certificate (Restorative) – over one semester, Graduate Diploma (Restorative) – over two semesters, and the DClin Dent (Prosthodontics) over six semesters. In first year, unless already completed, candidates are required to undertake the Orientation Course and Primar y Examination of the Royal Australasian College of Dental Surgeons. Applications close Wednesday 27 April 2011. For more information Dr Christine Wallace – Phone (02) 9845 7165 Professor Iven Klineberg – Phone (02) 9845 7192 – Email email@example.com Local applications (application form) http://sydney.edu.au/medicine/current-students/pdfs/apply-pg-coursework2010.pdf Applications to be forwarded to: Student Services Sydney Medical School Faculties of Dentistry and Pharmacy Edward Ford Building (A27) The University of Sydney NSW 2006 Faculty of Dentistry DClin Dent (Prosthodontics) RESPOnSE fROM THE AdA InfECTIOn COnTROL COMMITTEE CHAIRMAn Sir, I thank Dr Payne for his interest in this issue, which over the past decade has attracted considerable attention from the profession. The potential transmission of pathogens from one patient to another via contaminated dental instruments has led to single-use devices and more stringent assessment of re-sterilisation of instruments, as well as much debate on the topic of re-use of endodontic files. 1-16 As a first point, effective cleaning is essential before the first instrument use. A recent student project at the University of Queensland conducted by Poya Sobhanian showed that only two of 120 brand new endodontic files were microscopically clean, which is consistent with other research on unused files.6,8 ,16 There is good evidence to support reprocessing of rotary NiTi files using specified protocols. However, the same is not true for hand files whether they be made from NiTi or stainless steel. The two references referred to by Dr Payne describe rotary NiTi files treated with enzymatic agents. One cannot extrapolate the findings of these studies to hand files, which are difficult to clean using either hand or mechanical cleaning methods because of their small size and complex shape.2,3 Attempts to clean hand endodontic files by manual scrubbing, plunging them into sponge, or placing them into an ultrasonic cleaner without pre-treatment using enzymatic agents have all been shown to be equally ineffective.4,5 Debris was detected by microscopic examination on 76% of endodontic files retrieved from general dental practices.6 In a later study, visible debris was seen on 98% of a total of 220 endodontic files that had been used, cleaned, autoclaved and had been deemed ready for re-use.7 A further study of 250 reprocessed hand endodontic files collected from 25 general dental practices revealed that 75% had visual contamination.8 These data raise significant concerns regarding the common practice of re-using hand endodontic files. Recent research at UQ has tested the ‘Melbourne protocol’ which uses a combination of mechanical and chemical removal of debris from the files, beginning with 10 cycles of plunging files into sponges soaked with chlorhexidine to remove gross debris, followed by pre-soaking for 30 minutes in the dual enzymatic agent EmpowerTM and then 15 minutes of ultrasonic cleaning in same agent, and finishing with a 20 second rinse in running water. We found that while this protocol rendered all rotary NiTi files free of microscopic debris, when it was used with hand files (stainless steel K files, brand CC+, VDW Endodontic Synergy, Munich, Germany; and NiTi K files, brand Naviflex NT, Brasseler, Savannah, GA) it could not give reliable cleaning. Some 125 out of 600 cleaning cycles (21%) for stainless steel files left behind debris, while with NiTi hand files the failure rate across 600 cycles was almost identical at 20%. This supports other arguments behind the view that hand endodontic files should not be re-used, even though this may be acceptable for rotary NiTi files when the Melbourne protocol is used. Laurence J Walsh The University of Queensland 4000 *References supplied for both letters are available on request from firstname.lastname@example.org feedback
ADA News Bulletin March 2011
ADA News Bulletin May 2011