Linsuwanont P, Parashos P, Messer H H
School of Dental Science, University of Melbourne, Melbourne, Victoria, Australia.
Int Endod J. 2004 Jan;37(1):19-28. doi: 10.1111/j.1365-2591.2004.00747.x.
To develop and evaluate an effective cleaning procedure for rotary nickel-titanium (NiTi) endodontic instruments.
New rotary instruments (ProFile size 25/.04) were contaminated by preparing canals of extracted teeth. Three factors were evaluated to develop an effective cleaning sequence: dry or moist storage before cleaning; mechanical removal (brushing); and chemical dissolution in 1% NaOCl with ultrasonication. Debris on flutes was scored after staining in situ with Van Gieson's solution at x45 magnification. Debris was classified as stained or unstained particulate debris and organic film, and rated as none, slight, moderate or heavy. The effectiveness of a recommended cleaning sequence was tested on different instrument types and in private endodontic practices.
All new instruments showed metallic spurs and fine particulate debris on the surfaces. After contamination, brushing alone removed most particulate debris, but did not remove organic film. NaOCl effectively removed organic film. Under laboratory conditions, the sequential cleaning procedures (moist storage, brushing followed by immersion in 1% NaOCl and ultrasonic cleaning) totally removed organic debris. Dry storage before cleaning or autoclaving with debris present reduced cleaning effectiveness (P<0.001, one-way ANOVA). In three private practices, the cleaning protocol substantially reduced biological contamination, but complete cleaning was not always achieved (87% clean).
Complete removal of organic debris from instruments is feasible using a combination of mechanical removal and chemical dissolution, but requires meticulous attention to details.
制定并评估一种有效的旋转镍钛根管器械清洁程序。
通过预备拔除牙齿的根管来污染新的旋转器械（Profile 25/.04型号）。评估三个因素以制定有效的清洁顺序：清洁前干燥或湿润保存；机械清除（刷洗）；以及在1%次氯酸钠中超声化学溶解。用范吉森氏溶液原位染色后，在45倍放大倍数下对器械凹槽上的碎屑进行评分。碎屑分为染色或未染色的颗粒碎屑和有机膜，并评为无、轻度、中度或重度。在不同器械类型和私人牙髓治疗诊所中测试推荐清洁顺序的有效性。
所有新器械表面均有金属毛刺和细小颗粒碎屑。污染后，仅刷洗可去除大部分颗粒碎屑，但不能去除有机膜。次氯酸钠能有效去除有机膜。在实验室条件下，顺序清洁程序（湿润保存、刷洗后浸泡在1%次氯酸钠中并超声清洁）可完全去除有机碎屑。清洁前干燥保存或有碎屑时进行高压灭菌会降低清洁效果（P<0.001，单因素方差分析）。在三家私人诊所中，清洁方案显著降低了生物污染，但并非总能实现完全清洁（87%清洁）。
结合机械清除和化学溶解从器械上完全去除有机碎屑是可行的，但需要对细节予以精心关注。
