Investigating steam penetration using thermometric methods in dental handpieces with narrow internal lumens during sterilizing processes with non-vacuum or vacuum processes

Background: Dental handpieces are required to be sterilized between patient use. Vacuum steam sterilization processes with fractionated pre/post-vacuum phases or unique cycles for specified medical devices are required for hollow instruments with internal lumens to assure successful air removal. Entrapped air will compromise achievement of required sterilization conditions. Many countries and professional organizations still advocate non-vacuum sterilization processes for these devices.

Aim: To investigate non-vacuum downward/gravity displacement, type-N steam sterilization of dental handpieces, using thermometric methods to measure time to achieve sterilization temperature at different handpiece locations.

Methods: Measurements at different positions within air turbines were undertaken with thermocouples and data loggers. Two examples of widely used UK benchtop steam sterilizers were tested: a non-vacuum benchtop sterilizer (Little Sister 3; Eschmann, Lancing, UK) and a vacuum benchtop sterilizer (Lisa; W&H, Bürmoos, Austria). Each sterilizer cycle was completed with three handpieces and each cycle in triplicate.

Findings: A total of 140 measurements inside dental handpiece lumens were recorded. The non-vacuum process failed (time range: 0-150 s) to reliably achieve sterilization temperatures within the time limit specified by the international standard (15 s equilibration time). The measurement point at the base of the handpiece failed in all test runs (N = 9) to meet the standard. No failures were detected with the vacuum steam sterilization type B process with fractionated pre-vacuum and post-vacuum phases.

Conclusion: Non-vacuum downward/gravity displacement, type-N steam sterilization processes are unreliable in achieving sterilization conditions inside dental handpieces, and the base of the handpiece is the site most likely to fail.