by Andrea L. Cook
How to choose them wisely and make them last
|Andrea L. Cook|
All orthodontic instruments are not created equal. Today, many companies are in the business of manufacturing orthodontic instruments, each with differences that affect the quality and life expectancy of their products. Different grades of steel, finishes, and tipping processes distinguish the quality of one instrument from another. Due to high patient volumes in orthodontic practices, orthodontic instruments are subjected to more processing cycles on a daily basis than dental instrument are. This additional processing requires higher-quality materials and additional steps in reprocessing. Ultrasonic cleaning in a functioning ultrasonic unit with proper solution, thorough rinsing, and the use of surgical milk prior to autoclave sterilization is recommended to protect your instrument investment during processing.
When choosing orthodontic instruments, the determining purchasing factor should not be price alone. Many orthodontists are unaware of the differences between the manufacturing processes of their instruments. In many instances, the price of an instrument is not reflective of its quality.
Finding the Right Fit
Each instrument has a specific application in the orthodontic office. To maintain instrument sharpness, ligature and wire cutters, as well as distal end cutters, have specific wire size restrictions. Oftentimes, instruments are misused. For example, cutters are used on wires that are larger than recommended or for completely different applications altogether. If a cutting instrument is used for wire sizes beyond its recommendation or used in another application, the results can be tip scoring, dulling sooner than recommended usage provides, or even chipping of the cutting surfaces. When a hinged pliers (such as Weingart or Howe) is continually misused for purposes such as crimping stops on an archwire, the tips of the instrument can become warped and fail to meet flush together.
|Misuse of hinged pliers can result in splaying tips such as these.|
Orthodontic assistants using instruments that are in excellent working condition have an increase in chairside efficiency and a decrease in frustration. They are able to complete procedures without needing to leave the patient to get replacement instruments that are functioning properly. By making certain that you buy the correct instrument for the correct application, you allow the instrument to work properly and maintain its function for an extended period.
Instruments of the highest-quality surgical stainless steel withstand repeated cycles of autoclaving or dry heat sterilization. Many instruments on the market have chrome plating, which usually covers a lesser-quality steel. During use and processing, the chrome finish can become scratched, exposing the lesser-quality steel.
Once exposed, this steel can rust and/or corrode during autoclave sterilization. Once this corrosion starts, it can pass to otherwise healthy instruments during the sterilization process. Any instruments that begin to show signs of rust and/or corrosion should be immediately removed from the instrument rotation until they can be repaired or replaced. This will help reduce the spread to other healthy instruments.
A periodic audit of all instruments for rust, corrosion, residual adhesives, or other products will further assist in maintaining your instrument investment. All products (adhesives, sealants, etc) should be removed chairside prior to placing the instrument into a cassette and inserting the cassette into an ultrasonic cleaning unit. These units are designed to remove debris from instruments but will not remove adhesives or sealants.
|An example of chrome plating covering a lesser-quality steel with a box joint versus matte finish, high-grade steel using an orbit joint.|
Joints and Tips
Several types of joints are currently available on orthodontic instruments. The joint type can affect how the tips meet after multiple uses and sterilization processes. The orbit joint can be realigned if the instrument tips come out of alignment. The box joint will allow more flexibility in the joint, which may cause the tips to come out of alignment if not properly maintained.
Instruments that have cutting surfaces, such as ligature and wire cutters, often have carbide inserts at the tip of the instrument. This insert allows the instrument to perform its intended function without dulling or retaining scoring marks. The carbide material can cause corrosion and rust during the sterilization process if not treated prior to processing. If the instrument was not manufactured properly, the tip can have a higher risk of separation as it is an attachment to the instrument. Higher-quality instruments use the same-grade surgical stainless steel in all parts, with an increased level of carbon and chromium in the tips to help them stay sharp longer.
Fit the Handle to the Hand
|This is an example of corrosion on low-quality pliers after the chrome plating has exposed lesser-quality steel.|
Most manufacturers of orthodontic instruments offer some of their instruments with a longer handle. As more and more orthodontists are placing brackets on second molars, these longer handles have become more popular. It is important to try the instrument in the office prior to making a large purchase. Some technicians may not be able to comfortably use the longer handles and would prefer a more traditional length. Fitting an instrument to its operator is an important step in the instrument selection process. For example, if the instrument in consideration is for wire bending, the orthodontist may be the main operator of the instrument and should be the decision-maker about the type, tip, and length of handles.
Warranties and “Wrap” Up
Each manufacturer and distributor offers specific warranties on their instruments. Many manufacturers produce more than one quality level of instrument. Manufacturers may also produce instruments for another company to that company’s specifications. All of these factors can affect the warranty that is provided. A thorough understanding of the warranty and sterilization requirements necessary to maintain the warranty is imperative.
Many manufacturers say that their instruments can be autoclaved (although it is stated that dry-heat sterilization is recommended), but the process that is required during the sterilization process is unachievable by orthodontic offices—again, due to the high volume of patient visits each day. The recommendations for sterilization in certain autoclave sterilizers include the following:
|These pliers have an insert that has rusted due to improper manufacturing or lower-grade steel.|
- Dry the joint and tip thoroughly with compressed air or a towel, ensuring that the joint and tip are free from moisture.
- Place instruments flat on an autoclave tray with jaws open.
If a staff member does not strictly follow the sterilization recommendations and the instruments are damaged, the manufacturer can void the warranty. One company states, “The use of rust inhibitor and silicone lube in the instruments’ joints is required after each cleaning and sterilization.” The odds of this happening in a busy orthodontic practice are minimal, so it is always important to read the fine print before purchasing products.
The warranty will usually include a time frame on how often you should sharpen the cutting tips of ligature cutters, wire cutters, and other cutting instruments. Again, this varies by company and manufacturer, so it is necessary to review this when comparing instruments.
Your instruments are an investment, and how you handle these expensive tools after you buy them will affect how long they last. If instruments are loosely thrown into an ultrasonic cleaner and vibrated together without protection, damage is almost inevitable. The tips can become chipped or broken, instruments can get scratched, and fine tips can become bent. Your investment in quality instruments needs to be secured by protecting them throughout the cleaning and sterilization processes.
To read more articles by , search her name on this page.
Cassette processing will ensure that your instruments are protected during cleaning and sterilization. With cassette processing, instruments are held securely in place and not allowed to rub against other instruments during the ultrasonic cleaning and sterilization cycle, resulting in less damage (if any). Each clinician will have his or her necessary instruments in excellent working condition to complete procedures, saving time and allowing them to concentrate on providing quality patient care.
The use of high-quality instruments and cassettes will not only protect your instruments during processing, but also demonstrate to your patients, their parents, and other dental professionals that you are a responsible clinician. If instruments are corroded, rusty, or have residual adhesive or debris left on them, patients and parents have reason to question the level of sterilization and care that you are providing. Patients are becoming more accustomed to seeing a wrapped sterile package of instruments when they are seen for dental procedures. Using wrapped cassettes will ensure each patient that you have their protection and best interests in mind, and your referring dentists will be confident you are providing the quality care they expect for their patients.
Andrea L. Cook is an orthodontic clinical consultant. She bases her training systems on practical knowledge gained through 20 years of chairside experience in the office of David Turpin, DDS, MSD. She can be reached at