In relation to the current climate, I would like to give you an update on instruments and equipment and suggest possible solutions that can offer peace of mind going forward. Starting with high-speed turbines, I will highlight the measures within product designs to minimise cross-contamination, then look at options that reduce aerosols, before addressing decontamination of the inside of handpieces (lumens).
NSK pioneered the first non-suckback air turbines with non-retraction valves, and the proven effectiveness of this system is more important today than ever. All NSK high-speed turbines benefit from a ‘Clean Head System’ (Fig. 1) which prevents suckback into the head of the handpiece. Also within the coupling, there’s a non-retraction valve to stop contaminated fluids entering the handpiece water lines (Fig. 2).
However, there is still aerosol generation and the only option to reduce it is to use a rear venting turbine, such as the Ti-Max X450L used for minor oral surgery, which uses a water jet coolant rather than spray.
There is a more flexible alternative which allows you to also control the speed. This involves using a speed-increasing handpiece in combination with an electric micromotor to achieve low aerosols. Micromotors are electrically driven rather than air-powered, the torque and power comes from the motor and it allows you to set the speed (Fig. 4). Current slow-speed handpieces also fit on the NSK micromotor as they have an e-type fitting (Fig. 3) and again, the speed can be controlled electronically.
On all new chairs, you are encouraged to go for the micromotor option, but in most cases it’s a straightforward job for an engineer to install one on to your existing cart. Failing this, there are portable micromotors available.
A small amount of air is still used to atomise the spray within a speed-increasing handpiece. However, there’s a unique solution available to overcome this. The Ti-Max Z45L has a switch facility which allows you to operate with a water jet coolant (water only) rather than spray (water and air mix) (Fig. 5). The water jet coolant significantly reduces aerosols and the built-in micro filter within the Z45L handpiece prevents particles from entering the water system. Using the water jet in surgical procedures also prevents subcutaneous emphysema. Speed-increasing options offer far more than safety, but also how any handpiece is maintained is vital.
Internal disinfection of handpieces
One issue within the decontamination process is the internal (lumens) disinfection of handpieces. Guidance for external processing is simple enough, but for the internal workings (lumens), a solution needs to ensure the durability of the handpiece in terms of disinfection and lubrication.
NSK has successfully manufactured automated handpiece lubrication machines for many years with great results for practices in terms of reduced repair bills. The next step was to maintain this durability, meet European standards and literally offer a solution that internally disinfects handpieces. The iCare+ was subsequently developed, each cycle composed of three stages – cleaning, disinfection (inside and out) and handpiece lubrication, all prior to autoclave sterilisation. Essentially it replaces the function of a washer-disinfector with the added benefit of lubrication in one validated, time-saving process.
On a practical level, the iCare+ is easy to use and processes up to four handpieces at a time (Fig.6). Its footprint is just H355 x W400 x D405mm and requires a fitted 6mm air line. In the current climate, iCare+ offers peace of mind and has been tested to show it is effective against COVID-19.
Internal sterilisation of handpieces
The current climate has forced a re-evaluation of the decontamination process. In many cases this has highlighted that the UK lags behind the rest of Ireland and Europe in terms of sterilisation, where only Class B autoclaves using a full vacuum cycle are allowed to be used on a day-to-day basis. This guarantees items like handpieces are sterilised inside and out. To achieve this peace of mind, it requires investment, but is balanced by the extended life this gives to dental instruments.
As part of the NSK decontamination range, the iClave Class B autoclave (Fig. 7) features a powerful vacuum combined with a differentiated heating system to sterilise all materials and instruments, including the internal surfaces (lumens) of handpieces. The enhanced thermal efficiency of the chamber allows for lower running costs and the chamber design/shape offers 20 per cent more space than conventional 18 litre units, which means it is ideal for implant kits.
The efficient drying cycle eliminates many handpiece care and maintenance issues, including corrosion and discolouration. Pouching also eliminates contamination (soil/chemicals/oil) from other instruments and extends storage time, which limits over-reprocessing of less used instruments.
Our confidence in our autoclave has meant we are able to offer an additional six-month warranty on any NSK instrument, even for repairs.
As we all play the waiting game, I hope I’ve been able to offer you an insight, and give you some peace of mind that there are solutions available to combat current concerns over aerosols and decontamination.
For more information about NSK products and services visit www.mynsk.co.uk