Clinical Evaluation of Combined Manual Pre-treatment and Negative-Pressure Cleaning for Dental Implant Instrument Reprocessing

Summary

This study evaluates a combined manual pre-treatment and negative-pressure cleaning process for dental implant instruments, demonstrating improved cleaning quality and higher qualification rates while significantly reducing manual operation time. The approach enhances standardization, efficiency, and safety in instrument reprocessing, supporting its practical adoption in clinical sterilization workflows.

Abstract

This study evaluates a combined manual pre-treatment and negative-pressure cleaning process for dental implant instruments to improve cleaning quality and efficiency. A total of 200 contaminated dental implant toolkits were randomly assigned to a control group (traditional manual cleaning) or an experimental group (manual pre-treatment combined with negative-pressure cleaning), with 100 toolkits in each group. Cleaning quality was assessed using visual inspection, magnification, residual blood detection, and ATP fluorescence testing, and cleaning time was recorded.

The experimental group demonstrated higher qualification rates across multiple indicators compared to the control group, including improved outcomes under magnification and residual blood testing, as well as a higher complete qualification rate. Manual cleaning time was significantly reduced in the experimental group (6.48 ± 2.78 min) compared to the control group (28.94 ± 2.57 min). Although total processing time increased due to automated cleaning cycles, manual handling time was markedly reduced.

Overall, the combined approach improves cleaning quality, reduces manual workload, and enhances standardization. This approach enhances efficiency, standardization, and safety in clinical instrument reprocessing.

Introduction

With the continuous development of dental implant technology, implants have become an important treatment option for patients with missing teeth due to their excellent restorative function and aesthetic appeal. The instruments used in implant surgeries have complex structures and intricate geometries, which place high demands on cleaning quality¹. Inadequate cleaning can result in residual organic or inorganic materials that not only affect the effective contact of sterilization agents^2,3 but also form bacterial biofilms, reducing sterilization effectiveness and potenti....

Protocol

Study Design and Ethical Considerations

This study was reviewed by the Ethics Committee of the Affiliated Stomatological Hospital of Anhui Medical University and was determined not to require formal ethical approval, as it involved only the reprocessing of medical instruments and did not include patient interaction or identifiable patient data. The study was conducted in accordance with institutional guidelines and relevant regulations. Accordingly, the requirement for informed consent was waived.

From July to December 2024, a total of 200 dental implant instrument sets were retrieved from the Di....

Results

Comparison of Cleaning Quality Between the Two Groups

In visual observation, the qualification rate of the control group was 94%, while the qualification rate of the experimental group was 99% (Table 1; Figure 1). The difference between the two groups was not statistically significant (χ² = 1.546, p = 0.214). In the 5x magnification visual observation, the qualification rate was significantly higher in the expe.......

Discussion

Cleaning dental implant instruments presents significant challenges due to their complex structures, multiple components, and lumen-containing designs²². It demands high professional standards from personnel, equipment, and facilities, and increases the risk of infection for surgical patients. This has long been a key issue in hospital infection control and the improvement of cleaning efficiency^23,24. The combination of manual pre-treatmen.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
ATP fluorescence detector	Hygiena LLC, USA / 3M Company, USA	SystemSURE Plus (ATP-100) / Clean-Trace LM1	Used for ATP-based contamination detection
ATP test swabs	Hygiena LLC, USA	UltraSnap™ (US2020)	Compatible with ATP fluorescence detector
Cleaning indicator strips	3M Company, USA	Clean-Trace™ Test Strips (CTS100)	Used for process validation of cleaning efficacy
CSSD workbench	Belimed AG, Switzerland	WD290 IQ series	Instrument processing workstation
Dental implant instrument toolkits	Straumann Group, Switzerland / Nobel Biocare, Switzerland	Various (kit-specific)	Retrieved after implant surgery; used as study samples
Drying module (integrated system)	Shinva Medical Instrument Co., Ltd., China	SQ-Z series	Integrated drying unit in automated system
Enzymatic detergent	Ruhof Corporation, USA	Endozime® AW Plus (345SPD)	Used for manual pre-cleaning
Five-fold magnifying lens (5×)	Olympus Corporation, Japan	5× Loupe (ME-5X)	Used for magnified visual inspection
Negative-pressure cleaning and disinfection device	Shinva Medical Instrument Co., Ltd., China	SQ-D Series Pulsed Vacuum Washer Disinfector	Automated cleaning and disinfection system
Personal protective equipment (PPE)	Ansell Ltd., Australia	Microflex® 93-260	Gloves used during manual cleaning
Residual blood detection reagent/test kit	Healthmark Industries, USA	HemoCheck™ (HCK100)	Used for detecting residual blood contamination
Running water source	Hospital CSSD water system	Not applicable	Standard CSSD rinse water supply
Soft cleaning brushes	Healthmark Industries, USA	BRS-100 series	Used during manual cleaning
Temperature monitoring probe	Testo SE & Co., Germany	Testo 110	Used to monitor cleaning temperature (48–62 °C)
Timer / digital stopwatch	Casio Computer Co., Japan	HS-80TW	Used for recording cleaning duration
Ultrasonic cleaning machine	Branson Ultrasonics, USA	Branson 5800	Used for ultrasonic cleaning step
Water quality test kit	Merck KGaA, Germany	Aquamerck® Kit	Ensures water quality for cleaning processes
SPSS statistical software		21.0 software	Statistical anlysis software