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16 Dental Tribune United Kingdom Edition | 6/2016 TRENDS & APPLICATIONS Single-use hand instruments Making a case for their use in general dental practice By Robert Jagger, UK A wide range of single-use dis- posable dental and surgical instru- ments is now produced by a number of manufacturers. Instruments are available for purchase either singly or as procedure kits and are priced to be a realistic alternative to decon- taminating reusable instruments.1 Paradoxically,single-useinstrumen- tation is rarely seen as a viable alter- native by dental professionals, who typically associate single-use instru- ments with cheap unreliable plastic devices and a very limited product range. In reality, there are mirrors, probes, restorative instruments, en- dodontic instruments, minor oral surgical instruments and extraction forceps for both adult and paediat- ric use. Procedure packs too are availa- ble for specific procedures and con- tain all of the necessary instru- ments. Examples of packs include those for dental and periodontal examination, restorative proce- dures, maxillofacial biopsy, minor oral surgery, and periodontal mi- crosurgery. This article seeks to challenge current clinician percep- tions of single-use instrumenta- tion by examining the potential benefits of high-quality single-use instruments in daily practice. Quality Single-use instruments can be of extremely high quality and may be almost indistinguishable in use from reusable instruments. Clinicians often comment that they are impressed by their quality and functionality and that they appear far too good to throw away after just one use. These instru- ments are a significant step for- wards from the poorer quality equipment that was previously available. Before selecting a supplier of single-use instruments, however, it is critical to ensure that they comply fully with all relevant British and European medical de- vice regulatory standards and that they are manufactured from med- ical-grade surgical steel and un- dergo rigorous in-process quality assurance checks and batch test- ing. Purchasing instruments from a supplier approved by the British Dental Industry Association will provide practitioners with assur- ance that they are dealing with an appropriately regulated manu- facturer. Sterilisation One of the most significant changes to have affected the den- tal profession in recent years has been the adoption of rigorous sterilisation and cross-contami- nation procedures (HTM 01-05: Decontamination in Primary Care Dental Practices).2 Dangers posed by prion diseases, such as variant Creutzfeldt–Jakob Disease (vCJD), remain even with the most effec- tive dental sterilisation processes. The prion associated with vCJD is able to survive steam autoclaving under standard exposure condi- tions,2 suggesting that some reusa- ble surgical instruments are po- tentially being utilised in a con- taminated state. Use of single-use disposable instruments ensures that instruments are not contami- nated, protecting patients and clinical staff alike. Most general dental practices are now equipped with HTM 01-05-compliant equipment. Re- processing dental instrument trays, however, inevitably leads to significant wear and tear and ulti- mately instrument damage. Regu- lar sharpening (and replacement) of reusable instruments too is necessary for instruments such as luxators, chisels and elevators. This can add substantial costs to the reprocessing of reusable in- struments. Reprocessing protocols dictate that a dental practice must hold significant stock of expensive reusable instruments, much of which often lies redundant at any given point in time. Single-use instruments can provide a cost-effective contin- gency to cover unexpected emer- gency situations in which reusable instruments may be unavailable, for example when managing un- planned surgical complications or when washer disinfectors or steri- lisers are inoperable and signifi- cant clinical time may be lost while waiting for the arrival of a skilled service engineer. Single-use in- struments enable clinicians to forecast true procedure costs accu- rately, as there are no hidden costs associated with the decontamina- tion, sterilisation and packaging of reusable instrumentation. Convenience Among other applications, single-use packs allow rapid and efficient management of dental extractions that become compli- cated by, for example, crown frac- ture. Contingency stock of sin- gle-use surgical packs (comprising integral single-use scalpel handles and blades, tissue retractors, peri- osteal elevators, dental elevators and suture packs) enables highly convenient, efficient and cost- effective management of compli- cations. Single-use conservation and ex- amination packs provide a cost- effective means of extending the length of daily clinic treatment ses- sions, especially towards the end of the day, when access to sterile reus- able instruments may be compro- mised owing to sterilisation equip- ment downtime or cleaning rou- tines (when nursing staff are there- fore unavailable for clinical duties). In endodontics, clinicians can more effectively identify and con- trol procedure costs and maximise their return on time-consuming and costly procedures with the use of single-use rubber dams and root canal obturation packs. Safe- ty-conscious patients are increas- ingly requesting that single-use in- struments be used for their treat- ment because they feel more com- fortable if the hand instruments used to perform their procedure are brand new and have never been usedonanotherpatient.Single-use instruments eliminate infection prevention concerns associated with the reprocessing of reusable instruments. Single-use dental scalers are an efficient solution for dentists, den- tal hygienists and dental therapists, since every instrument is guaran- teed to be sharp for every proce- dure, enabling reduced treatment times and less patient discomfort. The Instrapac Periodontal Micro- surgery Pack (Robinson Healthcare) is designed to facilitate complex periodontal surgical procedures in a cost-effective way, ensuring that instruments are always functional and sterile. Robinson’s soft-tissue biopsy packs provide an off-the- shelf sterile, cost-effective solution for performing intra-oral tissue bi- opsies, particularly in general prac- tice, where these procedures are often performed infrequently. Inimplantdentistry,single-use periotomesandmicrosurgerypacks provide a cost-effective solution for procedures that require preci- sion and speed. Moreover, single-use conserva- tion and surgical packs offer bene- fits when managing medically vul- nerable patients, including those with immunocompromising con- ditions and those requiring dental treatment before elective cardiac and renal surgery and pre- and post-head and neck radiotherapy and chemotherapy. Environmental impact It is often forgotten that decon- tamination and sterilisation pro- cedures consume large amounts of energy, water, cleaning fluids and consumables, with associated sig- nificant environmental impact. Single-use surgical instruments are designated as a specialist clini- cal waste stream and as such must be disposed of in accordance with UK and European clinical waste management regulations. Histori- cally, this has meant that they were disposed of alongside clinical sharps waste and ultimately con- veyed to incineration and landfill. This has previously raised con- cerns over their adverse environ- mental impact. However, a recent innovative partnership between Robinson Healthcare and one of the coun- try’s largest specialist health care waste management companies, Healthcare Environmental Group (HEG), has led to the development of a unique UK-wide recycling programme for single-use surgi- cal-steel instruments. Under this initiative, HEG is now able to pro- vide dental practices with a unique reusable Healthcare Sharps waste container. The company has a fleet of dedicated, regulation-com- pliant, purpose-designed vehicles and the capacity to service individ- ual dental practices and clinics with scheduled waste container collections and deliveries. Contain- ers are tracked from practice to recycling station using GPS track and trace technology. Depending on the annual volume of steel re- cycled, HEG is potentially able to offer a payback to dental practices that use the Healthcare Sharps recycling service. Overall, HEG operates nine processing and en- ergy recovery sites across the UK, providing an energy recovery programme that maximises the environmental benefits. Conclusion The use of high-quality sin- gle-use instruments can provide significant advantages to dentists in general dental practice, particu- larly in terms of sterility, conve- nience, efficiencies and reduced operating costs. Packs, such as sur- gical, restorative, periodontal and implant packs, can be particularly helpful. The purchase costs of the single-use instrument option are less significant when the substan- tial hidden costs of reusable instru- ments are considered, and their cost in use is typically significantly less than the reusable instrument option. Furthermore, recent ad- vances in the way that these in- struments may be recycled have effectivelyaddressedenvironmen- tal concerns. Editorial note: A list of references is available from the publisher. © Romas_Photo/Shutterstock.com Robert Jagger is a consultant in restorative dentistry for the University of Bristol Dental Hospital and a senior clini- cal lecturer at the School of Oral and Dental Sciences. He can be contacted at R.Jagger@bristol.ac.uk. Costs