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Some things are only meant to be used once
One Patient, One Use
A Higher Standard of Care
The idea of using someone else's toothbrush or dental floss is out of the question for most people, so it may surprise you to learn that many of the items used during a root canal procedure have often been used in other patients. Undergoing root canal therapy can be stressful enough without added concerns about the cleanliness of the instruments that will be used to perform the procedure. While some items are easily cleaned, others, such as the files used to cut through the root canal path and extract the infected pulp, are much more difficult.

Even after sterilization, research shows it is possible for bacteria to remain on a file1. And further research demonstrates how each additional use can weaken a file, potentially increasing the risk of it breaking during the procedure and causing retreatment for the patient. These concerns have led many dental practitioners to consider root canal files to be single use.

Ask your dentist about single use of root canal files.
I know that if I was having a root canal done, I would want that instrument to be used only one time. So I'm doing exactly for my patients what I would want done for me.
- Dr. David Landwehr
Increased Damage With Each Use
In addition to being 100% certain that the instrument is sterile, patients deserve to know that their dentist is performing at their best and has done everything possible to ensure their procedure is a success. But to accomplish that requires instruments that perform at their best as well.

Similar to a knife, root canal files experience wear with each use and become less efficient at cutting, as seen in the photos to the left. Ultimately, this reduces the efficiency of the procedure, increasing fatigue for the patient and doctor. Additionally, research indicates that the reduced efficiency and increased stress on reused files increase the risk that the file will break off in the root canal during the procedure.4 Unfortunately, a broken file can result in a patient requiring additional treatments, sometimes including apical surgery to remove the file.
...some files tested positive for residual blood, even after manual cleaning and autoclaving.1
These photographs (below) clearly illustrate the differences in the condition of a popular nickel titanium rotary file before use, after one use and after three uses. The file was used according to manufacturer's directions in extracted teeth: multi-rooted molars with moderate curvature. (SEMs - 200x magnification, 6/06.)
Risk of Cross-Contamination
In 2003 the Centers for Disease Control and Prevention (CDC) acknowledged that due to the physical construction of root canal files, achieving 100% sterilization is difficult.2 Best-practice sterilization procedures require up to a four-step process, leaving ample room for human error. And even following these practices, researchers cannot be certain of 100% sterilization. Due to these factors, the CDC concluded that it may be practical to consider root canal files to be single use.

The potential for cross-contamination between patients through root canal files is well documented. In a study of used files published by the British Dental Journal, some files tested positive for residual blood, even after manual cleaning and autoclaving.1 Further research discusses how prion proteins, which transmit the extremely rare but fatal Creutzfeldt-Jakob disease, can remain on the instrument following even the most rigorous sterilization procedures, presenting the possibility of transmission during root canal therapy.3 In 2007, these concerns led the Department of Health in England to mandate endodontic instruments as single use.
1 Letters S, Smith AJ, McHugh S, Bagg J. A study of visual and blood contamination on reprocessed endodontic files from general dental practice. Br Dent J. 2005 Oct 22; 199(8):522-5.
2 CDC, Guidelines for Infection Control in Dental Health Care Settings, 2003.
3 Azarpazhooh A, Fillery ED. Prion disease: the implications for dentistry. J Endod. 2008 Oct;34(10):1158-66.
4 Kazemi RB, Stenman E, Spangberg LS. The endodontic file is a disposable instrument. J Endod. 1995 Sep;21(9):451-5

BRSPU Rev.1 2/15