ARTICLE 1
THE EFFECT OF AUTOCLAVING ON ENERGY
The authors subjected three
groups of curing lights to 25
sterilization cycles to test the ef-
fects of autoclaving on the cur-
ing tip's ability to transmit light.
They also investigated whether
polishing the tip at various inter-
vals would reduce the effects of
autoclaving on light transmis-
sion. They found that autoclav-
ing does diminish the ability of
the tips to transmit light, but
that these effects can be mini-
mized if the tip is polished at fre-
quent Intervals between auto-
claving cycles.
TRANSMISSION THROUGH LIGHT-CURING TIPS
FREDERICK A. RUEGGEBERG, D.D.S., M.S.; W. FRANK CAUGHMAN,
D.M.D., M.ED.; ROBERT W. COMER, D.M.D.
0urrent accepted disinfection and sterilization practices dictate
that the patient and office personnel be maximally protected from
the possibilities of cross-contamination.1'2 Between patients, an op-
eratory is decontaminated for the next procedure, and often nondis-
posable equipment such as the dental light-curing tip is merely dis-
infected with a liquid agent.
In the 1980s, dental product manufacturers introduced light-cur-
ing tips that could be autoclaved to increase protection from possi-
ble fomite transmission of oral pathogens.3 However, during the au-
toclave cycle, vaporized water is produced and deposits a
mineralized residue, or boiler scale, on the surface of the instru-
ments being sterilized. If a boiler scale were to form on the dental
light-curing tip, the intensity of irradiation transmitted from the
source bulb to the restorative material surface could be compro-
mised .4Such a decrease in intensity could significantly decrease the
physical properties5 and minimize the curing depth of a photoacti-
vated composite resin restoration.4 Decreased composite resin cure
also could lead to the potential for greater leaching of components
from the restoration, which may have an adverse biological impact.6
We conducted this study to examine the effect of repeated auto-
claving of a commercial dental light-curing tip on the intensity of ir-
radiation that passes through it. Using SEM analysis and using a
hand-held dental radiometer to measure the recovery of the trans-
mitted light energy, we also evaluated the effectiveness of a com-
mercial method of removing the boiler scale from the tip surface.
We also studied the ability of tip polishing to reduce the rate of
residue buildup.
MATERIALS AND METHODS
A conventional 75-watt, quartz-tungsten-halogen bulb served as the
light source in this study. The light was equipped with a controller
unit (model 400, Demetron Research Corp.) that set the duration of
light exposure. We used a rheostat to vary the voltage to the source
bulb and maintain a constant light intensity of 400 milliwatts/cen-
timeter2. The light intensity was measured using a tip that had not
been autoclaved as a control.
To measure the light intensity, we monitored the millivoltage
drop across an internal resistor of a curing radiometer (model 100,
JADA, Vol. 127, August 1996 1183
RESEARCH-

Group 1, intensity
values were obtained
after each autoclave
cycle for the first
seven cycles and
then every fifth cycle
from cycles 10 to 25.
We measured the
light intensity at the
same intervals for
the tips in Group 2,
but we polished
these tips only once
(immediately before
the first autoclaving
cycle) using a com-
mercially available
cleaning kit (Optical
Maintenance Kit,
Demetron Research
Corp.). The tips in
the third group were
cleaned after every
fifth autoclaving
cycle. We measured
NO. OF AUTOCLAVE CYCLES the light intensity
values of this group
after every fifth au-
toclaving cycle, as
well as after polish-
Figure 1. The graph illustrates the influence of repeated autoclaving on transmitted ing at similar cycle
energy in light-curing tips. Boxed points indicate no tip polishing (Group 1). stages.
Diamond points indicate one initial polishing only (Group 2). The T-bar represents
- I standard deviation. To test the influ-
ence of autoclaving
on light intensity,
Demetron Research Corp.). We Corp.). We tested three as-re- we performed a two-factor, re-
established a calibration scale ceived tips for the intensity val- peated measures analysis of
between the dial-face intensity ues before and after repeated variance on the intensity values
readings from the analog meter autoclaving procedures. The recorded for specimens from
and the measured millivoltage curing light tips were auto- Group 1 and Group 2. Post-hoc
drop values, which enabled us claved at a temperature of means comparison was per-
to convert the measured milli- 270 F for four minutes followed formed using Tukey's Honestly
voltage readings into intensity by a 14-min drying cycle in a Significant Difference Test.
values. Using the control tip, we standard autoclave (no. 3013, The ability of the polishing
monitored the light source be- AMSCO Int.) and were pack- tip to recover the level of pre-
fore and after each intensity aged in autoclavable envelopes autoclaved light intensity after
reading to ensure that it provid- before sterilization. a series of autoclave cycles with
ed the desired control value. In addition to establishing a subsequent polishing was tested
The light tips used were con- control group, we designed the using multiple regression anal-
ventional 8-millimeter-diameter study to include three test ysis. The difference between in-
glass bundles with a 30-degree groups, each with three light tensity values of autoclaved and
curve at the end of the tip (no. tips. All of the light tips were polished treatment values was
20941 N, Demetron Research autoclaved for 25 cycles. In studied as a function of the

1184 JADA, Vol. 127, August 1996

 RESEARCH

number of auto-
clave cycles.
The data were
logarithmically
transformed to
provide a linear
relationship. All
statistical test-
ing was per-
formed at the
significance
level of P = .05.
RESULTS
As Figure 1 il-
lustrates, the
transmitted
light energy
quickly decreas-
es after only a
few sterilization
treatments
when the tips
are not pol-
ished. After
only one cycle,
the intensity
dropped drasti- Figure 2. The effect of repeated autoclaving and subsequent tip polishing on transmitted
light intensity. The red bar indicates pre-polishing intensity. The blue bar indicates in-
cally from the tensity reading after polishing. The T-bar represents 2 I standard deviation.
pre-autoclaved
value of 100 per-
cent to 74 percent. The intensi- similar numbers of cycle treat- a significant influence on the dif-
ty continued to decrease but at ments. ference in intensity values
a slower rate after each succes- The data from Group 3 speci- (P = .0003), while no particular
sive sterilization cycle. After mens indicated that after the tip acted differently from the
only three cycles, the transmit- initial five autoclave cycles, the others (each P > .3). All the re-
ted intensity decreased to 50 light intensity dropped to 50 per- covered, polished tips produced
percent of its pre-autoclaved cent of its original reading. After intensity values similar to 100
value. The ANOVA indicated the tips were polished, the light percent of the as-received value.
that the autoclaving treatment intensity returned to its original Magnification of the as-re-
itself had a significant effect on level (Figure 2). After five more ceived tip x50 showed no gross
the light intensity (P = .0008), cycles, the intensity dropped contamination (Figure 3). After
as did repetition of the auto- again, but to only 80 percent of five autoclave cycles, magnifica-
claving treatment (P = .017). its original value. The original tion at the same level revealed
Figure 1 also shows that pol- value again was completely re- a dark, noncontinuous film over
ishing the tips only once before covered after polishing. The in- the surface (Figure 4). After pol-
autoclaving (Group 2) decreased tensity value after each subse- ishing, the appearance of the
the rate at which light intensity quent set of five autoclaving autoclaved curing tip was iden-
declined with repeated auto- cycles interrupted by polishing tical to that of the as-received
claving. This decrease is demon- remained near 95 percent of the state (Figure 3).
strated by the relative differ- maximum transmitted value.
ence in transmission values The regression analysis indicat- DISCUSSION
between the two graphs' having ed that the number of cycles had Our data show that the light in-

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RESEARCH-

units functioning within this

range would generate unaccept-
able light intensity values after
only three autoclaving cycles.
We also found that transmit-
ted intensity values do not con-
tinue to decline but instead
reach a plateau around 40 per-
cent after 10 cycles. This finding
implies that the boiler scale has
reached maximum saturation,
and the thickness of this layer
does not continue to increase.
It should be noted that the
quantity of buildup on the sur-
face of the curing tips may have
been affected by the autoclave
protocol that was used. We used
nondeionized water, which may
have increased the concentra-
tion of minerals in the heated
Figure 3. The as-received curing tip showing no gross surface contam- vapor. The heating cycle was
ination (X50, horizontal bar = 100 micrometers). The appearance of the
autoclaved tip that subsequently had been polished was identical to followed by a 14-min drying
the clean surface of the pre-autoclaved tips. cycle, which could have baked
the residue onto the light tip
surfaces. For the most part, the
tips were bagged separately. At
the most, two tips were bagged
together, but not frequently. In
all instances, other dental in-
struments, which also had been
bagged, were sterilized along
with the curing tips. Thus, the
conditions of sterilization repre-
sented the greatest potential for
boiler scale formation and pro-
vided a worst-case scenario for
residue formation.
Based on these results, we
would suggest use of the polish-
ing kit to re-establish light-cur-
ing intensity after autoclaving.
Not only did polishing re-estab-
lish light-intensity values to the
pre-autoclaved values, it also
Figure 4. A curing tip's typical appearance after only five autoclave cy- greatly reduced the rate at which
cles indicating the presence of an opaque residue or boiler scale. the boiler scale built up and,
thus, the extent to which light
tensity decreased by as much as cated that the minimal accept- became attenuated with repeat-
50 percent after only three con- able intensity of a curing source ed autoclaving (Figures 1 and 2).
secutive autoclave cycles. This is 300 mW/cm2. Typically, many
CONCLUSION
result has great clinical signifi- curing lights operate between
cance. Previous work4 has indi- 400 and 600 mW/cm2. Curing This study shows that autoclav-

1186 JADA, Vol. 127, August 1996

 I[SEABCH

We also Manufacturer's recommenda-

found that use tions for polishing the tip
of a polishing should be followed to restore
kit to clean the light output to its maximum po-
light tip com- tential. .
pletely re-
Dr. Rueggeberg Is Dr. Caughman Is a Dr. Comer l-a Pro- stores the The authors thank the Demetron Research
an clate profes- profeasor and chair, Corporation for supplying the light-curing
aor and aection dl- Department of Oral
feaaorandchair,
Deparbnent of Oral
transmitted in- tips and the Curing Tip Maintenance kit.
retor, D-e-rb-ent Rehabilitatlon, Diagnosis and tensity values 1. Centers for Disease Control.
School of Dentiatry,
of Dental Materilals,
School of Dentiatry, Medical College of School of r
to their pre- Recommended infection-control practices for
Medical College of G.eorgia, Augusta. Medical College of treated levels. dentistry, 1993. MWWR 1993;42:4-6.
Georgia, 1120 16th Georgia, Auguata This polishing 2. Miller CH. Cleaning, sterilization and
AU9U"tU. uAd ing of dental kit greatly re- disinfection: basics of microbial killing for in-
fection control. JADA 1993;124(i):48-56.
Addre reprint re- light-curing duces the rate of boiler scale
queats to Dr. tips can signif-
buildup on curing tips during 3. Caughman WF, O'Connor RP, Volkmann
Ruegoberg. KR, Schuster GS, Caughman GB. Visible-light
icantly de- subsequent autoclaving expo- curing devices: a potential source of disease
crease the ability of the unit to sures. transmission. Oper Dent 1987;12(i):10-4.
transmit light. Specifically, we The results of this study indi- 4. Rueggeberg FA, Caughman WF, Curtis
found that after only three au- cate that a clinician can greatly JW Jr. Effect of light intensity and exposure
duration on cure of resin composite. Oper
toclave cycles, the intensity of decrease the rate of buildup of Dent 1994;19(i):26-32.
transmitted light of the pro- boiler scale and maintain al-
5. Asmussen E. Restorative resins: hardness
cessed tip decreased by 50 per- most 100 percent tip transmis- and strength vs. quantity of remaining double
cent. This decrease in transmis- sion levels if the sterilized tips bonds. Scand J Dent Res 1982;90:484-9.
sion intensity plateaus at about are polished at frequent inter- 6. Caughman WF, Caughman GB, Shiflett
45 percent after only four auto- vals. Dentists should also con- RA, Rueggeberg FA, Schuster GS. Correlation
of cytotoxicity, filler loading, and curing time
clave cycles. This value does not sider frequent monitoring of the of dental composites. Biomaterials
change remarkably even after intensity of sterilized curing 1991;12(8):737-40.
25 repeated cycles. tips by using a radiometer.

JADA, Vol. 127, August 1996 1187