Sterilization is a process that kills or removes all organisms (and their spores) in a material or an

object.
In dentistry, sterilization is usually achieved by one of three methods:
1. moist heat (steam under pressure in an autoclave)
Steam is a very effective sterilizing agent as it:
• liberates latent heat when it condenses to form water, potentiating microbicidal activity
• contracts in volume during condensation, thus reinforcing penetration.
When water is heated in a closed environment, its boiling point is raised, together with the
temperature of the generated steam; for example, at 104 kPa (15 psi), the steam temperature is
121°C. This phenomenon is utilized in steam sterilization by the autoclave (Fig. 37.5). Put
simply, an autoclave is a glorified domestic pressure cooker with a double-walled or jacketed
chamber; steam circulates under high pressure inside the chamber, in which the objects for
sterilization (the load) have been placed. Once the sterilization cycle is complete, drying the
load is accomplished by evacuating the steam. Drying can be accelerated by the suction of
warm, filtered air into and through the chamber. It is important to expel the air in the chamber
at the beginning of a sterilization cycle because:
 the temperature of an air–steam mixture at a given pressure is lower than that of pure
steam
 air pockets interfere with steam penetration
There are two types of autoclaves:
a. Pre-vacuum autoclaves (porous load autoclaves), in which air is evacuated from a metal
chamber by vacuum suction. These, mainly used in central sterile supply units in
hospitals, are now becoming popular in dentistry due to wide availability as small, bench-
top units. Vacuum autoclaves are more desirable for routine dentistry than the gravity
displacement type.
b. Gravity displacement autoclaves are small, automatic bench-top autoclaves. They work
on the principle of downward displacement of air as a consequence of steam entering at
the top of the chamber. These used to be very popular in dentistry, but they are not
recommended now (see below).
The sterilization cycle
The sterilization cycle (either in an autoclave or a hot-air oven) can be divided into three periods
: the heating-up period, the holding period and the cooling period. For the bench-top
autoclave (routinely used in dentistry), this entails:
a. downward displacement of air by incoming steam while the chamber is heated to the
selected temperature
b. ‘holding’ the load, which is sterilized, for the appropriate period at the selected
temperature and pressure
c. drying the load to its original condition by a partial vacuum (this is assisted by the heat
from the jacket)
d. restoration of the chamber to atmospheric pressure by rapid exhaustion of steam.
2. dry heat (hot-air oven)
Dry heat penetrates less well and is less effective than moist heat; consequently, higher
temperatures and longer times are required for sterilization. The total time for heating up,
holding and cooling may be several hours (Table 37.3). It is therefore essential that hot-air ovens
should have a time lock on the door so that items cannot be added or removed during the cycle,
and a fan to distribute the heat evenly. Dryheat sterilizers used in dentistry include static-air and
forcedair types:
a. The static-air type (synonym: oven-type). Here, the heating coils in the bottom or sides
of the unit cause hot air to rise inside the chamber through natural convection.
b. The forced-air type (synonym: rapid heat-transfer sterilizer). Heated air is circulated
throughout the chamber at a high velocity, permitting more rapid transfer of energy from
the air to the instruments, thereby reducing the time needed for sterilization

3. gaseous chemicals (chemiclave).

A combination of formaldehyde, alcohols, acetone, ketones and steam at 138 kPa serves as an
effective sterilizing agent. (The premixed chemicals must be purchased from the manufacturer
as their balance is critical.) Microbial destruction results from the dual action of the toxic
chemicals and the heat. In general, chemical vapour units sterilize more slowly
than autoclaves (30 min versus 15–20 min, for packaged instruments) but are faster than hot-
air ovens. The usual temperature and pressure combinations are 127–132°C at 138–176 kPa
for a period of 30 min, once the correct temperature has been attained. This process cannot be
used for materials or objects that can be altered by the chemicals or are made of heat-sensitive
material. Rusting is unusual if instruments are dried before sterilization as there is relatively
low (7–8%) humidity throughout the process. The major advantages of the chemiclave are
that it is faster than dry-heat sterilization, it does not corrode instruments or burs, and dry
instruments are available as soon as the cycle is over. Adequate ventilation must be provided
in order to dispel the residual fumes released on opening the chamber at the end of the cycle.