{"id":6575,"date":"2026-06-01T11:35:40","date_gmt":"2026-06-01T09:35:40","guid":{"rendered":"https:\/\/magazine.zhermack.com\/?p=6575"},"modified":"2026-06-01T11:37:30","modified_gmt":"2026-06-01T09:37:30","slug":"clean-and-sterile-preparation-of-the-surgical-field","status":"publish","type":"post","link":"https:\/\/magazine.zhermack.com\/en\/hygiene-en\/clean-and-sterile-preparation-of-the-surgical-field\/","title":{"rendered":"Clean and sterile preparation of the surgical field"},"content":{"rendered":"\n

The management of asepsis <\/strong>is one of the cornerstones of dental-patient safety, especially in oral and implant surgery. The oral cavity hosts an extremely rich and complex microbiota, second only to the gut microbiota, with over 700 bacterial species and numerous microorganisms, including fungi, viruses, and protozoa. (1)<\/p>\n\n\n\n

Even after repeated rinsing, mechanical cleaning, or the use of antiseptics, the mouth cannot be rendered sterile, as shown by scientific studies on the persistence of oral flora<\/strong> even after antimicrobial rinses. (2, 3)<\/p>\n\n\n\n

For this reason, the rationale for using sterile devices in dentistry is not to sterilise the oral cavity \u2013 an impossible objective \u2013 but to prevent microorganisms foreign to the oral flora<\/strong>, originating from the patient’s skin or from operators, from contaminating the surgical site<\/strong> during tissue access. (4)<\/p>\n\n\n\n

The two types of surgical-field preparation: clean and sterile<\/h2>\n\n\n\n

It is on this principle that two types of surgical-field preparation<\/strong> used today are based: clean preparation and sterile preparation.<\/p>\n\n\n\n

Clean preparation of the surgical field<\/h3>\n\n\n\n

Clean preparation<\/strong> is the approach most widely used<\/strong> in most dental procedures, as well as in many short surgical procedures that are not excessively invasive or prolonged, such as simple extractions, apicectomies, and biopsies. (5)<\/p>\n\n\n\n

Several studies have shown that the use of non-sterile gloves in such procedures does not increase postoperative complications, either in dentistry or in minor outpatient procedures in other disciplines. (6,7)<\/p>\n\n\n\n

Similarly, in uncomplicated dental extractions, no significant differences in infection risk have been found between the use of sterile gloves and clean gloves, as also confirmed by prospective studies in oral surgery. (8, 9)<\/p>\n\n\n\n

Furthermore, for an infection to develop after oral surgery<\/strong>, a very high microbial load<\/strong> is required, exceeding 10\u2075 microorganisms per millilitre<\/strong>, a value significantly higher than that detectable on clean gloves and never achieved in clinical practice. (10,11) It is therefore clear that clean preparation is a safe option in many procedures, provided that instruments coming into contact with tissues are always sterile <\/strong>and that adequate control is maintained over surfaces on which they are placed and with which the operator comes into contact.<\/p>\n\n\n\n

Sterile preparation of the surgical field<\/h3>\n\n\n\n

Sterile preparation<\/strong>, by contrast, becomes necessary in more complex<\/strong> or prolonged procedures, or in those involving the use of biomaterials, such as bone regeneration, grafting, or maxillary sinus lift procedures, where even the slightest contamination can compromise healing in materials with no initial vascular supply. (12)<\/p>\n\n\n\n

In such cases, the operating field should be isolated with adhesive sterile drapes<\/strong>, the team should wear sterile gowns, and thorough surgical hand scrub should be performed, with emphasis on cleansing hands, wrists, and forearms according to standardised techniques. (13)<\/p>\n\n\n\n

Surface cleaning<\/strong> in the operating room, and protection of equipment cables, are also routine, critical steps that are often overlooked but are crucial for reducing the risk of indirect contamination during surgical maneuvers.<\/p>\n\n\n\n

Suitable disinfectants for the patient and the surgical field<\/h2>\n\n\n\n

In both preparation protocols<\/strong>, the patient must perform a preoperative rinse with 0.2% chlorhexidine<\/strong> for at least one minute, a practice that significantly reduces the intraoral bacterial load, and helps decrease salivary contamination of the field. (14) The perioral skin is cleansed with povidone-iodine using centrifugal movements, to avoid dragging skin microorganisms towards the surgical area.<\/p>\n\n\n\n

In sterile preparation, rectangular drapes and adhesive U-drapes<\/strong> are then applied, exposing a very limited area, whereas in clean preparation a single adhesive drape<\/strong> may be sufficient.<\/p>\n\n\n\n

The difference between the two approaches<\/strong> also concerns the composition of the team<\/strong>: sterile preparation requires a dedicated scrub assistant<\/strong>, who in the dental setting may be a dental nurse, and a larger number of people involved, whereas clean preparation can be managed by a smaller team<\/strong>, while still maintaining the use of sterile gloves by the operators.<\/p>\n\n\n\n

Available studies show no significant differences in implant survival rates between clean and sterile preparation when procedures are limited, localised, and do not involve bone regeneration, as indicated by two large retrospective analyses of implants placed under different conditions. (15,16)<\/p>\n\n\n\n

However, the absence of differences in simple contexts does not allow this equivalence to be extended to complex interventions. Where grafts or biomaterials are handled<\/strong>, which is often necessary during implant dentistry procedures, the risk associated with contamination is higher<\/strong>, and clinical recommendations suggest treatments under strict sterile conditions, emphasising that the duration and complexity of the procedure increase the risk of contamination proportionally. (17)<\/p>\n\n\n\n

For these reasons, clean preparation is considered adequate for extractive oral surgery<\/strong> and other surgical procedures in which biomaterials are not handled, such as surgical reopening stages, whereas sterile preparation is to be preferred for implantology<\/strong> and complex regenerative<\/strong> procedures, where contamination control is essential for therapeutic success.<\/p>\n\n\n\n

Zeta Hygiene for disinfecting the operating field<\/h2>\n\n\n\n

Zhermack offers Zeta Hygiene<\/a><\/strong>, a complete range of cleaning and disinfection products<\/strong> for every area of dental practice: instruments, surfaces, hands, suction circuits, and impressions.<\/p>\n\n\n\n

A broad spectrum of activity, rapid action, ease of use, absence of toxic substances such as aldehydes and phenols, and high material compatibility make Zeta Hygiene the ideal solution for the most demanding professionals<\/strong>, ensuring high levels of safety and protection for both user and patient.<\/p>\n\n\n\n

Zeta Hygiene products for instruments, surfaces, impressions, and hands<\/h3>\n\n\n\n

The products in the Zeta Hygiene range are divided according to the application for which they were designed.<\/p>\n\n\n\n

For instrument care:<\/p>\n\n\n\n

    \n
  • Zeta 1 Ultra<\/strong>, a concentrated liquid for cleaning and disinfecting surgical and rotary instruments, based on quaternary ammonium compounds and amines.<\/li>\n\n\n\n
  • Zeta 2 Sporex<\/strong>, a powdered detergent, disinfectant, and cold chemical sterilant based on peracetic acid.<\/li>\n<\/ul>\n\n\n\n

    For surface disinfection:<\/p>\n\n\n\n

      \n
    • Zeta 3 Soft, <\/strong>an alcohol-based, ready-to.use cleaning and disinfecting spray.<\/li>\n\n\n\n
    • Zeta 3 Foam, <\/strong>an alcohol-free, ready-to-use foam cleaner and disinfectant for more delicate surfaces.<\/li>\n\n\n\n
    • Zeta 4 Wash<\/strong> for cleaning floor, bathroom, and door surfaces.<\/li>\n<\/ul>\n\n\n\n

      For specialist applications:<\/p>\n\n\n\n

        \n
      • Zeta 5 Power Act<\/strong>, for the disinfection and cleaning of aspiration circuits and spittoons, based on quaternary ammonium compounds.<\/li>\n<\/ul>\n\n\n\n

        For disinfecting impressions:<\/p>\n\n\n\n

          \n
        • Zeta 7 Spray<\/strong>, a ready-to-use alcohol-based disinfectant, and Zeta 7 Solution<\/strong>, a concentrated liquid disinfectant to be used by immersion. \u00a0<\/li>\n\n\n\n
        • Finally, Zeta 6 Hydra <\/strong>is a gentle soap for hand hygiene.<\/li>\n<\/ul>\n\n\n\n
          \n\n\n\n

          References<\/strong>:<\/p>\n\n\n\n

            \n
          1. Deo PN, Deshmukh R. Oral microbiome: Unveiling the fundamentals. J Oral Maxillofac Pathol. 2019;23(1):122\u20138.<\/li>\n\n\n\n
          2. Dahlen G. Effect of antimicrobial mouthrinses on salivary microflora in healthy subjects. Eur J Oral Sci. 1984;92(1):38\u201342.<\/li>\n\n\n\n
          3. Delilbasi C, Saracoglu U, Keskin A. Effects of chlorhexidine and amoxicillin\/clavulanic acid on alveolar osteitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:301\u20134.<\/li>\n\n\n\n
          4. Scaini R, Rossi MC, Weinstein T, et al. Raccomandazioni cliniche sul controllo dell\u2019asepsi in chirurgia implantare: preparazione pulita versus preparazione sterile. Quintessenza Internazionale & JOMI. 2014;30(1):79\u201387.<\/li>\n\n\n\n
          5. Chiapasco M. Manuale di chirurgia orale. Elsevier; 2001.<\/li>\n\n\n\n
          6. Chiu WK, Cheung LK, Chan HC, Chow LK. A comparison of post-operative complications following wisdom tooth surgery performed with sterile or clean gloves. Int J Oral Maxillofac Surg. 2006;35(2):174\u20139.<\/li>\n\n\n\n
          7. Bruens ML, van den Berg PJ, Keijman JMG. Minor surgery in general practice: Are sterilised gloves necessary? Br J Gen Pract. 2008;58(549):277\u20138.<\/li>\n\n\n\n
          8. Rogues AM, Lasheras A, Amici JM et al. Infection control practices and complications in dermatological surgery. J Hosp Infect. 2007;65(3):258\u201363.<\/li>\n\n\n\n
          9. Brewer JD et al. Comparison of sterile vs nonsterile gloves in cutaneous and outpatient dental procedures: A systematic review. JAMA Dermatol. 2016;152(9):1008\u201314.<\/li>\n\n\n\n
          10. Adeyemo WL et al. Are sterile gloves necessary in nonsurgical dental extractions? J Oral Maxillofac Surg. 2005;63(7):936\u201340.<\/li>\n\n\n\n
          11. Elek SD. Experimental staphylococcal infections in human skin. Ann N Y Acad Sci. 1956;65(3):85\u201390.<\/li>\n\n\n\n
          12. Robson MC et al. Rapid bacterial screening in wound treatment. J Surg Res. 1973;14(5):426\u201330.<\/li>\n\n\n\n
          13. Raahave D et al. Infective dose of bacteria in postoperative wound sepsis. Arch Surg. 1986;121(8):924\u20139.<\/li>\n\n\n\n
          14. Creamer J, Davis K, Rice W. Sterile gloves: do they make a difference? Am J Surg. 2012;204(6):976\u201380.<\/li>\n\n\n\n
          15. Sharf DR, Tarnow DP. Success rates of osseointegration for implants placed under sterile versus clean conditions. J Periodontol. 1993;64(10):954\u20136.<\/li>\n\n\n\n
          16. Cardemil C et al. Influence of different operatory setups on implant survival rate. Clin Implant Dent Relat Res. 2009;11(4):288\u201391.<\/li>\n\n\n\n
          17. Friberg B. Sterile operating conditions for placement of intraoral implants. J Oral Maxillofac Surg. 1996;54(11):1334\u20136.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

            The management of asepsis is one of the cornerstones of dental-patient safety, especially in oral and implant surgery. The oral cavity hosts an extremely rich and complex microbiota, second only to the gut microbiota, with over 700 bacterial species and numerous microorganisms, including fungi, viruses, and protozoa. (1) Even after repeated rinsing, mechanical cleaning, or […]<\/p>\n","protected":false},"author":1,"featured_media":6532,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[37],"tags":[],"class_list":["post-6575","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hygiene-en"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/posts\/6575","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/comments?post=6575"}],"version-history":[{"count":3,"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/posts\/6575\/revisions"}],"predecessor-version":[{"id":6579,"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/posts\/6575\/revisions\/6579"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/media\/6532"}],"wp:attachment":[{"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/media?parent=6575"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/categories?post=6575"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/magazine.zhermack.com\/en\/wp-json\/wp\/v2\/tags?post=6575"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}