The continuing pandemic has had a terrific affect on many fields in dentistry, together with routine procedures and the best way by which dental training is delivered. So as to discover out extra concerning the extent to which the sector of implant dentistry has been affected, Dental Tribune Worldwide contacted Prof. Maher Almasri, dean of the School of Drugs and Dentistry at Ulster College in Birmingham within the UK, and Prof. Curd Bollen, head of implant dentistry on the identical establishment. On this interview, they talk about how implant dentistry can finest be tailored to the present scenario.
Profs. Almasri and Bollen, basic dental care was enormously affected by the pandemic owing to the mandatory shut proximity of dentist and affected person and the manufacturing of aerosols. Are there any remedy choices in implant dentistry that can’t be carried out in the intervening time?
Bollen: Implant dentistry faces, in fact, the identical an infection dangers as basic dentistry, though the usage of aerosols in our area is extra restricted. Utilizing piezo-surgical devices is, nonetheless, not really useful within the present scenario. Within the case of sinus elevation procedures, for instance, a closed approach (Summers’ approach) is most popular, because the lateral window approach wants high-speed water-coolant or piezo-surgical gear—each inducing excessive aerosols. All different surgical and prosthetic remedies can nonetheless be carried out, so long as the strict an infection prevention guidelines are revered by the affected person, the practitioner and the workers.
Almasri: Intra-oral radiographs, though inflicting minimal radiation, ought to be reconsidered due to the upper contamination threat compared with an extra-oral radiograph. Nonetheless, in fact, we should always not all of the sudden neglect the ALARA precept, however a partial dental panoramic tomogram or CBCT with a small area of view is really useful.
Prof. Maher Almasri. (Picture: Ulster College)
For basic dentistry, study findings have established certain measures that can reduce the risk of infection. What are some measures that dental implantologists could apply throughout this difficult time?
Bollen: A radical remedy room disinfection after each affected person contact is of the utmost significance. These days, there may be glorious gear obtainable that makes use of ultraviolet C to ensure strict disinfection of air, flooring and surfaces of the operation room. Each revered clinic ought to be outfitted with it!
One other risk is that of making use of non-submerged methods the place attainable. When a one-stage non-submerged approach is used to put in the dental implant, there isn’t a want for a second surgical appointment to uncover the implant. The usage of tissue-level implants provides this benefit and is nicely documented.
Almasri: An alternative choice is to put dental implants that use low-speed drilling with out cooling. Some particular manufacturers, as Bicon or Nobel Biocare (N1 implant), present excessive long-term success charges with osteotomy drilling at 50 rpm with out cooling.
Are there another measures that may be taken to scale back the danger of an infection for sufferers and workers throughout dental implant procedures?
Bollen: To start with, each affected person ought to rinse earlier than each intra-oral process with hydrogen peroxide (0.5%) or povidone-iodine (0.2%), that are extremely efficient towards SARS-CoV-2 particles. We all know that chlorhexidine has no impact on the virus in any respect!
It’s also advisable to make use of magnification gear resembling a loupe or a microscope. These instruments create extra distance between the practitioner and the oral cavity of the affected person, though not the really useful 2 m (6 ft), in fact. This additionally helps to enhance your posture. Moreover, the introduction of a totally digital workflow will be useful: no extra—presumably contaminated—impressions should be despatched to the laboratory and fewer appointments are wanted to complete the ultimate reconstruction.
Almasri: Let’s attempt to keep away from treating compromised sufferers, if the remedy will be postponed. Dental implant surgical procedure is not any first help. Severely immunocompromised sufferers in addition to sufferers taking anti-coagulants usually current extra problems and subsequently require extra consideration and postoperative care. Throughout a pandemic, this implies additional and pointless appointments.
The restricted entry to routine dental care has had a unfavorable affect on the oral well being of many sufferers. How do you consider the scenario for dental implant sufferers?
Almasri: As talked about earlier than, implant dentistry is not any first help. The one discomfort sufferers should face might be a delay of their remedy plan. Surgical or prosthetic appointments are sometimes postponed, resulting in a lengthened remedy course of. So be it!
After all, sufferers affected by postoperative ache or infectious issues round their implants must have entry to a primary help service. Additionally, prosthetic repairs ought to stay obtainable for the affected person.
Prof. Curd Bollen. (Picture: Ulster College)
Along with the psychological burden, the pandemic is financially difficult for sufferers and observe house owners. Earlier than SARS-CoV-2, the dental implant market was one of many quickest rising markets within the dental sector. How do you understand the present scenario?
Bollen: As with the psychological issues, the monetary affect has two elements: the affect on the sufferers and the affect on the clinicians. Each teams face monetary insecurities these days owing to much less revenue and rising bills.
On the one hand, for sufferers this usually results in selecting private care bills over the dearer remedies—like implant-supported rehabilitations—that are consequently postponed. Dental practitioners, however, are confronted with further bills that don’t improve their revenue. Solely not often is the federal government prepared to assist these additional prices for all the brand new precautionary measures.
This results in an absence in return on funding and might trigger big monetary issues for brand new or not too long ago began clinics or clinics with an unstable monetary foundation. Since there isn’t a finish date for a pandemic, the psychological and monetary evolution in the course of the subsequent months or years is hardy to foretell. Nonetheless, occasions would possibly keep powerful for some time.
In your opinion, do you suppose the pandemic may have a long-term affect on the observe of dental implantology? If sure, in what means?
Bollen: Sure, it should. Since former pandemics usually lasted a number of years and even many years, it’s attainable that we should face this pandemic for an extended interval than we had hoped for. Though a number of vaccines can be found now, there is no guarantee that they will be functional against the new or mutated SARS-CoV-2 variants.
Almasri: The one factor we’ve got in our personal arms is the flexibility to guard ourselves and our fellows as a lot as attainable. Implant dentistry can contribute to this safety by bearing in mind these additional measures that Prof. Bollen and I’ve talked about.
Would you want so as to add anything?
Bollen: As with all earlier pandemics, humanity will survive these darkish occasions. But, if we need to win towards this or any future virus, we’ll want a unified method in any respect ranges of society.
