|
 
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| PERSPECTIVE |
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| Year : 2022 | Volume
: 13
| Issue : 4 | Page : 158-161 |
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Lessons Learned from the COVID-19 Pandemic in Implant Dentistry Settings
Mohammed Hussein M Hussein Alsharbaty1, Moein Hoseini Shirazi2, Nawres Bahaa Mohammed3, Fatemeh Akbari4
1 Clinical Lecturer, Department of Prosthodontics, College of Dentistry, University of Al-Ameed, Karbala, Iraq
2 Assistant Professor of Prosthodontics and Implantology, Department of Prosthodontics, Mazandaran University of Medical Sciences, Mazandaran, Iran
3 Assistant Professor of Oral and Maxillofacial Surgery, College of Dentistry, University of Al-Ameed, Karbala, Iraq
4 Private Practice, Mazandaran, Iran
| Date of Submission | 26-Sep-2022 |
| Date of Decision | 15-Oct-2022 |
| Date of Acceptance | 17-Oct-2022 |
| Date of Web Publication | 12-Dec-2022 |
Correspondence Address:
Moein Hoseini Shirazi
Prosthodontics Department, Mazandaran University of Medical Sciences, Mazandaran
Iran
Mohammed Hussein M Hussein Alsharbaty
Head of Prosthodontics Branch, College of Dentistry, University of Al-Ameed, Karbala
Iraq
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/denthyp.denthyp_119_22
In 2019, Wuhan city of China announced the epidemic of COVID-19 as a public health disaster which has been recognized as an uncommon type of single stranded RNA virus belonging to Coronaviridae family and then quickly spread all over the world. Clinically symptomatic patients are identified as the primary source of COVID-19 transmission. Most of dental procedures require the use of high-speed handpieces which leads to aerosol generation. Implant dentistry is the field of dentistry which deals with prosthetic rehabilitation with minimal aerosol generation ensuring an aseptic surgical environment. There are several decisive recommendations regarding COVID-19 precautions that should be appreciated in implant dentistry. Sharp drills in slow speed drilling machines are preferred during surgery. Regular irrigation with high volume suction is greatly encouraged. Osteotomes are encouraged over ultrasonic devices to minimize the generation of aerosols during surgical procedures. Immediate implants placement is more preferred as the number of visits to the dentists is reduced. Impression techniques should be shifted to the digital approach instead of conventional methods. Full mouth rehabilitation cases requiring complex procedures should be accomplished restrictedly.
Keywords: COVID-19, implant dentistry, infection control
How to cite this article:
Hussein Alsharbaty MM, Shirazi MH, Mohammed NB, Akbari F. Lessons Learned from the COVID-19 Pandemic in Implant Dentistry Settings. Dent Hypotheses 2022;13:158-61 |
| Introduction | |  |
In early December 2019, the Wuhan city of China declared the epidemic of coronavirus disease as a public health crisis which quickly spread to all parts of the world.[1] This virus has been identified as an uncommon type of single stranded RNA virus belonging to Coronaviridae family.[2] Several inferences have emerged regarding a “live-animal” and “sea food” origin of this virus, discussing about the initial transmission from animals to humans and then an uncontrollable spread among human beings across the globe.[3] The International Committee on Taxonomy of Viruses has titled it as SARS-CoV-2 due to the close resemblance with other ß-coronaviruses, although, it is commonly referred as COVID-19 virus.[4]
COVID-19 infected patients frequently present with dry cough,[5] fever,[6] muscular pain,[7] lethargy,[8] and breathlessness[9] as clinical symptoms, upon investigations abnormal chest scans are reported.[1],[10] Less commonly reported symptoms include, headache, abdominal pain, nausea, emesis, hemoptysis, loose stools, and/or increased mucous production.[11] Sense of smell and taste have also been reported to alter with COVID-19 infection. COVID related disease onset can rapidly lead to progressive respiratory failure affecting the alveolar mucosa,[12] and in some cases leading to pleural effusion.[13]
Inhalation of airborne particles originating from the sneezing or coughing of an infected individual has been documented as the primary transmission pathway of COVID-19.[14] Typically, the clinical presentation of COVID-19 does not involve ocular symptoms, however, the conjunctival sample investigations revealed the presence of viral rRNA. It is thereby suggested that a direct contact with mucous membrane of oral,[15] nasal,[16] fecal,[17] or ocular[18] regions of infected individuals would lead to transmission of virus. Mixed opinions about the role of saliva in direct or in-direct transmission of COVID-19 have been published.[19],[20] Although the clinically symptomatic patients are identified as the primary source of COVID-19 transmission, the role of asymptomatic cases in transmission of COVID-19[21],[22] and transmission during the incubation period[23] has been recently debated. Debates regarding the possible transmission during the recovery process have been issued.[24]
Most of the dental procedures require the use of high-speed handpieces which leads to aerosol generation. Implant dentistry is a fundamental field of dentistry which deals with prosthetic rehabilitation of missing dentition with minimal aerosol generation ensuring an aseptic surgical environment. This aseptic approach is strictly indicated for the surgical procedure.
The current study focused on the impact of COVID-19 in the field of implant dentistry. The economic, clinical, environmental, and psychological impacts will be discussed. Numerous publications are issuing guidelines concentrating on COVID-19 related workplace safety for both clinicians and patients.
| Ecological Influence and Standpoints | | |
When the patient presents at a dental clinic, the body temperature must be evaluated using a non-contact forehead thermometer or if available cameras with infrared temperature sensors can be used. All elective dental procedures must be deferred for 2 weeks in case a body temperature of above 100.4°F or 38°C is detected with or without the involvement of a respiratory disease.[25] According to the evidence base, the COVID-19 suspected individuals should be seated according to the social distancing plan that ensures 6 feet distance between every individual.[26],[27] Arkarapotiwong and Chindapol[28] concluded that 12 air changes per hour (ACH) ventilation is considered appropriate to ensure safe working environment. Prevention of infection is paramount for a surgeon which include wearing N95 masks, sterile surgical gowns, protective face shields, and a pair of surgical or latex gloves.[29] Patients should be directed to wear a surgical mask, hand hygiene using appropriate chemical disinfectants, respiratory precautionary measure pre- and post-treatment, and wear mask throughout the consultation process.[30] Chemical disinfection of medical equipment (thermometer, sphygmomanometer, dental unit, stools, etc.) must be carried out following every dental treatment.[19] Patients must be advised to administer self-quarantine and inform their family physician to avoid spread of COVID-19.
Confirmed cases of COVID-19 must be prohibited from entering the operating rooms. All surgical treatments must be carried out under aseptic conditions while ensuring the use of personal protective equipment. Ultraviolet-C beams having a wavelength of 200 to 280 nm has a bactericidal and viricidal effect. Commercially available beams sources can be used to disinfect surgical theatres and operating rooms. Bollen et al.,[31] reported that UV-C beams can reduce 90% of bacteria and viruses in ambient air and the airflow capacity can enhance to 120 m3/h.
| Clinical Influence and Standpoints | | |
Emphasis should be made on following points from a clinical perspective:
Reduce the number of appointments
The more contact there is between staff and patients, the higher the risk of disease transmission. Reducing the number of appointments is not always possible, but with a different approach, a large reduction in the overall contact time can be guaranteed.- Non-submerged techniques: When a one-stage non-submerged technique is used to place the dental implant, there is no need for the second surgical appointment to uncover the implant. The use of tissue-level implants offers this advantage and is a well-documented approach. Esposito et al.,[32] have reported that there is no difference in the final outcome between a one-stage versus a two-stage implant placement.
- Avoiding compromised patients: Severely immunocompromised patients as well as those patients taking several anticoagulants often present more complications and therefore require more attention and postoperative care. In a pandemic, it is therefore advised to reschedule such patients until after a pandemic or alternatively, refer them to a hospital setting.
- Full digital workflow: Using an intraoral scanner with the concept of a full digital workflow has several advantages. Not only are fewer visits scheduled, but the chance of cross-infection is also strongly reduced. Using a scanner avoids contact with blood and any remnants.
Avoid specific treatment options
Just like ultrasonic scalers are not recommended to be used in periodontal treatments, similarly, alternative approaches have been advised in implant dentistry.- Radiography: Panoramic radiography and cone-beam computed tomography (CBCT) have a lower risk of contamination; therefore, are the preferred imaging techniques during a viral pandemic, since there is no contact with saliva.
- Piezosurgery: Since piezosurgery is an ultrasonic procedure that involves the generation of aerosols, using this equipment is not advised. The same is applicable to water-cooled Nd-YAG lasers or titanium brushes for the treatment of peri-implantitis.
- Sinus lifting procedures: Closed technique is preferred technique for sinus lift and bone augmentation as it has lower chances of aerosol generation.
Implement further tools
- Field Magnification: Use of a visual aid which include dental loupes or dental microscopes provides a considerable advantage over direct vision. Although this distance is far below the advised 6 ft. of social distancing, it still offers some distance, which contributes to a safer workplace.
- Rinsing: Before every intraoral dental procedure the patient has to rinse thoroughly with a disinfectant. H2O2 (0.5%) and povidone-iodine/iodopovidone (0.2%) are both effective against coronavirus particles. Chlorhexidine has a lower activity toward coronaviruses.[33]
- Implant surface coatings: Poggio et al.,[34] have reported that surface coatings with Cu-alloy was found to reduce the survival of coronavirus to less than 4 hours. This technique can be applied in the future to coat instruments and surfaces for medical practices.
Apply novel approaches
Most implant systems use high speed drilling for osteotomy preparations (850–2000 rpm), always in combination with external water cooling. Kim et al.,[35] rejected the hypothesis that inadequate cooling of the bone during low-speed drilling can result in osteoblast degeneration.- Bicon: The Bicon implant system (short and wide implants) has been on the market for more than 30 years. This system requires use of a slow speed handpiece at 50 rpm. The coolant is not recommended by the manufacturer. Due to this approach a lot of extra bone can be harvested from the osteotomy.[36]
- Nobel Biocare N1: Similar to the Bicon implant system, this system functions at slow speeds with the use of a specific Osseoshaper but in the absence of a cooling mechanism. Unfortunately, there is no scientific study yet shows the clinical outcomes of this approach.[37]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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