|Year : 2020 | Volume
| Issue : 1 | Page : 1-2
Dental Implant Practice in the Post COVID-19 Era: Wading the Realities
ProSmile Dental Clinic and Implant Centre, Consultant Prosthodontist and Implant Dentist, Dr. L. H. Hiranandani Hospital, Mumbai, Maharashtra, India
|Date of Submission||23-Jun-2020|
|Date of Acceptance||23-Jun-2020|
|Date of Web Publication||08-Jul-2020|
Dr. Sharat Shetty
ProSmile Dental Clinic and Implant Centre, Consultant Prosthodontist and Implant Dentist, Dr. L. H. Hiranandani Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shetty S. Dental Implant Practice in the Post COVID-19 Era: Wading the Realities. J Dent Implant 2020;10:1-2
Ever since the declaration of COVID-19 as a pandemic by the World Health Organization (WHO) in the mid-March 2020, the new and novel coronavirus has affected a large populous, with 80% being asymptomatic or minimalistically ill, 15% being severely ill, and 5% being critically ill. It shows a community spread nature and is a respiratory infection, evidently transmitted mainly by droplet particles and nuclei and contact routes with fomites. Airborne transmission is only suspected but not conclusively reported. There is a need to find out if there is a dose-dependent relation between viral load contact and severity of the disease. Moreover, in view of no past experiences with this disease and no conclusive and evidence-based universal curative or preventive measures till date, many fear-related prejudices have taken roots in various disciplines of health care.
Dentistry is worst affected considering the prevalence of aerosols associated with most dental procedures. The dental clinics in India and many countries around the world have closed down with the implementation of lockdowns, and only emergency and urgent cares are being delivered at dedicated centers. A lot of economies have shut done, and an apparent recession has set in with a grinding halt to the entire dental industry. The world is waiting abatingly for the arrival of cost-effective and rapid diagnostic testing methods, curative medications for the affected, and vaccine as a preventive approach. However, these appear a distant dream and are more confusing with premature, incorrect, and biased information coming from respected authorities. Due to the lack of universal guidelines for dental care deliveries, there appears to be new and different normal in every country.
The use of dental environment cleaning and disinfection technologies, hand hygiene, and personal protective equipment (PPE) have soared though no substantive evidences are supporting them with proofs while treating asymptomatic patients. However, with passing days and many efforts to understand the virus and its potential spread, there is a strong evolution of processes differentiating medical and dental aerosols. This is further substantiated with no reports of spread from dental clinics across the globe. With no positive prospective avenues and possibilities of future waves, dentistry is poised for difficult times.
Today, dental interventions are restricted only to emergency and urgent needs and deferral of elective procedures, denying routine checks, and corrective and maintenance protocols for optimum dental health. The bad news is that dental problems are getting more chronic and progressively irreversible, which will result in future aggressive, extensive, and complex therapies. This will also lead to more loss of oral functions and of course more loss of teeth in the short run. More replacements will then be necessary.
So our confronting question is: Should we deny right dental treatment if due care is taken while rendering it? Is implant treatment going to be a distant dream for practitioners and the rightful recipients (our patients)?
Resumption of routine dental practice to previous normal is not expected in the near future. However, the dental fraternities still need to practice patient-centered and progressive dentistry. Replacements and esthetics will spur the market and dental implants will remain the most promising method of replacements of missing teeth for improved quality of oral and overall life and elevated self-esteem. Reliable standard operating procedures for dental practice will have to be implemented for safe delivery of dental implant treatment. This will involve dental personnel and patients and their personal protections, decontaminated dental settings, improved dental trade, and laboratory practices.
The following aspects are encouraging for the delivery of appropriate dental implant solutions:
- No reports of transmission of COVID-19 from dental settings across the globe so far
- Basic WHO-accepted sterilization protocols and practice standards in dental practices being followed more strictly
- Telephonic triages and screening at reception for safe entry to patients
- Treatment of asymptomatic pre-appointed patients only, in clinical practice
- No overlapping of patient appointments and physical distancing
- Acceptable PPE for dentist, assistants, other dental personnel, and patients (masks, goggles, face shields, and gowns)
- Dental premises' sanitization with air purification, fumigation, and air circulation and ventilation
- High evacuation equipment
- Preprocedural rinses with 1.5%–3% hydrogen peroxide or 0.2% povidone-iodine solutions, reducing the oral microbes considerably
- Adequate hand-washing protocols and alternate use of alcohol-based hand sanitizer with approximately 70% alcohol by all people.
Dental implant therapy is similar to any other dental procedure and can be effectively done as it:
- Has a high success and survival rate
- Is performed as an outpatient procedure
- Is still manageable in the clinics for most complications
- Will only see a reasonable raise in costs of the procedures as compared to raise in other dental procedures.
- n spite of the looming economic recession and improving uncertainties, most market surveys have projected that the dental implant market is forecasted to grow by approximately 5% every year and increase by 1.5 billion USD by 2024. However, the pandemic is going to send these estimates to an unexpected future
- Advances in technologies such as computer-aided design/computer-aided manufacturing and three-dimensional printing systems and use of surgical guides can shorten dental implant surgical time and in turn the time of exposures
- Use of four-handed dentistry at the chairside and a circulating assistant for other assistances, thus reducing treatment time and maintaining effective control of droplet and aerosol propagation.
The following personal recommendations when followed by dental professionals will further ensure quality delivery of dental and implant services:
- Maintenance of good health (includes good sleep, adequate exercises, and correction of nutritional and vitamin deficiencies)
- Facial hair to be trimmed for good fit of the masks
- Use of full or half respirators for those who wish to keep beards
- Regular appropriate hand-washing practices with soap and water with intermittent use of glycerin-based moistures
- Good respiratory behavior and habits.
Another noticeable and incredible change seen during the last 4 months is free access to innumerable webinars by every established dental expert, on all aspects of dentistry, especially implant practice. Dentists across India and abroad had a wonderful opportunity to update themselves with ample time and absorbing minds. These will further ensure contemporary standards of implant care to all the needy patients.
Hence, dentists have compelling reasons to open their dental practices to provide safety-laden care to their patients and also for economic survival of their clinics. There have been earlier acceptance and adaptation to previous dangerous infections across the globe such as the HIV and severe acute respiratory syndrome, so the dental fraternity will need to adapt to this pandemic of COVID-19 with strict compliance of the accepted new norms to protect everyone, and it can be done with evolving evidences. This will rebuild trust, elevate the quality of dental care, and recover dentistry from this crisis, so will dental implant practice.
Avoiding danger is no safer in the long run than outright exposure. The fearful are caught as often as the bold.
– Helen Keller.