The human error effectUncategorised
Posted by: The Probe 16th May 2020
Thanks to an explosion of scientific advancements and technological developments, implant dentistry has come a long way in recent years. As a result, implant placement is now safer, more predictable, efficient and effective – for the most part anyway. Indeed, there will always be a small percentage of cases where a successful outcome is simply not achievable and for all the best intentions in the world, mistakes can and do occur. The reason? Human error.
China’s solution to this has been to create a robot that can carry out implant surgery on patients without any active involvement from dental professionals; a feat that was first successfully achieved back in September 2017.[i] While there can be no doubt that such an accomplishment is a medical marvel, one could argue that artificial intelligence is not a suitable replacement for a human as far as judgement and intuition is concerned. Firstly, because instinct is at the heart of dentistry, and secondly because technology doesn’t have the intelligence to work creatively, which is essential given that implantology is as much an art as it is a science.
What the profession needs to be doing instead is focusing its energy on minimising the risk of human error, beginning with identifying some of the potential complications that can occur and how they can be overcome. If professionals are more consciously aware of possible problems and have a greater understanding of the consequences of poor practice, they are arguably a lot less likely to make those mistakes. So, what are the most common complications that practitioners should be aware of?
Injury or damage to surrounding structures
If the practitioner makes an error in judgement when determining the distance to adjacent structures or places the implant at an incorrect angle, it is possible that damage can be caused to the surrounding teeth. Injury can also occur if excessively wide fixtures are used due to insufficient height of the residual alveolar bone or there is too much heat generated during the osteotomy process. If the bone overheats it can lead to bone cell death, and ultimately unsuccessful osseointegration.[ii]
In cases where a dental implant is placed in the upper jaw, it can protrude into the maxillary sinus. This may happen during placement itself or after prosthetic restoration, and can occur for a number of reasons. Patients with a decreased height of the residual alveolar bone are particularly at risk, as are those who require bone grafting at the time of placement. As such, it is the practitioner’s responsibility to explore these potential problems and make the necessary preparations during planning to minimise the risks and optimise the success of treatment. Likewise, appropriate case selection and knowing one’s limitations are crucial, as it has been proven that these complications often occur due to a lack of experience.[iii]
As with all other dental procedures, infection can be a huge problem with dental implants. Naturally, there are instances where the practitioner is not to blame; for example, where there are predisposing systemic conditions such as uncontrolled diabetes, osteoporosis, steroid use, or the patient is a smoker. But infection – and subsequent perio-implant disease – can also be a result of improper irrigation of the implant site, poor infection control and unequal occlusal load distribution,[iv] all of which the practitioner is responsible for. Luckily, with an early diagnosis and appropriate treatment, it is possible to eradicate infection and rectify the problem (although it is not always possible to achieve a successful outcome).
Other complications are not so easy to correct – nerve damage being one of them. Completely preventable but irreversible, nerve damage can lead to numbness or tingling in the tongue, lips, gingiva and face, which in turn can affect everyday activities and long-term quality of life. Possible causes of nerve damage include traumatic flap reflection, traction on the mental nerve in an elevated flap, poor flap design, and penetration of the osteotomy preparation.[v]
There are some complications that are beyond the control of the practitioner, but it is clear that many of them could be avoided simply by gaining the relevant experience, following proper case selection and treatment planning, and implementing good surgical techniques. Utilising high-quality equipment that has been specially designed to ensure successful implant outcomes is also a must, so it is important that practitioners take great care when choosing tools for their armamentarium.
To facilitate atraumatic surgery, enhance precision, aid patient comfort and maximise the chances of treatment success, W&H recommends the Implantmed. This is a must-have surgical unit for every implant dentist, as it features an automatic torque control and thread cutter function. The Implantmed can also be equipped with the Osstell ISQ module, which is backed by more than 1,000 scientific studies, and can be used to measure the stability of implants in order to determine the ideal time for loading. With implant scaler tips from W&H facilitating effective implant maintenance, practitioners can work with complete confidence.
The risk of human error will never be completely eradicated, but with the right training and equipment practitioners can be sure to deliver the safest and most predictable implant treatment possible.
[i] South China Morning Post. ‘Chinese robot dentist is first to fit implants in patient’s mouth without any human involvement’. Published 21 September 2017. Accessed online 9 January 2020 at https://www.scmp.com/news/china/article/2112197/chinese-robot-dentist-first-fit-implants-patients-mouth-without-any-human
[ii] Yoon WJ, Kim SG, You JS. Prognosis and evaluation of tooth damage caused by implant fixtures. J Korean Assoc Oral Maxillofac Surg. 2013 Jun; 39(3):144-147. Accessed online 9 January 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858169/
[iii] An JG, Park SH, Oh HK. Treatment of dental implant displacement into the maxillary sinus. Maxillofac Plast Reconstr Surg. 2017 Dec; 39(1):35. Accessed online 9 January 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701899/
[iv] Hanif A, Qureshi S, Haroon R. Complications in implant dentistry. Eur J Dent. 2017 Jan-Mar; 11(1):135-140. Accessed online 9 January 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379828/
[v] Misch K, Wang HL. Implant Surgery Complications: Etiology and Treatment. Implant Dentistry. 2008; 17 (2): 159-168. Accessed online 9 January 2020 at https://www.endoexperience.com/documents/ImplantsurgerycomplicationsMischetal.pdf
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