Technical platform in implantology

Technical platform in implantology

Introduction

Evolution of the practice of implantology
Technical conditions to be met for the placement of implants

Layout of the premises
Working conditions
Sterilization process
Instrumentation

Plan

Preoperative management and planning
Processing of biomedical material
Organization of the premises
Implementation of specific material actors in implantology
Intraoperative procedures
Postoperative procedure

Balance sheet – planning

A surgical intervention should not be prepared at the last minute; it is better to check everything a week beforehand so that you can possibly place an order with a supplier.
If several implants are to be placed within a week, the necessary equipment for all procedures must be available.
An assistant will check that everything necessary for the intervention is ready:

Dental scanner (patient file)
The chosen implants
The implantology kit
The kit of surgical instruments for implantology
The equipment necessary for the procedure (physiological serum, contra-angle, filling materials, membrane, threads, blades)
Sterile fields and sheaths
Sterile dressing for the surgeon and assistant
Dressing for the patient

Level of processing of medical devices

Spaulding classification:

Critical category: single-use or sterilization of multiple-use medical devices
Semi-critical category: intermediate level disinfection
Non-critical category: low-level disinfection

Critical category

Concerns any medical material or device which, during its use, penetrates sterile tissues or cavities (after breaking through the mucosa or bone)
Classified as high risk of infection transmission
Single use or sterilized after each use
In implantology, this can include drills, scalpels, etc.

Semi-critical category

Some instruments in contact with the oral mucosa and saliva
Medium risks; intermediate level disinfection
Disinfectant or a bactericidal, fungicidal process…
It is also possible to apply a higher level of processing to them
In dental surgery, instruments in this category are most often autoclavable, such as the examination mirror.
In implantology, these can be anesthesia cartridges, photo mirrors or retractors, X-ray film or sensor, etc.

Non-critical category

Without direct contact with the patient (oral cavity) or in contact with healthy skin.
Not critical because the direct risk of infection is low
But contamination of this material can facilitate cross-transmission
They are low-level disinfection products with bactericidal and fungicidal action.
A disinfectant detergent product can be used in this case
In implantology, this could be the operating trolley, the motor, a camera, etc.

sterilization

To be effective, sterilization and disinfection procedures require preliminary operations such as: disassembly, pre-disinfection, rinsing, cleaning and packaging
these steps are imperative
pre-disinfection:

protects staff and facilitates subsequent cleaning by lowering the level of contamination
immersion of all instruments used in the mouth immediately after use in a disinfectant detergent solution $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210121_220748.jpg$
large immersion tank with a lid
cleaning

the pre-disinfected material removed from the bin will be rinsed thoroughly
all equipment, composed of detachable parts, must be dismantled $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_135100.jpg$
the cleaning action is physical (thermal), chemical, mechanical
a detergent or disinfectant detergent solution is used
Various techniques exist: manual cleaning by brushing, ultrasonic cleaning or cleaning by machines
rinsing and drying $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_115221.jpg$

Thorough rinsing is mandatory after the cleaning action
rinsing is carried out under running water
after the rinsing step, the medical device is dried
packaging

packaging with reusable or single-use packaging
sealed bags with a minimum seal width of 8 mm $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210121_221537.jpg$
Double packaging is recommended because it extends the shelf life and makes it easier to set up the equipment.
Sterilization

Steam sterilization, the benchmark process today
It requires a temperature of 134°C maintained for 18 minutes
Load control at the end of sterilization (integrity of the packaging, absence of humidity in the load, digital or graphic recording of the cycle) $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_115317.jpg$
Store in a dry place

Traceability

Surgical instruments to be used for the procedure must be sterilized in double bags with a physicochemical test to confirm that all the parameters necessary for the sterility of the product have been reached, a second test will be placed in the autoclave $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_115338.jpg$
These witnesses must be archived in a register within the practice as well as in the patient file to ensure quality traceability within the practice.
The duration of sterility of an instrument depends on its packaging method and its storage method.
An instrument in a single sachet stored in an unclosed place has a sterility period of 1 month.
An instrument in a simple bag stored in a closed place (cupboard drawer) has a shelf life of 2 to 3 months.
An instrument in a double bag and stored in a closed place for a period of 4-6 months.

Architecture of the premises

The layout of the rooms must be determined in relation to the potential risk of contamination, namely:

Administrative areas: reception, office, patient waiting area
Potentially “contaminated” areas: material processing area, waste storage area, area for household equipment, toilets
So-called “protected” areas: examination and treatment areas, areas for packaging, sterilization and storage of sterile equipment and medications

Patient circulation and instrumentation

The patient must follow a simple and precise circuit from entry to exit
Sterile instruments are stored near the operating room
At the end of the procedure, the circuit of soiled instruments must be short
The concept of “forward march” or “progressive asepsis”

Procedure room and equipment

By reducing the level of environmental contamination, maintenance is one of the links in the chain of preventing the risk of infection. $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_115357.jpg$

Water/Air Treatment

Different types of water are therefore necessary depending on the uses:

Infiltrated water for surgical hand washing
Sterile water for surgical irrigation
Technical water for various devices: autoclave, washing machines, etc.
Drinking water for other uses
Specific air treatment is therefore not necessary to carry out implant surgeries, but the control of three parameters (air renewal, disinfection of surfaces, circulation of operators) makes it possible to control the air in the operating room.

Patient

The protocol for preparing a patient before implant surgery involves five steps:

Oral disinfection with an iodine or biguanide mouthwash
Dressing with a non-sterile gown, shoes and a hairnet
Patient installation in the operating room $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_115420.jpg$
Skin antisepsis with an alcoholic antiseptic
Draping the patient with surgical and sterile drapes

Practitioner/assistant

The protocol for preparing the practitioner and operating assistants before implant surgery involves four stages:

Wearing specific non-sterile clothing including a tunic and treatment trousers
Wearing clogs, a surgical mask, a hairnet or balaclava and glasses or magnifying glasses
Surgical hand washing or surgical disinfection treatment by friction $C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_115436.jpg$
Putting on a sterile gown or helmet and surgical gloves

C:\Users\LENOVO\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20210122_115452.jpg

Instrumentation

An examination tray: mirror, tweezers, probe and mouth spatula
A periodontal probe
A scalpel with single-use blades
A straight and sickle syndesmotome
Strippers
A crusher
Metal spacers
Elevators
Curettes, rugines
A pair of gouges
A claw clip
A suture kit: needle holder, suture thread , scissors
Compresses
Surgical suction cannulas, suction tubes
Physiological fluid bags and irrigation tubes
A pair of pliers for handling instruments

Anesthesia

An anesthesia syringe
Different needles depending on the anesthesia used
Sufficient number of anesthesia cartridges

Site preparation

A surgical guide, if necessary
A strawberry ball
Surgical instruments: bone scissors, curette, etc.
An implant surgery kit containing a set of drills, taps if necessary, parallelism rods, etc.
An irrigation system with sterile water
A motor, a contra-angle, a handpiece