Technical platform IN IMPLANTOLOGY
Technical platform
- RISK OF INFECTION IN IMPLANTOLOGY
The osseointegration technique must follow a rigorous protocol to allow high success rates in implantology.
Infectious risk factors can be endogenous or exogenous.
Endogenous risk factors arise from the patient’s general condition, personal flora and age.
Exogenous risk factors arise from exogenous contamination due, for example, to a defect in the material handling procedure or hand hygiene treatment.
- Treatment of surgical and biomedical material
The level of treatment of medical devices is determined as a priority based on the potential infectious risk linked to the indication of these devices.
The Spaulding classification according to the type of contact is the reference for the treatment of medical devices: critical, semi-critical and non-critical.
This classification relates the level of criticality of the material, the level of infectious risk and the minimum level of treatment required.
This classification imposes the choice of sterilization or disinfection methods after treatment for each patient and for each medical device.
- critical category => single use or sterilization of multiple-use medical devices
This category concerns any medical equipment or device that, during its use, penetrates sterile tissues or cavities (after mucosal or bone breach) or the patient’s vascular system. These instruments are classified as high risk of infection transmission and will be single-use or sterilized after each use. Failing this, high-level disinfection is possible and concerns devices that cannot be sterilized due to their heat sensitivity.
In implantology, this can be drilling bits, scalpel, etc.
- semi-critical category => intermediate level disinfection
This category concerns certain instruments in contact with the oral mucosa and saliva. They are classified as presenting medium risks and must be disinfected by a disinfection that will be called intermediate level (IL). This disinfection will use a disinfectant* or a bactericidal, fungicidal, virucidal and mycobactericidal or tuberculocidal process. It is also possible to apply a higher level of treatment to them as for those in the critical category: sterilization or single use.
In dental surgery, instruments in this category are most often autoclavable, such as the examination mirror.
In implantology, these can be anesthesia cartridges, mirrors or spacers.
Technical platform IN IMPLANTOLOGY
- non-critical category => low level disinfection
Devices without direct contact with the patient (in particular the oral cavity) or in contact with the patient’s healthy skin are classified as non-critical because the direct risk of infection is low but contamination of this material can facilitate cross-transmission. They require a disinfection that will be described as low level and which has a bactericidal and fungicidal action.
A detergent-disinfectant* product can be used in this case.
In implantology, this can be the block carriage, the motor, etc.
- Processing steps for a reusable medical device
Sterilization and disinfection procedures require, to be effective, preliminary operations such as disassembly, pre-disinfection, rinsing, cleaning and packaging. These steps are imperative.
All handling for the pre-disinfection and cleaning phases requires the wearing of resistant gloves (suitable for chemical risks). It is also necessary to wear goggles and a mask against the risk of projection.
- Pre-disinfection
This step, which protects the staff, facilitates subsequent cleaning by lowering the level of contamination. It involves immersing all instruments used in the mouth (including dynamic instruments: turbines, contra-angles, handpieces and disassembly keys) as soon as they are no longer in use in a detergent-disinfectant solution in order to avoid encrustations and reduce the level of contamination of the equipment. The immersion tank must be large enough and fitted with a lid.
- Cleaning
This is the set of operations aimed at removing dirt (particles, waste, stains, etc.) from the treated objects. The pre-disinfected materials removed from the tank will be rinsed thoroughly. The cleaning action is physical (thermal), chemical, mechanical. A detergent* or detergent-disinfectant solution is used. Any equipment composed of detachable parts must be dismantled.
Various techniques exist: manual cleaning by brushing, ultrasonic cleaning, cleaning in washing machines or cleaning by machines.
- Rinsing and drying
This step is carried out manually or automatically, a thorough rinsing is mandatory after the cleaning action. Rinsing is carried out under running water.
After the rinsing step, the medical device is dried using clean, single-use non-woven support or a drying machine or by filtered compressed air.
- Sterilization
The effectiveness of the sterilization procedure depends directly on the correct execution and quality of the previous steps. It is strictly forbidden to resterilize single-use medical devices.
- Steam sterilization, the benchmark process today
It requires a temperature of 134°C maintained for 18 minutes (according to the recommendations of circular no. 138 of March 14, 2001 relating to the precautions to be observed during care in order to reduce the risks of transmission of non-conventional transmissible agents).
Technical platform IN IMPLANTOLOGY
- Specific measures for certain devices
- Surgical drilling guide
Surgical guides belong to the critical category. They are mainly made of resin and therefore cannot withstand autoclave sterilization at 134°C. They will therefore undergo a high-level disinfection treatment using exclusively disinfectant products for heat-sensitive medical devices. All cleaning steps must be carried out before use.
- Rotary (or dynamic) instruments: contra-angles, handpieces, turbines
Bacterial and viral contamination of rotating instruments (handpieces, contra-angles and turbines) comes from direct contact with the hard tissues of the tooth, the patient’s saliva and blood, the spray and indirect contact with other instruments, objects or substances. These instruments belong to the critical category but given the heat sensitivity of certain materials, it is not always possible to carry out sterilization in an autoclave. Failing this, high-level disinfection will most often be carried out. Handpieces, contra-angles and turbines must be disconnected from the unit* and undergo the treatment steps already mentioned.
- Surgical aspiration and irrigation
Two suction systems are preferable, one dedicated to saliva aspiration and the other to the drilling phases in order to recover bone debris if desired.
In implantology, the suction system is composed of a surgical suction, a suction cannula and sterile, single-use tubing. It is necessary to clean and disinfect the filter before and after each procedure.
The irrigation system is coupled to the micro lathe. The contra-angle connection cord must be disassembled, pre-disinfected, cleaned and then sterilized; if this is not possible, it must be disinfected and a sterile sheath or hose protector must be used.
- Lingerie
Only gowns and lingerie used for surgery must be sterilized. They can be either single-use or reusable after cleaning with a normal washing and drying cycle and then sterilization by type B autoclave by programming the textile cycle.
In some situations, it may be more economical to use disposable items such as sterile single-use gowns for aseptic procedures.
- Preparation and positioning of the patient
The patient will have received, beforehand, prophylactic antibiotic treatment as recommended by the French Agency for the Safety of Health Products and, if necessary, analgesic, anti-inflammatory or sedative premedication.
The protocol for preparing a patient before implant surgery involves five steps:
– oral disinfection with an iodine or biguanide-based mouthwash;
– dressing with a non-sterile gown, overshoes and a hairnet;
– installation of the patient in the operating room;
– skin antisepsis with an alcoholic antiseptic;
– draping the patient with surgical and sterile fields.
Technical platform IN IMPLANTOLOGY
- Preparation and set-up of the practitioner and operating assistants
Implant surgery protocols typically describe the participation of three stakeholders:
– a practitioner;
– an operating assistant also called an instrumentalist, sterile or aseptic;
– a circulating assistant
The preparation protocol for practitioners and operating assistants before implant surgery involves four steps:
– wearing specific non-sterile clothing including a treatment tunic and trousers;
– wearing clogs, a surgical mask, a hairnet or hood and glasses or magnifying glasses;
– surgical hand washing or surgical disinfection treatment by friction;
– putting on a sterile gown or coat and surgical gloves
- Installation of surgical equipment
The operating room is prepared before the patient arrives, but the surgical equipment can be installed upon the patient’s arrival so that the time during which the devices are placed outside their packaging, even when covered with a drape, is as short as possible.
- Organization of work plans
A surgical table, covered with a sterile drape, will be prepared by the assistant in aseptic clothing. This table will receive the sterile instrumentation essential for the procedure. This is the surgical box, the procedure-specific kit, the single-use sterile suction cannulas and the head drape. Everything will be covered with a sterile drape that will serve as a body drape for the patient.
Technical platform IN IMPLANTOLOGY
- Different operating times
The different operating times will be described in terms of the technical platform, ergonomics and mastery of asepsis. The different operating techniques and protocols will not be detailed because they do not systematically modify the technical platform.
For each step, the specific material is described
First of all, the essential equipment includes classic surgical equipment including:
– 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;
– curettes, rugines;
– a gouge pliers;
– a claw clip;
– a suture kit: needle holder forceps, suture thread, scissors;
– compresses;
– surgical suction cannulas, suction tubes;
– physiological fluid bags and irrigation tubes
- Anesthesia
Anesthesia can be of three types: local, loco-regional or general .
- The materials needed for this step are:
– an anesthesia syringe,
– different needles depending on the anesthesia used,
– sufficient number of anesthesia cartridges.
In the case of general anesthesia, the intervention takes place in an operating room and the anesthesia is performed by a doctor dedicated to anesthesia in the operating room with all the required conditions in accordance with current regulations.
- Incision and flap detachment
Incision and flap detachment provide access to the bone site.
The bony site can be isolated by suturing the flaps to the surrounding mucosa.
This allows for better visibility, frees up a hand and can help prevent saliva contamination of the implant site.
- Preparation of the implant site
Preparation of the implant site involves drilling a bone well in order to place the implant.
The current trend is to favor single-use drilling kits, delivered in sterile packaging, including drill bits, taps, etc. The various materials are usually stored in ergonomic boxes provided by the various manufacturers.
- The material includes:
– A surgical guide, if necessary;
– A ball strawberry;
– 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.
Technical platform IN IMPLANTOLOGY
- Implant placement
The implant is positioned in the direction of preparation using the contra-angle.
There is an implant gripping system so that nothing comes into contact between the implant surface and the bone well. The implant is removed from its double sterile packaging and fitted onto an implant holder if it does not have one.
This step is essential with regard to asepsis and operating procedures.
- The necessary equipment includes:
– an implant gripping system
– an implant, a cover or healing screw
– a tightening key with torque system
The treatment steps will then differ depending on the techniques used: a healing screw or a pillar is put in place using specific screwdrivers
- Flap repositioning
The flap is gently repositioned and then compressed to bring the edges together. Sutures can be performed.
Technical platform IN IMPLANTOLOGY
- CONCLUSION
The practice of implantology requires a technical environment adapted to this type of surgery.
The practitioner practicing implantology must pay attention to various parameters that could compromise the asepsis of the intervention: the treatment of biomedical and surgical material, the architecture of the premises, the preparation of the different actors, the operating times and the post-operative procedures.
Dental crowns are used to restore the shape and function of a damaged tooth.
Bruxism, or teeth grinding, can cause premature wear and often requires wearing a retainer at night.
Dental abscesses are painful infections that require prompt treatment to avoid complications. Gum grafting is a surgical procedure that can treat gum recession. Dentists use composite materials for fillings because they match the natural color of the teeth.
A diet high in sugar increases the risk of developing tooth decay.
Pediatric dental care is essential to establish good hygiene habits from an early age.