Vanchit John

Designing a safety checklist for dental implant placement: a Delphi study.

BACKGROUND Complications during and after dental implant placement can be a hindrance to successful treatment. Checklists are emerging as useful tools in error reduction in various fields. The authors selected a Delphi panel to explore the appropriate clinical practices involved in implant placement, with the objective of formulating a safety checklist that would aid in reducing errors. METHODS The authors administered a Delphi method survey to an expert panel of 24 board-certified periodontists to determine if consensus existed regarding the critical steps involved in implant placement. They defined consensus as 90 percent agreement among participants. Using the Delphi data, the authors designed a safety checklist for implant placement. RESULTS The panelists generated 20 consensus statements regarding essential steps in implant placement. The authors divided the statements into preoperative, intraoperative and postoperative phases. To determine the rationale for consensus decisions, the authors conducted a thematic qualitative analysis of responses to all open-ended questionnaire items, asking panel members how or why a particular procedure was performed. CONCLUSION The panelists reached a consensus regarding the steps they considered critical in implant placement. Further research is needed to assess the acceptance and effectiveness of this type of checklist in a clinical setting. Practical Implications. The authors developed a checklist that may be useful in reducing errors in placement of dental implants. If effective, this checklist ultimately will aid in minimizing risk and increasing implant success rates, especially for inexperienced practitioners, dental students, surgical residents and dental implant trainees (that is, dentists undergoing training to place implants through continuing education courses).

Cervical Enamel Projections and Associated Pouch-Like Opening in Mandibular Furcations

BACKGROUND Cervical enamel projections (CEPs) have been listed among the tooth-associated risk factors that could lead to isolated furcation defects around molar teeth. This is more likely when Grade III CEPs are present. However, the histologic aspects of the CEP interface with regard to the presence or absence of cementum over the enamel projection within the furcation have not been well described. This study was initially undertaken to evaluate this relationship. METHODS Thirty-five mandibular molars with Grade III CEPs were selected from a collection of extracted teeth and evaluated for the presence of cementum covering these areas by stereomicroscopy, light microscopy, and scanning electron microscopy (SEM). RESULTS Sixteen of the 35 teeth (45.7%) with Grade III CEPs appeared completely covered by cementum. SEM evaluation showed the presence of a narrow pouch-like opening between cementum and enamel in 15 of 16 teeth (93.8%). Light microscopy evaluation confirmed the presence of the pouch along with some indication of residual degenerated mesenchymal tissue within the defects. SEM evaluation showed the presence of globular bodies in this pouch. CONCLUSIONS This study reports on the presence of a pouch-like opening between the enamel and cementum in mandibular molars with Grade III CEPs. The clinical significance of these cementum pouches has yet to be determined but bacterial contamination of these pouch-like structures in areas of furcation periodontal breakdown may serve as a nidus for recolonization and disease recurrence or for the development of furcation caries if exposed to the oral cavity after surgical procedures.

Peri-Implant Bone Loss and Peri-Implantitis: A Report of Three Cases and Review of the Literature

Dental implant supported restorations have been added substantially to the clinical treatment options presented to patients. However, complications with these treatment options also arise due to improper patient selection and inadequate treatment planning combined with poor follow-up care. The complications related to the presence of inflammation include perimucositis, peri-implant bone loss, and peri-implantitis. Prevalence rates of these complications have been reported to be as high as 56%. Treatment options that have been reported include nonsurgical therapy, the use of locally delivered and systemically delivered antibiotics, and surgical protocols aimed at regenerating the lost bone and soft tissue around the implants. The aim of this article is to report on three cases and review some of the treatment options used in their management.

Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study

With the increased number of elderly and medically compromised individuals receiving dental care and the presence of systemic comorbidities and associated treatment modalities in this patient population, it is imperative that dentists be prepared to manage a variety of medical emergencies. The aim of this study was to assess the knowledge of and preparedness to manage common medical emergencies of cohorts of practicing periodontists, specialty residents, and faculty members, both for comparative purposes and as an aid to refining a dental schools standardized case scenarios. The study, conducted in 2017, was designed for four groups of randomly selected participants with at least 20 in each group; the actual number of voluntary participants was 28 private practice periodontists, 22 residents in specialty programs, 21 specialist faculty members, and 24 general practice faculty members. Participants were asked to evaluate ten clinical emergency cases and identify the diagnosis and indicated intervention for each. Groups were also evaluated for differences among correct responses for each case. Overall, there were no statistically significant differences for number of correct diagnoses or interventions among the four groups. However, several cases had varying degrees of incorrect diagnoses and management across all groups. Participants who had recently graduated or were still in school were able to treat cases appropriately more often than the other participants. Further refinement of cases to assess provider preparedness to correctly diagnose and manage medical emergencies is needed, specifically establishing case-specific features and addressing areas of potential confusion before the cases are used for educational purposes.

Treatment of an Erratic Extraction Socket for Implant Therapy in a Patient with Chronic Periodontitis

As implant therapy becomes more commonplace in daily practice, preservation and preparation of edentulous sites are key. Many times, however, implant therapy may not be considered at the time of tooth extraction and additional measures are not taken to conserve the edentulous site. While the healing process in extraction sockets has been well investigated and bone fill can be expected, there are cases where even when clinicians perform thorough debridement of the sockets, connective tissue infiltration into the socket can occur. This phenomenon, known as “erratic healing,” may be associated with factors that lead to peri-implant disease and should be appropriately managed and treated prior to surgical implant placement. This case report describes the successful management of an erratic healing extraction socket in a 62-year-old Caucasian male patient with chronic periodontitis and the outcomes of an evidence-based treatment protocol performed prior to implant therapy. Careful preoperative analysis and cone beam computed tomography imaging can help detect signs of impaired healing in future implant sites and prevent surgical complications.

Original ContributionsCover StoryDesigning a safety checklist for dental implant placement: A Delphi study

BACKGROUND Complications during and after dental implant placement can be a hindrance to successful treatment. Checklists are emerging as useful tools in error reduction in various fields. The authors selected a Delphi panel to explore the appropriate clinical practices involved in implant placement, with the objective of formulating a safety checklist that would aid in reducing errors. METHODS The authors administered a Delphi method survey to an expert panel of 24 board-certified periodontists to determine if consensus existed regarding the critical steps involved in implant placement. They defined consensus as 90 percent agreement among participants. Using the Delphi data, the authors designed a safety checklist for implant placement. RESULTS The panelists generated 20 consensus statements regarding essential steps in implant placement. The authors divided the statements into preoperative, intraoperative and postoperative phases. To determine the rationale for consensus decisions, the authors conducted a thematic qualitative analysis of responses to all open-ended questionnaire items, asking panel members how or why a particular procedure was performed. CONCLUSION The panelists reached a consensus regarding the steps they considered critical in implant placement. Further research is needed to assess the acceptance and effectiveness of this type of checklist in a clinical setting. Practical Implications. The authors developed a checklist that may be useful in reducing errors in placement of dental implants. If effective, this checklist ultimately will aid in minimizing risk and increasing implant success rates, especially for inexperienced practitioners, dental students, surgical residents and dental implant trainees (that is, dentists undergoing training to place implants through continuing education courses).

Designing a safety checklist for dental implant placement

BACKGROUND Complications during and after dental implant placement can be a hindrance to successful treatment. Checklists are emerging as useful tools in error reduction in various fields. The authors selected a Delphi panel to explore the appropriate clinical practices involved in implant placement, with the objective of formulating a safety checklist that would aid in reducing errors. METHODS The authors administered a Delphi method survey to an expert panel of 24 board-certified periodontists to determine if consensus existed regarding the critical steps involved in implant placement. They defined consensus as 90 percent agreement among participants. Using the Delphi data, the authors designed a safety checklist for implant placement. RESULTS The panelists generated 20 consensus statements regarding essential steps in implant placement. The authors divided the statements into preoperative, intraoperative and postoperative phases. To determine the rationale for consensus decisions, the authors conducted a thematic qualitative analysis of responses to all open-ended questionnaire items, asking panel members how or why a particular procedure was performed. CONCLUSION The panelists reached a consensus regarding the steps they considered critical in implant placement. Further research is needed to assess the acceptance and effectiveness of this type of checklist in a clinical setting. Practical Implications. The authors developed a checklist that may be useful in reducing errors in placement of dental implants. If effective, this checklist ultimately will aid in minimizing risk and increasing implant success rates, especially for inexperienced practitioners, dental students, surgical residents and dental implant trainees (that is, dentists undergoing training to place implants through continuing education courses).

Cover story: Designing a safety checklist for dental implant placement: A Delphi study

BACKGROUND Complications during and after dental implant placement can be a hindrance to successful treatment. Checklists are emerging as useful tools in error reduction in various fields. The authors selected a Delphi panel to explore the appropriate clinical practices involved in implant placement, with the objective of formulating a safety checklist that would aid in reducing errors. METHODS The authors administered a Delphi method survey to an expert panel of 24 board-certified periodontists to determine if consensus existed regarding the critical steps involved in implant placement. They defined consensus as 90 percent agreement among participants. Using the Delphi data, the authors designed a safety checklist for implant placement. RESULTS The panelists generated 20 consensus statements regarding essential steps in implant placement. The authors divided the statements into preoperative, intraoperative and postoperative phases. To determine the rationale for consensus decisions, the authors conducted a thematic qualitative analysis of responses to all open-ended questionnaire items, asking panel members how or why a particular procedure was performed. CONCLUSION The panelists reached a consensus regarding the steps they considered critical in implant placement. Further research is needed to assess the acceptance and effectiveness of this type of checklist in a clinical setting. Practical Implications. The authors developed a checklist that may be useful in reducing errors in placement of dental implants. If effective, this checklist ultimately will aid in minimizing risk and increasing implant success rates, especially for inexperienced practitioners, dental students, surgical residents and dental implant trainees (that is, dentists undergoing training to place implants through continuing education courses).