Efficiency unleashed: Morven McCauley discusses five key tips for successful dual-arch implant surgery management.
As general dentists with a special interest in implants, the longest and most taxing appointments we tend to encounter is that of a dual-arch case of immediately loaded fixed full arch implants.
When presented with a surgery of potentially four to five hours in duration, if not more, how we can avoid physical and mental fatigue, not only of the providing surgeon but also of the receiving patient?
Here are my essential tips to achieve precision and efficiency with your dual-arch surgeries.
1. Patient selection
Certainly, the medical history of a patient significantly influences the assessment of their suitability for an extended procedure. A patient presenting with complicating medical factors and any concern over an increased healing risk would be advised to be staged over two separate surgeries.
A psychological evaluation is also beneficial to assess their tolerance to a prolonged invasive appointment. Patients with high-stress and anxiety may present additional challenges, even with the provision of sedation.
The patient must be psychologically prepared for the appointment with a thorough and honest explanation of the process to help manage expectations and reduce anxiety.
I often receive feedback after full-arch surgery that the patient is exhausted, ‘like they’ve ran a marathon’. Do we need to reflect upon the stamina of a patient, taking into consideration factors such, as the age of the patient, their fragility and their physical fitness to be able to endure the lengthy surgical process?
2. Sedation
Why not leverage all available resources at your disposal to enhance patient comfort, improve cooperation, and optimise surgical efficiency? Whether it is administrated by yourself or a visiting sedationist, the provision of sedation will provide substantial benefits to both patient and surgeon.
If the patient’s medical history contraindicates the administration of intravenous sedation, it is probable that they may not be deemed medically suitable for an extensive invasive surgical procedure in any case.
Sedation can be carefully titrated in small doses throughout the procedure. It is important to inform patients that they may become more aware towards the final hour of treatment as the temporary prostheses are being fabricated and fitted. This not only allows a suitable recovery period for the patient but aids in competency to accurately assess the occlusion and aesthetic of the provisional restorations.
3, Visualising two distinct stages
It could be asserted that the most efficient approach to lengthy restorative or surgical procedures is to complete each section/quadrant or arch at each step simultaneously.
Concerning dual–arch implant surgeries, however, this may give rise to various challenges. Separating the surgery into two distinct stages, fully completing the upper arch before re-starting with the lower, will firstly minimise bone exposure and soft tissue contraction for improved healing outcomes.
Secondly, this will enable more proficient and predictable anaesthesia.
And finally, it enhances mental focus and concentration, safeguarding the surgeon from feeling overwhelmed or becoming disoriented during the process.
4. Helping hands: Utilising a chairside technician
Utilising a chairside technician may reduce your profit margin (with a range of fees from £500 to £1000+ per session). However, the value of reduced stress, increased efficiency and ease of adaptability is priceless.
With the ability to address any unforeseen prosthetic challenges or variations in the patient’s anatomy as they arise during the surgery, the dental technician will not only enable optimal fit and function, but a much more polished aesthetic result than a potentially fatigued dentist.
5. Don’t get ‘stuck’ at the last stage
A final clinical tip. The temporary prosthesis pick-up can be a crucial, make-or-break and time-sensitive stage.
When picking up the final provisional bridge, ensure the opposing arch is coated in petroleum jelly. This precautionary measure prevents the acrylic bridges from adhering together, averting the potential stressful challenge of separating them.
Catch Morven’s previous Implant Insights columns:
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