15 March 2021

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Computer guided implant surgery: clinical and medical-legal aspects

Authors: Marco Brady Bucci, Antonio Guida, Maria Sofia Rini, Dario Brady Bucci

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The objective of this work is to analyze, in light of the current diagnostic and therapeutic possibilities offered by digital technologies applied to implant prosthetic dentistry, the clinical implications and the medical-legal implications related to these procedures.

We suggest a method to control the quality of the treatment, based on a check-list, which constitutes, for the implantologist and implant prosthetician, a draft work to facilitate the good clinical practice, representing an element of prevention and / or management of a potential litigation. This tool is to be considered a trace, to be customized based on the specifics of the individual treatment and the individual patient.

MATERIALS AND METHODS

In the appendix to the "Clinical Recommendations in Odontostomatology" released by the Ministry of Health in 2017, it is considered that the so-called "guided implantology" or "computer assisted" can be successfully used in implant surgery as an alternative method to classical technique for designing and the positioning of the implants. Indeed, numerous studies have shown the accuracy of the technique.

In this work an analysis of the guided computer implantation surgical procedure was performed, updated to 2018. Since there is not a single procedural standard, reference has been made to one of the most tested environments for rehabilitation design and construction of surgical templates, provided by the Nobel Biocare company.

Specifically, it was evaluated as a reference design platform, the Nobel Clinician software and as a "hardware" part the realization of templates through Nobel Biocare's “Nobel Guide” centralized production system, by means of which it was made an analysis of the working protocol, of the various critical elements related to each clinical procedure, as well as to the sources of possible clinical error. Once the computer-guided implant prosthetic procedure has been defined, the clinical details that lead to the correct execution of the procedure will be analyzed, illustrating the steps in order to highlight the critical elements and the possible sources of error intrinsic to the procedure itself.

RESULTS

After an analysis of the foregoing, as a natural evolution of the reasoning, it was decided to propose, as an operational climatic model, the drafting of a preoperative checklist, with the triple purpose of constituting element of pre-surgical implant clinical analysis, to represent an element for the sharing of an informed consent to the processing and to draw up a further document to be available in the event of a dispute, that can demonstrate prudence, skill and operational diligence and lead to a "simple" (and therefore not punishable) complication of a potential clinical, real or presumed failure.

CLINICAL SIGNIFICANCE

The high reliability of computer assisted implant prosthetic systems is subjected to a strict adherence to standardized and validated protocols. We propose the use of a personalized check list as a tool of daily use for the implant-prosthodontist clinician. Although aimed primarily at obtaining a predictable clinical result, through a careful analysis of the decision-making processes, the proposed tool can also represent a valuable communication tool, to be used both with the patient and with any clinical and technical collaborators.