How to Practice the Aseptic Technique in Dental Implant Surgery

Oral Implantology is the fastest growing segment of clinical cosmetic dentistry, and many general dentists are learning surgical implant placement. However, with the excitement of incorporating implantology in your practice comes the responsibility of maintaining a more rigorous standard of infection control, the Aseptic Technique. You may wonder, what exactly Is the aseptic technique, and more importantly, how is it practiced in surgical implant dentistry?

What is the Aseptic Technique?

Simply put, the Aseptic Technique is the method used to prevent cross-contamination and the spread of harmful bacteria. Use of the aseptic technique during dental surgical procedures, and particularly dental implant surgery, is a critical component to proper healing, a successful surgical result, and the health of your patient.

While the Clean Technique is routinely practiced in modern dental offices (this includes hand washing, the use of non-sterile gloves and masks, and a strict sterilization process for instruments), the aseptic technique should be the standard for any surgical dental implant procedure as a protection to the patient, surgical team, and yourself.

What Do I Need to Practice Aseptic Technique?

The Joint Commission outlines four aspects to the aseptic technique.

• Barriers – Sterile gowns, sterile drapes, sterile gloves, and masks.
• Patient and Equipment Preparation – Antiseptic skin preparation for the patient, sterile instruments, sterile equipment and devices such as handpieces and surgical burs.
• Environmental Controls – Doors should be kept closed, traffic in and out of the operatory should be minimized, and only necessary personnel present during the surgical procedure.
• Contact to Contact Guidelines – Only sterile to sterile contact is allowed. The chairside assistant and doctor will rely on a secondary assistant to open non-sterile items, record operative notes, etc. The secondary assistant will not touch any sterile field, instruments or equipment.

Assistants and staff not already familiar with the aseptic technique should be trained in proper protocol, which will include the preparation and storage of all items necessary in aseptic technique, operatory set up, maintaining the sterility of instruments, drapes, and equipment, as well as what is expected from a chairside and secondary assistant. Many dental implant continuing education programs, such as the 3 Day Live Implant Surgery Program, encourage bringing along your assistant so that they can see the aseptic technique being practiced from start to finish in surgical dental implant procedures, ask any questions they may have, and get firsthand information about surgical setup, autoclaving and storing sterile items, and assisting during dental implant surgery.

How is the Aseptic Technique Applied? 

The application of the aseptic technique begins with the preparation and sterilization of the complete surgical setup. This will include instrumentation, stainless steel basins, handpieces, surgical burs, suction and saliva ejector tips, polypropylene tubing for suction hoses, and cotton gauze.  For convenience, you may choose to have a supply of these items on hand for quick setup, or you may prepare the items in advance of each surgical case.

• The surgical instruments (ie retractors, mirrors, etc.) can be wrapped in the basins and autoclaved together.
• Handpieces should be wrapped and autoclaved individually.
• Surgical burs can be wrapped and autoclaved on a bur block for ease of access.
• A suction tip and saliva ejector may be packaged and autoclaved together.
• Polypropylene tubing can be cut to length for suction and handpiece hoses to be autoclaved.
• A supply of 2×2 and 4×4 gauze can be autoclaved for use during surgery and for post-operative care.
• Alcohol solution and sterile saline rinse should be on hand for necessary non-sterile burs, etc.

Once the sterile supplies are prepared, you can move forward with the operatory set up. You may assign 1 or 2 assistants to the setup. All non-sterile draping should be applied first (light handle covers, headrest cover, etc.), followed by the draping of the operatory tray. All sterile items should be placed upon a sterile field and handled by an assistant wearing sterile gloves. Any necessary surgical items that have not been sterilized previously must be placed in the alcohol solution before being handled or placed on the sterile field. Instrumentation setup and the placing of sterile drapes should be done in sterile gloves.

During Surgical Procedures

When the implant surgery or other surgical procedure is under way, the chairside assistant will confine all movements to the sterile field, instruments should be passed to the doctor above the sterile field, and both will rely on the secondary assistant to provide any additional items necessary. The secondary assistant will open all sterile packets by grasping the corners and emptying contents on the sterile tray, including individual implants. Note that dental implants are packaged in an outer non-sterile container and inner sterile vial, so the secondary assistant may open the outer container and empty the sterile vial onto the sterile field.

There are several sterile items you may choose to have in multiple for each procedure, such as sterile gauze packs, handpieces, sterile gloves for both the doctor and assistant, and basic instrumentation. Having extras on hand will ensure a smooth implant surgery even if an item is dropped or otherwise becomes unsterile.

Conclusion

While applying the aseptic technique in surgical dentistry requires planning ahead and extra steps both before and during surgical implant procedures, it is vital to reduce to likelihood of cross-contamination or infection as much as possible. This is as much to protect your patient and team as it is to protect your implant practice, as well as an integral part of the success of the implant surgery and site healing. Making the aseptic technique a routine part of your surgical implant practice will be one way in which you can offer your patients the gold standard of care in implantology.

Resources

http://www.virox.com/files_docs/content/pdf/msds/dental.pdf

http://www.jointcommission.org/assets/1/6/CLABSI_Toolkit_Tool_3-8_Aseptic_versus_Clean_Technique.pdf

http://medical.tpub.com/14275/css/Rules-Of-The-Aseptic-Technique-152.htm

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