Dental Implantology – Time for Change?

Dental Implantology – Is it time for a change?

The availability of dental implants has become more mainstream with over 130,000 placed back in 2012. This figure is now thought to have doubled. With success rates reported to be around 95% after 10 years to restore a missing tooth or even to fully restore an edentulous arch, it’s easy to see why this procedure is proving popular.

As the year on year number of dental implant procedures increase, so does the amount of clinical waste. Historically the clinical setting whilst placing dental implants is completely transformed. The surgery is de-cluttered, surgical drapes cover the work tops, plastic sheaths and covers are placed on dental light handles, hand-pieces, suction hoses and the dental team (usually consisting of 3 member a dirty nurse, clean nurse and surgeon) don disposable surgical gowns, hats and sometimes shoe covers. The patient is usually covered in a drape as well.

Once surgery is completed these items are all placed into an orange clinical waste bag, which according to HTM01-05 can be incinerated or chemically treated and taken to landfill. So where is the evidence? Why do we prepare the surgery in such a way and does it improve success rates of osseointegration and the overall survival of the dental implant?

Since a truly sterile environment cannot be achieved in the oral cavity, it is questionable if the above measures are necessary in the oral environment (Scharf DR et al. 1993). A study published in 2009 looked at   1285 patients and a total of 4000 implants placed between 1985 and 2003, comparing the survival rate of implants using a simplified surgical setup compared to the original Branmark setup (Cardemil C et al. 2009). The simplified setup of a simple drape/bib for the patient, surgical gloves and no gown. there was no statistically significant difference between the two groups and the survival rates of the implants placed.

The success of dental implants are multifactorial. The patient’s health, oral hygiene, volume and quality of bone, placement technique and positioning of the implant along with the type and function of the final prosthesis. Studies show that the level of asepsis is in the manipulation of the implant itself during placement and the use of traditional aseptic techniques is no longer supported by evidence. A “clean” approach should be adopted and a more simplified surgery setup utilised.

Moving forward in a world where we as a profession should be more sustainable, reducing clinical waste for incineration and/or landfill should be a priority. I would suggest decluttering the dental surgery, wiping down the dental surfaces and as per HTM01-05, having a clean and dirty area. A clean reusable bib that is wiped before treatment could be used instead of a disposable drape, plastic covers on dental chair lights, handles, suction tubes and surgery motor coverings could be removed and simply whipped before treatment as they are actually nowhere near the operating area. Disposable surgical gowns should no longer be indicated and normal hand hygiene measures sufficient.

With these small changes when over 130,000 dental implants are placed annually in the U.K. dental practices could significantly reduce their clinical waste and help the environment in the long term.


Cardemil C, Ristevski Z, Allen B, Dahlin C. Influence of Different Operatory Setups on Implant Survival Rate: A Retrospective Clinical Study. Clin Implant dent Relat Res 2009;11:288-291

Scharf DR and Tarnow DP. Success rates of osseointegration for implants placed under sterile versus clean conditions. J Periodontol 1993;64954-956

Dr Andrew M Farr

Broad Street Dental Surgery, Hereford

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