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Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 158-161

Lessons Learned from the COVID-19 Pandemic in Implant Dentistry Settings

1 Clinical Lecturer, Department of Prosthodontics, College of Dentistry, University of Al-Ameed, Karbala, Iraq
2 Assistant Professor of Prosthodontics and Implantology, Department of Prosthodontics, Mazandaran University of Medical Sciences, Mazandaran, Iran
3 Assistant Professor of Oral and Maxillofacial Surgery, College of Dentistry, University of Al-Ameed, Karbala, Iraq
4 Private Practice, Mazandaran, Iran

Date of Submission26-Sep-2022
Date of Decision15-Oct-2022
Date of Acceptance17-Oct-2022
Date of Web Publication12-Dec-2022

Correspondence Address:
Moein Hoseini Shirazi
Prosthodontics Department, Mazandaran University of Medical Sciences, Mazandaran
Mohammed Hussein M Hussein Alsharbaty
Head of Prosthodontics Branch, College of Dentistry, University of Al-Ameed, Karbala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/denthyp.denthyp_119_22

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In 2019, Wuhan city of China announced the epidemic of COVID-19 as a public health disaster which has been recognized as an uncommon type of single stranded RNA virus belonging to Coronaviridae family and then quickly spread all over the world. Clinically symptomatic patients are identified as the primary source of COVID-19 transmission. Most of dental procedures require the use of high-speed handpieces which leads to aerosol generation. Implant dentistry is the field of dentistry which deals with prosthetic rehabilitation with minimal aerosol generation ensuring an aseptic surgical environment. There are several decisive recommendations regarding COVID-19 precautions that should be appreciated in implant dentistry. Sharp drills in slow speed drilling machines are preferred during surgery. Regular irrigation with high volume suction is greatly encouraged. Osteotomes are encouraged over ultrasonic devices to minimize the generation of aerosols during surgical procedures. Immediate implants placement is more preferred as the number of visits to the dentists is reduced. Impression techniques should be shifted to the digital approach instead of conventional methods. Full mouth rehabilitation cases requiring complex procedures should be accomplished restrictedly.

Keywords: COVID-19, implant dentistry, infection control

How to cite this article:
Hussein Alsharbaty MM, Shirazi MH, Mohammed NB, Akbari F. Lessons Learned from the COVID-19 Pandemic in Implant Dentistry Settings. Dent Hypotheses 2022;13:158-61

How to cite this URL:
Hussein Alsharbaty MM, Shirazi MH, Mohammed NB, Akbari F. Lessons Learned from the COVID-19 Pandemic in Implant Dentistry Settings. Dent Hypotheses [serial online] 2022 [cited 2023 Feb 6];13:158-61. Available from:

  Introduction Top

In early December 2019, the Wuhan city of China declared the epidemic of coronavirus disease as a public health crisis which quickly spread to all parts of the world.[1] This virus has been identified as an uncommon type of single stranded RNA virus belonging to Coronaviridae family.[2] Several inferences have emerged regarding a “live-animal” and “sea food” origin of this virus, discussing about the initial transmission from animals to humans and then an uncontrollable spread among human beings across the globe.[3] The International Committee on Taxonomy of Viruses has titled it as SARS-CoV-2 due to the close resemblance with other ß-coronaviruses, although, it is commonly referred as COVID-19 virus.[4]

COVID-19 infected patients frequently present with dry cough,[5] fever,[6] muscular pain,[7] lethargy,[8] and breathlessness[9] as clinical symptoms, upon investigations abnormal chest scans are reported.[1],[10] Less commonly reported symptoms include, headache, abdominal pain, nausea, emesis, hemoptysis, loose stools, and/or increased mucous production.[11] Sense of smell and taste have also been reported to alter with COVID-19 infection. COVID related disease onset can rapidly lead to progressive respiratory failure affecting the alveolar mucosa,[12] and in some cases leading to pleural effusion.[13]

Inhalation of airborne particles originating from the sneezing or coughing of an infected individual has been documented as the primary transmission pathway of COVID-19.[14] Typically, the clinical presentation of COVID-19 does not involve ocular symptoms, however, the conjunctival sample investigations revealed the presence of viral rRNA. It is thereby suggested that a direct contact with mucous membrane of oral,[15] nasal,[16] fecal,[17] or ocular[18] regions of infected individuals would lead to transmission of virus. Mixed opinions about the role of saliva in direct or in-direct transmission of COVID-19 have been published.[19],[20] Although the clinically symptomatic patients are identified as the primary source of COVID-19 transmission, the role of asymptomatic cases in transmission of COVID-19[21],[22] and transmission during the incubation period[23] has been recently debated. Debates regarding the possible transmission during the recovery process have been issued.[24]

Most of the dental procedures require the use of high-speed handpieces which leads to aerosol generation. Implant dentistry is a fundamental field of dentistry which deals with prosthetic rehabilitation of missing dentition with minimal aerosol generation ensuring an aseptic surgical environment. This aseptic approach is strictly indicated for the surgical procedure.

The current study focused on the impact of COVID-19 in the field of implant dentistry. The economic, clinical, environmental, and psychological impacts will be discussed. Numerous publications are issuing guidelines concentrating on COVID-19 related workplace safety for both clinicians and patients.

  Ecological Influence and Standpoints Top

When the patient presents at a dental clinic, the body temperature must be evaluated using a non-contact forehead thermometer or if available cameras with infrared temperature sensors can be used. All elective dental procedures must be deferred for 2 weeks in case a body temperature of above 100.4°F or 38°C is detected with or without the involvement of a respiratory disease.[25] According to the evidence base, the COVID-19 suspected individuals should be seated according to the social distancing plan that ensures 6 feet distance between every individual.[26],[27] Arkarapotiwong and Chindapol[28] concluded that 12 air changes per hour (ACH) ventilation is considered appropriate to ensure safe working environment. Prevention of infection is paramount for a surgeon which include wearing N95 masks, sterile surgical gowns, protective face shields, and a pair of surgical or latex gloves.[29] Patients should be directed to wear a surgical mask, hand hygiene using appropriate chemical disinfectants, respiratory precautionary measure pre- and post-treatment, and wear mask throughout the consultation process.[30] Chemical disinfection of medical equipment (thermometer, sphygmomanometer, dental unit, stools, etc.) must be carried out following every dental treatment.[19] Patients must be advised to administer self-quarantine and inform their family physician to avoid spread of COVID-19.

Confirmed cases of COVID-19 must be prohibited from entering the operating rooms. All surgical treatments must be carried out under aseptic conditions while ensuring the use of personal protective equipment. Ultraviolet-C beams having a wavelength of 200 to 280 nm has a bactericidal and viricidal effect. Commercially available beams sources can be used to disinfect surgical theatres and operating rooms. Bollen et al.,[31] reported that UV-C beams can reduce 90% of bacteria and viruses in ambient air and the airflow capacity can enhance to 120 m3/h.

  Clinical Influence and Standpoints Top

Emphasis should be made on following points from a clinical perspective:

Reduce the number of appointments

The more contact there is between staff and patients, the higher the risk of disease transmission. Reducing the number of appointments is not always possible, but with a different approach, a large reduction in the overall contact time can be guaranteed.
  1. Non-submerged techniques: When a one-stage non-submerged technique is used to place the dental implant, there is no need for the second surgical appointment to uncover the implant. The use of tissue-level implants offers this advantage and is a well-documented approach. Esposito et al.,[32] have reported that there is no difference in the final outcome between a one-stage versus a two-stage implant placement.
  2. Avoiding compromised patients: Severely immunocompromised patients as well as those patients taking several anticoagulants often present more complications and therefore require more attention and postoperative care. In a pandemic, it is therefore advised to reschedule such patients until after a pandemic or alternatively, refer them to a hospital setting.
  3. Full digital workflow: Using an intraoral scanner with the concept of a full digital workflow has several advantages. Not only are fewer visits scheduled, but the chance of cross-infection is also strongly reduced. Using a scanner avoids contact with blood and any remnants.

Avoid specific treatment options

Just like ultrasonic scalers are not recommended to be used in periodontal treatments, similarly, alternative approaches have been advised in implant dentistry.
  1. Radiography: Panoramic radiography and cone-beam computed tomography (CBCT) have a lower risk of contamination; therefore, are the preferred imaging techniques during a viral pandemic, since there is no contact with saliva.
  2. Piezosurgery: Since piezosurgery is an ultrasonic procedure that involves the generation of aerosols, using this equipment is not advised. The same is applicable to water-cooled Nd-YAG lasers or titanium brushes for the treatment of peri-implantitis.
  3. Sinus lifting procedures: Closed technique is preferred technique for sinus lift and bone augmentation as it has lower chances of aerosol generation.

Implement further tools

  1. Field Magnification: Use of a visual aid which include dental loupes or dental microscopes provides a considerable advantage over direct vision. Although this distance is far below the advised 6 ft. of social distancing, it still offers some distance, which contributes to a safer workplace.
  2. Rinsing: Before every intraoral dental procedure the patient has to rinse thoroughly with a disinfectant. H2O2 (0.5%) and povidone-iodine/iodopovidone (0.2%) are both effective against coronavirus particles. Chlorhexidine has a lower activity toward coronaviruses.[33]
  3. Implant surface coatings: Poggio et al.,[34] have reported that surface coatings with Cu-alloy was found to reduce the survival of coronavirus to less than 4 hours. This technique can be applied in the future to coat instruments and surfaces for medical practices.

Apply novel approaches

Most implant systems use high speed drilling for osteotomy preparations (850–2000 rpm), always in combination with external water cooling. Kim et al.,[35] rejected the hypothesis that inadequate cooling of the bone during low-speed drilling can result in osteoblast degeneration.
  1. Bicon: The Bicon implant system (short and wide implants) has been on the market for more than 30 years. This system requires use of a slow speed handpiece at 50 rpm. The coolant is not recommended by the manufacturer. Due to this approach a lot of extra bone can be harvested from the osteotomy.[36]
  2. Nobel Biocare N1: Similar to the Bicon implant system, this system functions at slow speeds with the use of a specific Osseoshaper but in the absence of a cooling mechanism. Unfortunately, there is no scientific study yet shows the clinical outcomes of this approach.[37]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ciotti M, Angeletti S, Minieri M et al. COVID-19 outbreak: an overview. Chemotherapy 2019;64:215-23.  Back to cited text no. 1
Payne S. Chapter 17-Family Coronaviridae. In: Susan Payne. Chapter 17-Family Coronaviridae. Viruses. Academic Press; 2017. p. 149-58.  Back to cited text no. 2
Can MF, Şimşek E, Demirci A, Demirci S, Özkan A. The evaluation of the early impacts of the COVID-19 pandemic on the export of fishery commodities of Turkey. MLS. 2020;2:18-27.  Back to cited text no. 3
Guo Y-R., Cao Q-D., Hong Z-S. et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak-an update on the status. Mil Med Res 2020;7:1-10.  Back to cited text no. 4
Tripathi S, Tripathi MM. The COVID-19: current understanding. Vet World. 2020;13:1998-2005.  Back to cited text no. 5
Alimohamadi Y, Sepandi M, Taghdir M, Hosamirudsari H. Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis. J Prev Medand Hyg 2020;61:E304-12.  Back to cited text no. 6
Mesri M, Saber SSE, Godazi M et al. The effects of combination of Zingiber officinale and Echinacea on alleviation of clinical symptoms and hospitalization rate of suspected COVID-19 outpatients: a randomized controlled trial. J Complement Integr Med 2021;18:775-81.  Back to cited text no. 7
Kamali Aghdam M, Jafari N, Eftekhari K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect Dis 2020;52:427-9.  Back to cited text no. 8
Olumade TJ, Uzairue LI. Clinical characteristics of 4499 COVID‐19 patients in Africa: a meta‐analysis. J Med Virol 2021;93:3055-61.  Back to cited text no. 9
Liu C, Ye L, Xia R et al. Chest computed tomography and clinical follow-up of discharged patients with COVID-19 in Wenzhou City, Zhejiang, China. Ann Am Thora Soc 2020;17:1231-37.  Back to cited text no. 10
Slim A, Daghfous H, Mansour AB et al. Predictive factors of delayed sputum conversion in pulmonary tuberculosis. Eur Respir J 2019;54:PA4616.  Back to cited text no. 11
Chen H, Ai L, Lu H, Li H. Clinical and imaging features of COVID-19. Rdiol Infec Dis 2020;7:43-50.  Back to cited text no. 12
Fahad AM, Al-Khalidi HA, Alhaideri YAA, Altimimi YQM, Alshewered AS. Pleural effusion in a patient with COVID-19 pneumonia and lung cancer: a case report. Respir Med Case Rep 2020;31:101302.  Back to cited text no. 13
Wilson N, Corbett S, Tovey E. Airborne transmission of covid-19. BMJ 2020;370:m3206.  Back to cited text no. 14
Ding S, Liang TJ. Is SARS-CoV-2 also an enteric pathogen with potential fecal-oral transmission? A COVID-19 virological and clinical review. J Gastroenterol 2020;159:53-61.  Back to cited text no. 15
Bleier BS, Ramanathan Jr M, Lane AP. COVID-19 vaccines may not prevent nasal SARS-CoV-2 infection and asymptomatic transmission. Otolaryngol Head Neck Surg 2021;164:305–7.  Back to cited text no. 16
Hindson J. COVID-19: faecal-oral transmission? Nat Rev Gastroenterol Hepatol 2020;17:259.  Back to cited text no. 17
Dockery DM, Rowe SG, Murphy MA, Krzystolik MG. The ocular manifestations and transmission of COVID-19: recommendations for prevention. J Emerg Med 2020;59:137-40.  Back to cited text no. 18
Baghizadeh Fini M. Oral saliva and COVID-19. Oral Oncol 2020;108:104821.  Back to cited text no. 19
Li Y, Ren B, Peng X et al. Saliva is a non‐negligible factor in the spread of COVID‐19. Mol Oral Microbiol 2020;35:141-5.  Back to cited text no. 20
Byambasuren O, Cardona M, Bell K, Clark J, McLaws M-L., Glasziou P. Estimating the extent of asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis. J Assoc Med Microbiol Infect Dis Can 2020;5:223-34.  Back to cited text no. 21
Yu X, Yang R. COVID‐19 transmission through asymptomatic carriers is a challenge to containment. Influenza Other Respir Viruses 2020;14:474-5.  Back to cited text no. 22
Li P, Fu J-B., Li K-F. et al. Transmission of COVID-19 in the terminal stages of the incubation period: a familial cluster. Int J Infect Dis 2020;96:452-3.  Back to cited text no. 23
Zhang T, Cui X, Zhao X et al. Detectable SARS‐CoV‐2 viral RNA in feces of three children during recovery period of COVID‐19 pneumonia. J Med Virol 2020;92:909-14.  Back to cited text no. 24
Abramovitz I, Palmon A, Levy D et al. Dental care during the coronavirus disease 2019 (COVID-19) outbreak: operatory considerations and clinical aspects. Quintessence Int 2020;51:418-25.  Back to cited text no. 25
Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent 2020;21:56-7.  Back to cited text no. 26
Lin Y. Ventilation in the dental clinic: an effective measure to control droplets and aerosols during the coronavirus pandemic and beyond. Chin J Dent Res 2020;23:105-7.  Back to cited text no. 27
Arkarapotiwong P, Chindapol S. Dental setting design guideline adaptation in the COVID-19 pandemic in Northern Thailand. CMU J Nat Sci 2022;21:e2022007.  Back to cited text no. 28
Boccalatte L, Larrañaga J, Raffo GP et al. Brief guideline for the prevention of COVID-19 infection in head and neck and otolaryngology surgeons. Am J Otolaryngol. 2020;41:102484.  Back to cited text no. 29
Müller L, Heider J, Frankenberger R et al. Guideline: dealing with aerosol-borne pathogens in dental practices. Dtsch Zahnärztl Z Int 2020;2:240–5.  Back to cited text no. 30
Bollen C, Najmi Y, Almasri M. COVID-19 and dental implants: impact and perspectives. Implant Dent Tod. 2021;15:7-11.  Back to cited text no. 31
Esposito M, Grusovin MG, Chew YS, Coulthard P, Worthington HV. One-stage versus two-stage implant placement. A Cochrane systematic review of randomised controlled clinical trials. Eur J Oral Implantol 2009;2:91-9.  Back to cited text no. 32
O’Donnell VB, Thomas D, Stanton R et al. Potential role of oral rinses targeting the viral lipid envelope in SARS-CoV-2 infection. Function (Oxf). 2020;1:zqaa002.  Back to cited text no. 33
Poggio C, Colombo M, Arciola CR, Greggi T, Scribante A, Dagna A. Copper-alloy surfaces and cleaning regimens against the spread of SARS-CoV-2 in dentistry and orthopedics. From fomites to anti-infective nanocoatings. Materials 2020;13:3244.  Back to cited text no. 34
Kim S-J., Yoo J, Kim Y-S, Shin S-W. Temperature change in pig rib bone during implant site preparation by low-speed drilling. J Appl Oral Sci 2010;18:522-7.  Back to cited text no. 35
Kanwal B, Jayadev S, Balaji DL et al. Covid 19 and its impact of dental implants cases: systematic review. Turk J Physiother Rehabil 2021;32:17541-4.  Back to cited text no. 36
Sanz M, Noguerol B, Sanz‐S anchez I et al. European Association for osseointegration Delphi study on the trends in implant dentistry in Europe for the year 2030. Clin Oral Implants Res 2019;30:476-86.  Back to cited text no. 37


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