Considerations for Oral and Maxillofacial Surgeons in COVID-19 Era: Can We Sustain the Solutions to Keep Our Patients and Healthcare Personnel Safe?

Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.

Soft tissue surgery for implants.

Adequate quality and quantity of soft tissue plays an integral part in the esthetic outcome of dental implants. Adequate band of attached tissue decreases the incidence of mucositis and improves hygiene around implants. This article discusses a variety of techniques for soft tissue augmentation. Soft tissue grafting can be achieved at various stages of implant therapy. Epithelial connective tissue grafts are commonly used to increase the band of attached tissue. Subepithelial connective tissue grafts are great for increasing soft tissue thickness and improving the gingival biotype.

Summary of current consensus on the effect of smoking on implant therapy.

Implant therapy has become a very predictable treatment option in the general population; however, there are certain factors that increase the risk of implant failure. The 2008 National Health Interview Survey estimates that 24.8 million men and 21.1 million women are smokers. The literature regarding cigarette smoking and dental implants currently suggests that advising the patient to stop smoking completely is best, but if this approach is not tenable, then the patient should be warned of the increased risk of implant failure and postoperative complications.

Alveolar distraction osteogenesis for implant site development.

Alveolar distraction osteogenesis can be a valuable tool for implant site development. Simultaneous regeneration of hard and soft tissue and an overall decrease in treatment time compared with other methods of site preparation can be an advantage. The authors advocate the concept of "prosthetically driven alveolar distraction." Surgical planning should begin with visualization of the final restoration to determine the volume and position of the soft and hard tissue deficiency. Surgical guides will help the surgeon determine the vector of distraction. Adherence to surgical principles to avoid damage to adjacent vital structures and maintain vascular supply to the transport segment is necessary for success. Bone grafting may be necessary before or after distraction to increase the surgical success of the procedure. Close follow-up is needed to verify the appropriate distraction vector and volume. Patient management and acceptance should be considered in distractor design and placement.