Applications of Cone-Beam Computed Tomography in Oral and Maxillofacial Surgery: An Overview of Published Indications and Clinical Usage in United States Academic Centers and Oral and Maxillofacial Surgery Practices.

PURPOSE: The American Association of Oral and Maxillofacial Surgeons appointed a task force to study the indications, safety, and clinical practice patterns of cone-beam computed tomography (CBCT) in oral and maxillofacial surgery (OMS). The charge was to review the published applications of CBCT in OMS, identify the current position of academic thought leaders in the field, and research the adoption and usage of the technology at the clinical practitioner level. MATERIALS AND METHODS: This study reviewed the CBCT world literature and summarized published indications for the modality. A nationwide survey of academic thought leaders and practicing oral and maxillofacial surgeons was compiled to determine how the modality is currently being used and adopted by institutions and practices. RESULTS: This report summarizes published applications of CBCT that have been vetted by the academic and practicing OMS community to define current indications. The parameters of patient safety, radiation exposure, accreditation, and legal issues are reviewed. An overview of third-party adoption of CBCT is presented. CONCLUSION: CBCT is displacing 2-dimensional imaging in the published literature, academia, and private practice. Best practices support reading the entire scan volume with a written report defining results, patient exposure, and field of view. Issues of patient safety, ALARA ("as low as reasonably achievable"), accreditation, and the legal and regulatory environment are reviewed. Third-party patterns for reimbursements vary widely and seem to lack consistency. There is much confusion within the provider community about indications, authorizations, and payment policies. The current medical and dental indications for CBCT in the clinical practice of OMS are reviewed and an industry guideline is proposed. These guidelines offer a clear way of differentiating consensus medical indications and common dental uses for clinicians. This matrix should bring a predictable logic to third-party authorizations, billing, and predictable payments for this emerging technology in OMS.

An audit of implant practice websites: content and regulatory compliance.

AIMS AND OBJECTIVES: To audit the content of dental practice websites offering dental implant services against a framework based on the GDC 2012 Guidelines for Ethical Advertising and other relevant advertising standards. METHODS: An audit framework was constructed and applied to the top fifty websites resulting from a Google UK search using the search term 'dental implant specialist'. RESULTS: Compliance with many elements of the GDC Guidance remains poor. Sixty-eight percent of websites claimed that the practitioner providing the service was a GDC registered specialist, though examples were found where this claim was unfounded. Fourteen percent of practice websites claimed that the service was being carried out by an 'implant specialist' and 16% claimed the practitioner was an 'implantologist'; the majority of sites using these terms (10%) involved practitioners that had no specialist status. The display of potentially misleading memberships and fellowships of a range of dental associations, academies, societies and foundations remains common (52%), as does the adoption of the title 'Dr' (60%). CONCLUSION: Comparison with earlier studies indicates that compliance with recent GDC standards is generally improving, though whether the pace of improvement is seen as acceptable or not is something that policymakers and regulatory authorities may need to consider further.

Managing the untoward anesthetic event in an oral and maxillofacial surgery practice.

The safe and efficient use of outpatient surgical anesthesia modalities is a significant part of the training and expertise of the oral and maxillofacial surgeon. Although adverse outcomes are rare, they can have considerable traumatic psychological and professional consequences for the surgeon involved. The goal of this article is to develop guidelines to educate the doctor, the second victim, on how to manage a bad outcome and how to navigate through a difficult and arduous process.

Medical litigation in oral surgery practice: lessons learned from 20 lawsuits.

The aim of this study was to investigate all the lawsuits related to oral surgery practice over a period of three years, and to analyze the different causes of litigation. Inclusion criteria involved all the closed cases that proved malpractice against an oral and maxillofacial surgeon or involved a dentist who performed an oral and maxillofacial surgical procedure. The most common causes of litigation were oro-antral communication, neurological deficit, and bleeding. The study presented the lessons learned from 20 cases, and concluded that most of the lawsuits in oral surgery practice can be prevented either through preoperative measures or by dealing with the impact of the surgical error through good patient rapport and communication.

The law and dentoalveolar complications: trends and controversies.

Complications are an inherent part of oral and maxillofacial surgery. A risk in surgery is a complication that occurs despite treatment that meets or exceeds the professional standard of care. When treatment fails to meet the standard of care, a complication may be considered the result of malpractice, resulting in claims for compensation. Whether a surgical procedure meets the standard of care is determined by expert witnesses evaluating the evidence. This article reviews legal issues and cases where complications have resulted in claims of malpractice. Recommendations for patient communication and documentation to reduce or eliminate such claims are presented.

Professional liability in oral surgery: legal and medical study of 63 court sentences.

OBJECTIVES: Dentistry, like all other health care professions, has in recent years been subjected to an increase in legal pressure by patients. Nevertheless, there are areas of activity in dentistry in which, whether because of their frequency or due to the importance of the damage and sequelae claimed, this legal pressure is greater. Amongst these areas of activity is that of oral surgery. STUDY DESIGN: To be meticulously analyzed in this report are 63 sentences issued by courts of second instance or higher levels regarding lawsuits involving oral surgery. The data collection file includes 13 variables. The descriptive and comparative statistical study by cross-referencing certain variables provides us with a clear and accurate picture of the lawsuit profile. RESULTS AND CONCLUSIONS: Implantological surgery was the practice subject to the most claims due to surgery (55.6 percent: 35 sentences), and it drew our attention that in 71.4% of all cases (45 sentences) there was a ruling against the professional. The most frequent range of damage payments was between €18,001 and €60,000 (40.9%: 18 sentences), the highest amount having been €24,000, an important factor to take into account when contracting professional civil liability insurance.

Office accreditation experiences with 3 accrediting agencies and suggestions for changes in private oral and maxillofacial surgery facility evaluations.

Historically, oral and maxillofacial surgeons have had considerable autonomy in operating their offices. Oral and maxillofacial surgeons have had a singular history of safety, training, and success in outpatient anesthesia in their offices. However, preventable patient morbidity and mortality in private office-based surgical facilities of a variety of professions have brought increased scrutiny to the office environment. The present report describes the experiences of 3 oral and maxillofacial surgeons with 3 accrediting agencies in obtaining office accreditation and offers recommendations to be considered for the future of our specialty in terms of private office certification.