– Dr Snehal Kamble, Dr Shruti Gawande
Covid-19 (Corona virus disease 2019) is a RNA-based virus that came to light in December 2019 when China informed World Health Organization (WHO) of a rampant spread of pneumonia-like cases. On March 11, 2020,Covid-19 was declared as a pandemic, a public health crisis that is still having a rippling effect in every sector. Due to its implications, dental healthcare has faced several clinical, psychological and financial repercussions, having unforeseen consequences on dental professionals, patients and lab personnels. Unlike other routine dental procedures prosthodontic treatment demands multiple patients’ visits which throw a unique challenge to ensure bilateral safety and to avoid collateral damage at every visit. This article presents necessary recommendations regarding the prosthodontic dental treatment procedures with standards of care and infection control.
Keywords: Coronavirus, COVID-19, Dentistry, Dental treatment, Prosthodontics
The outbreak of coronavirus disease 2019 (COVID-19) in the area of Wuhan, China, has evolved rapidly into a public health crisis 1 and has spread exponentially to other parts of the world. The novel coronavirus belongsto a family of single-stranded RNA viruses known as Coronaviridae. 2 This family of viruses are known to be zoonotic or transmitted from animals to humans. These include severe acute respiratory syndrome coronavirus (SARS-CoV), first identified in 2002, and the Middle East respiratory syndrome coronavirus (MERS-CoV),first identified in 2012. 3
The Covid-19 virus, having diameter in the range of 100 nm, primarily transmits through person to personcontact and direct contact with respiratory droplets. 4 The word ‘corona’ is derived from its appearance as ‘crown-like’ while being observed under the electron microscope. 5 It primarily transmits through person to person contact and direct contact with respiratory droplets. Spread through asymptomatic carriers has also been recently documented and is one of the major reasons for creating fear and dilemma in the minds of dental practitioners. 6 The close proximity to oral fluids, aerosols and long incubation period of the virus, place the dental fraternity at a high risk of contracting and transmitting the virus. 7 Ministry of Health and Family Welfare (MOHFW), India has formulated specific guidelines and is playing a pivotal role to constantly update them with changing dynamics of disease. At present, only emergency and urgent procedures have been recommended to be taken up, with extreme focus on personal protective equipment and disinfection protocols.8 However, the fleeting nature of specialty-wise guidelines and overlap of recommendations given by various organizations; has convoluted its implementation in dental set up.9
The prosthodontic procedures especially need to be modified during the COVID times. The target population, comprising of the geriatric group with or without co-morbidities, post-cancer immunocompromised patients or patients with extra-oral maxillofacial defects requiring prosthetic rehabilitation, makes it imperative to lay down guidelines which are versatile and compliant by the patients and doctors as well.10,11
I) General Considerations
- Initial tele-screening of dental patients to identify suspected COVID-19 carriers
- Considering every patient as a potential asymptomatic COVID-19 carrier.
- Considering recently recovered patients as potential virus carriers for at least 30 days after the recovery confirmation by a laboratory test.
- Meticulous screening of even asymptomatic patients is important. Patients should be requested to fill out detailed questionnaire regarding COVID-19.
- Maintenance of proper record, address, contact details are of paramount importance. Since the incubation period of SARS-CoV-2 may extend over 2 weeks, a positive response to any of the above queries mandates deferring the appointment for at least 2 weeks.
- Additionally the patients should be encouraged to self quarantine at home and contact their primary care physician for tele-consultation. 11,12,13
- Those patients who seem fit for appointment scheduling should be advised to wear a surgical face mask and preferably come alone or with a single attendant at the time of their dental visit.
- Dental office and the waiting area should be well ventilated at all times along with spaced out seating of patients.
- Patients should be instructed to arrive on time for their appointments.
- Remove magazines, reading materials, toys and other objects.
- Schedule appointments to minimize possible contact with other patients in the waiting room.
- Use of contact less thermal screen and pulse oximeter device should be considered even if the patient answers no to the COVID symptoms questions. 11
- Use of pulse oximeter can be expanded in general dental office screening procedures during this pandemic. An oxygen saturation of below 90% is a good marker for some form of oxidative distress in the body. Use of pulse oximeters can help in screening of patients that might be asymptomatic but are actually having the disease.
- Patients should be instructed for hand sanitization and proper hand washing as soon as he/she enters the clinic.
- The prosthodontist in his clinic should ensure that entire team is well versed with the universal precautions.13
II) Prosthodontic Considerations
1) Removable prosthodontics: This includes fabrication of complete and partial dentures. Age has been documented as primary risk factor for increasing COVID-19 mortality rate, compounded with the presence of co-morbidities.14 Hence, a thorough medical case history is a must before starting any geriatric patient to evaluate risk versus need benefit. Completion of pending procedures must be given preference in comparison to starting of new cases to avoid unnecessary implications.
Chair-side protocol –
- Fractured prosthesis should be repaired by first disinfecting it thoroughly.
- Ulcerations or mucosal erosions can be handled through tele consultation by advising some analgesic and antiseptic gels for local application and discontinuation of the prosthesis for the time being.
- Mild smoothening of sharp borders can be advised with sandpaper if patient can't come to the clinic.
- Patients should be recalled in the clinic on strict appointment schedule if any further adjustment of the prosthesis is mandatory to restore its function.
- Denture adjustment should be done using a low speed micro motor.
- New prosthesis should be fabricated if it is affecting the systemic health of the patient.
- Primary impressions should be made in well-fitting stock trays and secondary impressions should be made in custom trays which can be discarded after obtaining the master cast.
- One step border molding can be done to minimize chair side time.
Laboratory protocol –
Record bases and wax rims should be adjusted on prior basis in order to avoid any modifications after insertion in the mouth. Care should be taken to minimize processing errors in lab and dentures should be remounted to adjust occlusion. This will ensure lesser follow up visits of the patient.
2) Fixed Prosthodontics: The fixed prosthodontics includes fabrication of crowns and bridges, inlays, onlays, smile designing, veneers, full mouth rehabilitation, post and cores etc. These are elective and aerosol generating procedures. So, adherence to strict precautions and disinfection protocols is mandatory. Digital impressions using intraoral scanners is safe alternative but the cost- benefit ratio needs to be taken care of. Papi et al. have compared digital workflow with conventional workflow and concluded that digital method reduces human contact at multiple steps thereby decreasing risk of transmission of virus, saves time and improves efficacy.16
Chair side protocol-
- Use of rubber dam and high vacuum suction are recommended during tooth preparations where supragingival margins are planned.17 This effectively wipes out most of the blood and saliva contaminants; also keeping the viral load to a minimum.
- Clinicians should avoid any undercuts and underreduction in their tooth preparations to prevent lab errors and multiple appointments.
- Shade matching should be preferably done by digital spectrophotometers and consent of patient should be taken.
- Intraoral photographs can be sent online to the laboratory to avoid any shade mismatch.
- Removal of fractured and faulty prosthesis using crown removers is advisable.
- Recementation of the dislodged prosthesis can be done, whereas adjustment of the temporary crowns should be done extra-orally using a micromotor.
- The dental tools such as air rotor and burs should be autoclaved as per manufacturer'sinstructions.
- Additional steps include working position of dentist at 11–12 o’ clock, reduced air pressure in 3-way syringes, full protection PPE for both doctor and assistant, use of anti-retraction hand pieces and disposableburs.5
- Frequent rinsing and spitting should be prohibited.
Crown & bridge impressions and trays need to be carefully disinfected/autoclaved.
3) Implant surgery and it’s implications in prosthodontics
Implant dentistry is the most fascinating and earning division for prosthodontists these days. Deferring patients for placement of implants can lead to big financial and mental trauma to the dental and lab personnel. But implant treatment planning involves multiple dental visits which, along with use of surgical aerosol generating hand pieces, call for extreme precaution in regard to disinfection and infection control. Following recommendations are suggested by authors though personal discretion is a must.
Chair side protocol-
- Healthy patients with no other co-morbidities can be taken up based on CBCT and virtual planning.
- During surgery, slow speed drilling with sharp drills is preferable.
- Intermittent external irrigation along with high volume suction should be done.
- Use of ultrasonic devices and piezoelectric surgery should be minimized; whereas use of osteotomes should be encouraged in order to reduce aerosol formation.18
- Immediate implants with immediate loading should be taken up wherever indicated as they require lesser time number of visits.
- It is advisable to avoid complex full mouth procedures.
- Digital impression with scan bodies is suggested as an alternative to conventional impression making.
Implant impressions and components need to be carefully disinfected/autoclaved before reusing them.
4) Handling dental impressions:Dental impressions are a high risk source of infection transmission and should be handled with care to minimise transmission to lab personnel – which is also the duty of the dentist.
- Autoclaved stock trays should be used and material should be loaded carefully to avoid gag reflex.
- Impression should be kept under running water avoiding direct flow over tissue surface to avoid losing surface details.
- Spray disinfectant can be used for chair side disinfection followed by packing in zip lock bags before sending the impressions to laboratory for pouring.
- Work authorization forms should be sent in separate zip lock bag. 19
Recommendations given in Table 1 should be followed in the lab for disinfection as per the material.4,6
In these extraordinary times, extraordinary measures need to be taken by all dental professionals. Prosthodontists, assistants, other essential supporting staff, and patients are at a potentially higher risk ofCOVID‐19 infection during prosthodontic treatments. Dental team needs to update their knowledge and learn the use of new approaches such as Tele‐dentistry whenever possible to manage patients and to avoid the risk of cross infection. The chances of contracting COVID‐19 are very low to very high while instituting holistic prosthodontic care to the patients depending on the treatment protocols adopted in the clinics.
1).Centers for Disease Control and Prevention. Transmission of coronavirus disease 2019 (COVID-19).Available at: https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html. Accessed 18 March, 2020.
2).Gorbalenya AE, Baker SC, Baric RS, et al. The species Severe acute respiratory syndrome related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020.https://doi.org/10.1038/s41564-020-0695-z.
3) Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020. https://doi.org/10.1007/ s12630-020-01591-x.Accessed 18 March, 2020
4) Boopathi S Poma AB Kolandaivel P Novel 2019 coronavirus structure, mechanism of action, antiviral drugpromises and rule out against its treatment JBiomol Struct Dyn 2020:1-10
5) Bhanushali P, Katge F, Deshpande S, Chimata VK, Shetty S, Pradhan D. COVID-19:changing trends and its impact on future of dentistry. Int J Dent. 2020;2020:8817424.
6) Yu X Yang R Covid transmission through asymptomatic carriers is a challenge to containment Influenza other respir viruses 2020 14
7) 8Ge ZY, Yang LM, Xia JJ, Fu XH, Zhang YZ. Possible aerosol transmission of COVID-19 and specialprecautions in dentistry. J Zhejiang Univ – Sci B. 2020;21:361–368.
8). Ministry of Health and Family Welfare, Government of India. Guidelines for Dental Professionals in Covid-19 Pandemic Situation. New Delhi, India: Ministry of Health and Family Welfare, Government of India;2019https://www.mohfw.gov.in/pdf/ Dental AdvisoryF.pdf.
9) Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32:181–186.
10). Marchini L, Ettinger RL. COVID-19 pandemics and oral health care for older adults. Spec Care Dent. 2020;40:329–331.
11). Martins-chaves RR, Gomes CC, Gomez RS. Immunocompromised patients and coronavirus disease 2019: a review and recommendations for dental health care. Braz OralRes.2020;34:e048.
12) Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID19):Implications for Clinical Dental Care. J Endod . 2020;46(5):1–11.
13). Guan W, Ni Z, Hu Y. Clinical characteristics of 2019 novel corona virus infection in China. N Engl J Med . 2020;382:1708–20.
14). Lee HE. Effects of different denture cleaning methods to remove Candida albicans from acrylic resin denture based material. J Dent Sci. 2011;6:216–23
15) Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 inChina: a nationwide analysis. Eur Respir J. 2020;55:2000547.
16). Papi P, Di Murro B, Penna D, Pompa G. Digital prosthetic workflow during COVID19pandemic to limitinfection risk in dental practice [published online ahead of print, 2020 May 27]. Oral Dis. 2020.https://doi.org/10.1111/odi.13442.
17). Samaranayake LP, Reid J, Evans D. The efficacy of rubber dam isolation in reducing atmospheric bacterialcontamination. ASDC (Am Soc Dent Child) J Dent Child.1989;56:442–444.
18). Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacialsurgery during COVID-19 pandemic. J Cranio-Maxillo-Fac Surg. 2020;48:521–526
19). Bhat VS, Shetty MS, Shenoy KK. Infection control in the prosthodontic laboratory. J IndianProsthodont Soc. 2007;7:62–6
Shruti Gawande, MD, COVID-19 (Ugonjwa wa Virusi vya Corona 2019) ni virusi vinavyotegemea RNA ambavyo vilijulikana mnamo Desemba 2019 wakati China iliiarifu Shirika la Afya Ulimwenguni (WHO) juu ya kuenea kwa kesi kama za nimonia. "Mwezi Machi 11, 2020, COVID-19 ilitangazwa kama janga, ""mshtuko wa afya ya umma ambao bado una athari kubwa katika kila sekta.""" Kwa sababu ya athari zake, huduma za afya za meno zimekabiliwa na athari kadhaa za kliniki, kisaikolojia na kifedha, na kuwa na matokeo yasiyotazamiwa kwa wataalamu wa meno, wagonjwa na wafanyikazi wa maabara. Tofauti na taratibu nyingine za kawaida za meno, matibabu ya prosthodontic yanahitaji wageni wengi wa wagonjwa ambao hutupa changamoto ya kipekee kuhakikisha usalama wa pande mbili na kuepuka uharibifu wa dhamana katika kila ziara. Makala hii inatoa mapendekezo muhimu kuhusu taratibu za matibabu ya meno ya prosthodontic na viwango vya utunzaji na udhibiti wa maambukizo. "Kifungu cha kwanza: ""Ugonjwa wa coronavirus wa 2019 (COVID-19) katika eneo la Wuhan, China, umebadilika haraka kuwa mgogoro wa afya ya umma na umeenea kwa kasi kwa sehemu nyingine za ulimwengu.""" Virusi vya corona ni sehemu ya familia ya virusi vya RNA vyenye nyuzi moja vinavyoitwa Coronaviridae. Virusi vya aina hii huambukizwa kutoka kwa wanyama hadi kwa wanadamu. Virusi hivyo ni pamoja na SARS-CoV-2, ambayo iligunduliwa kwa mara ya kwanza mnamo 2002, na MERS-CoV-2, ambayo iligunduliwa kwa mara ya kwanza mnamo 2012. Virusi vya COVID-19 vina kipenyo cha 100 nm na huambukizwa kupitia mawasiliano ya mtu na mtu na kuwasiliana moja kwa moja na matone ya kupumua. 4 Neno "corona" linatokana na kuonekana kwake kama "taji-kama" wakati wa kuchunguzwa chini ya darubini ya elektroni. 5 Inasambazwa hasa kupitia mawasiliano ya mtu kwa mtu na mawasiliano ya moja kwa moja na matone ya kupumua. Kuenea kwa njia ya wabebaji wasio na dalili pia kumethibitishwa hivi karibuni na ni moja ya sababu kuu za kuunda hofu na shida katika akili za madaktari wa meno. Ukaribu wa karibu na umajimaji wa mdomo, aerosols na kipindi kirefu cha kuvuja kwa virusi, huweka ushirika wa meno katika hatari kubwa ya kuambukizwa na kuambukiza virusi. Wizara ya Afya na Ustawi wa Familia (MOHFW) imeandaa miongozo maalum na ina jukumu muhimu la kuisasisha mara kwa mara na mabadiliko ya ugonjwa. Kwa sasa, taratibu za dharura na za haraka tu zimependekezwa kuchukuliwa, na kuzingatia sana vifaa vya kinga ya kibinafsi na itifaki za disinfection.8 Walakini, asili ya muda mfupi ya miongozo ya utaalam na mapendekezo yaliyotolewa na mashirika mbalimbali; imesababisha utekelezaji wake katika muundo wa meno.9 Taratibu za prosthodontic hasa zinahitaji kubadilishwa wakati wa COVID-19. "Kwa idadi ya watu, ikiwa ni pamoja na kikundi cha wazee na au bila co-morbidities, wagonjwa wa post-cancer immunocompromised au wagonjwa wenye kasoro za maxillofacial za nje ya mdomo zinazohitaji ukarabati wa prosthetic, inahitajika kuweka miongozo ambayo ni ya kila aina na inapatana na wagonjwa na madaktari pia. "" - Dr. John H. Kelley, MD, MD, ""Utafiti wa kwanza wa meno wa wagonjwa wa COVID-19." - Kuangalia wagonjwa waliopona hivi karibuni kama wabebaji wa virusi kwa angalau siku 30 baada ya uthibitisho wa kupona kwa jaribio la maabara. - Uchunguzi wa uangalifu wa hata wagonjwa wasio na dalili ni muhimu. Wagonjwa wanapaswa kuombwa kujaza maswali ya kina kuhusu COVID-19. - Kudumisha rekodi sahihi, anwani, maelezo ya mawasiliano ni ya umuhimu mkubwa. Kwa kuwa kipindi cha incubation cha SARS-CoV-2 kinaweza kupanuka kwa zaidi ya wiki mbili, majibu mazuri kwa maswali yoyote ya juu yanahitaji kuahirisha uteuzi kwa angalau wiki mbili. Kwa kuongezea, wagonjwa wanapaswa kuhamasishwa kujitenga nyumbani na kuwasiliana na daktari wao wa huduma ya msingi kwa ushauri wa simu. Wagonjwa ambao wanaonekana kuwa na uwezo wa kupanga miadi ya matibabu wanapaswa kushauriwa kuvaa kinyago cha uso cha upasuaji na, bora, kuja peke yao au na msaidizi mmoja wakati wa ziara yao ya meno. - Ofisi ya meno na eneo la kusubiri linapaswa kuwa na hewa nzuri wakati wote pamoja na viti vya wagonjwa vilivyogawanyika. - Wagonjwa wapaswa kuelekezwa kufika kwa wakati kwa ajili ya miadi yao. - Ondoa magazeti, vifaa vya kusoma, vitu vya kuchezea na vitu vingine. - Panga miadi ili kupunguza uwezekano wa kuwasiliana na wagonjwa wengine katika chumba cha kungojea. - Matumizi ya skrini ya joto isiyo na mawasiliano na kifaa cha kipimo cha oksijeni ya msukumo inapaswa kuzingatiwa hata ikiwa mgonjwa anajibu hapana kwa maswali ya dalili za COVID. Matumizi ya pulse oximeter yanaweza kupanuliwa katika taratibu za uchunguzi wa jumla wa ofisi ya meno wakati wa janga hili. Ukomavu wa oksijeni chini ya 90% ni ishara ya aina fulani ya shida ya oksijeni katika mwili. Matumizi ya pulse oximeters yanaweza kusaidia katika uchunguzi wa wagonjwa ambao wanaweza kuwa asymptomatic lakini kwa kweli wana ugonjwa huo. - Wagonjwa wanapaswa kuelekezwa kwa sanitization ya mikono na kuosha mikono vizuri mara tu anapowasili kwenye kliniki. - Daktari wa meno ya prosthetic katika kliniki yake inapaswa kuhakikisha kwamba timu nzima ni vizuri versed na tahadhari ya ulimwengu.13 II) prosthetic kuzingatia 1) removable prosthetics: Hii ni pamoja na utengenezaji wa meno ya meno kamili na sehemu. Uzee umethibitishwa kuwa sababu ya msingi ya hatari ya kuongezeka kwa kiwango cha vifo vya COVID-19, pamoja na uwepo wa magonjwa ya pamoja.14 Kwa hivyo, historia kamili ya kesi ya matibabu ni lazima kabla ya kuanza mgonjwa yeyote wa geriatric kutathmini hatari dhidi ya faida ya mahitaji. Kukamilika kwa taratibu zilizosalia lazima kupewa upendeleo ikilinganishwa na kuanza kesi mpya ili kuepuka athari zisizohitajika. Mkataba wa upande wa kiti <unk> - Protesi iliyovunjika inapaswa kurekebishwa kwa kuifuta kwanza kabisa. - Ulcerations au mucosal erosions inaweza kushughulikiwa kupitia teleconsultation kwa kushauri baadhi ya analgesic na antiseptic gels kwa ajili ya matumizi ya ndani na kusimamishwa kwa prosthesis kwa wakati huu. - Kupunguza kwa kiasi kidogo mipaka mikali kwaweza kushauriwa kwa kutumia karatasi ya mchanga ikiwa mgonjwa hawezi kuja kwenye kliniki. - Wagonjwa wanapaswa kuitishwa tena kwenye kliniki kwa ratiba kali ya miadi ikiwa marekebisho zaidi ya kiungo cha mgongo ni ya lazima ili kurudisha kazi yake. - Marekebisho ya meno ya meno yanapaswa kufanywa kwa kutumia injini ndogo ya kasi ya chini. - Protesi mpya inapaswa kutengenezwa ikiwa inathiri afya ya mfumo wa mgonjwa. - Maonyesho ya msingi yanapaswa kufanywa katika trays well-fitting hisa na maonyesho ya sekondari yanapaswa kufanywa katika trays desturi ambayo inaweza kutupwa baada ya kupata mtaalamu kutupwa. - Hatua moja mipaka molding inaweza kufanyika kupunguza kiti upande wakati. Maabara itifaki <unk> Rekodi misingi na wax rims lazima kurekebishwa juu ya msingi wa awali ili kuepuka marekebisho yoyote baada ya kuingizwa katika kinywa. Uangalifu unapaswa kuchukuliwa ili kupunguza makosa ya usindikaji katika maabara na meno ya meno yanapaswa kuwekwa tena ili kurekebisha kufungwa. Hii itahakikisha ziara ndogo za kufuatilia mgonjwa. Fasta prosthetics ni pamoja na utengenezaji wa taji na madaraja, inlays, onlays, smile kubuni, veneers, kamili kinywa rehabilitation, post na cores, na kadhalika. Hizi ni utaratibu wa kuchagua na aerosol kuzalisha. Kwa hiyo, kufuata tahadhari kali na itifaki za kuua viini ni lazima. Vipimo vya dijiti kwa kutumia scanners za ndani ya mdomo ni mbadala salama lakini uwiano wa gharama na faida unahitaji kutunzwa. Papi et al. "Kama ilivyoelezwa hapo juu, ""Mafunzo ya dijiti hupunguza mawasiliano ya binadamu katika hatua nyingi, hivyo kupunguza hatari ya maambukizi ya virusi, kuokoa muda na kuboresha ufanisi.""16 Utaratibu wa upande wa kiti - Matumizi ya bomba la mpira na suction ya utupu wa juu hupendekezwa wakati wa maandalizi ya meno ambapo mipaka ya supragingival imepangwa.17 Hii inasafisha kwa ufanisi uchafuzi wa damu na saliva; pia kuweka mzigo wa virusi." - Madaktari wanapaswa kuepuka undercuts yoyote na underreduction katika maandalizi yao ya meno ili kuzuia makosa ya maabara na miadi nyingi. - Shade mechi inapaswa kupendekezwa kufanyika na digital spectrophotometers na idhini ya mgonjwa lazima kuchukuliwa. - Intraoral picha inaweza kutumwa online kwa maabara ili kuepuka yoyote shade kutofautiana. - Inafaa kuondoa protesi iliyovunjika na yenye kasoro kwa kutumia vifaa vya kuondoa taji. - Recementation ya protesi dislodged inaweza kufanyika, wakati marekebisho ya taji ya muda inapaswa kufanyika extra-oral kutumia micromotor. - Vifaa vya meno kama vile rotor hewa na burs lazima autoclaved kwa mujibu wa maelekezo ya mtengenezaji. - Hatua za ziada ni pamoja na nafasi ya kazi ya daktari wa meno saa 11-12; shinikizo la hewa la chini katika sindano za njia tatu; ulinzi kamili wa PPE kwa daktari na msaidizi; matumizi ya vipande vya mkono vya kuzuia retraction na brushes za kutumiwa mara moja. Taji na daraja hisia na trays haja ya kuwa makini disinfected / autoclaved. Implant dentistry ni sehemu ya kuvutia zaidi na kupata kwa prosthodontists siku hizi. Kuahirisha wagonjwa kwa ajili ya uwekaji wa implants inaweza kusababisha kubwa ya kifedha na kiakili trauma kwa wafanyakazi wa meno na maabara. Lakini mipango ya matibabu ya implant inahusisha ziara nyingi za meno ambazo, pamoja na matumizi ya vipande vya mkono vinavyotokana na aerosol ya upasuaji, inahitaji tahadhari kubwa kwa habari ya disinfection na udhibiti wa maambukizo. Mapendekezo yafuatayo yanapendekezwa na waandishi ingawa busara ya kibinafsi ni lazima. Mkataba wa upande wa kiti - Wagonjwa wenye afya bila magonjwa mengine yanaweza kuchukuliwa kulingana na CBCT na mipango ya kweli. - Wakati wa upasuaji, kuchimba kwa kasi ya polepole kwa visima vyenye makali ni bora. - Mtiririko wa maji wa nje wa mara kwa mara pamoja na kunyonya kwa kiasi kikubwa kunapaswa kufanywa. - Matumizi ya vifaa vya ultrasonic na upasuaji wa piezoelectric inapaswa kupunguzwa; wakati matumizi ya osteotomies yanapaswa kuhamasishwa ili kupunguza malezi ya aerosol. - Implants ya haraka na mzigo wa haraka inapaswa kuchukuliwa popote iliyosemwa, kwani inahitaji muda mdogo wa ziara. - Ni vyema kuepuka taratibu ngumu za mdomo kamili. - Digital uchapishaji na scan miili ni alipendekeza kama mbadala wa kawaida uchapishaji kufanya. Implant hisia na vipengele haja ya kuwa makini disinfected / autoclaved kabla ya kutumia tena. Kuchukua alama za meno ni chanzo cha hatari ya maambukizi na inapaswa kushughulikiwa kwa uangalifu ili kupunguza maambukizi kwa wafanyakazi wa maabara, ambayo pia ni wajibu wa daktari wa meno. - Autoclaved hisa tray inapaswa kutumika na nyenzo inapaswa kupakiwa kwa uangalifu ili kuepuka gag reflex. - Mfano unapaswa kuhifadhiwa chini ya maji ya mtiririko kuepuka mtiririko wa moja kwa moja juu ya uso wa tishu ili kuepuka kupoteza maelezo ya uso. - Disinfectant kunyunyizia inaweza kutumika kwa ajili ya disinfection kiti upande ikifuatiwa na kufunga katika zip kufuli mifuko kabla ya kutuma hisia kwa maabara kwa ajili ya kumwagika. - Fomu za idhini ya kazi zinapaswa kutumwa katika mfuko tofauti wa kufuli. """Mipango iliyotolewa katika Jedwali la 1 inapaswa kufuatwa katika maabara kwa ajili ya disinfection kama kwa vifaa vya matibabu, katika nyakati hizi za ajabu, hatua za ajabu zinahitaji kuchukuliwa na wataalamu wote wa meno." Wataalamu wa meno ya prosthetic, wasaidizi, wafanyakazi wengine muhimu wa kusaidia, na wagonjwa wako katika hatari kubwa ya maambukizi ya COVID-19 wakati wa matibabu ya meno ya prosthetic. Timu ya meno inahitaji kusasisha maarifa yao na kujifunza matumizi ya mbinu mpya kama vile Tele-Dentistry wakati wowote iwezekanavyo kusimamia wagonjwa na kuepuka hatari ya maambukizi ya msalaba. Uwezekano wa kuambukizwa COVID-19 ni mdogo sana hadi wa juu sana wakati wa kuanzisha huduma ya jumla ya prosthodontic kwa wagonjwa kulingana na itifaki za matibabu zilizopitishwa katika kliniki. 1) Vituo vya Kudhibiti na Kuzuia Magonjwa. Ugonjwa wa coronavirus wa 2019 (COVID-19) unaonekana katika tovuti ya CDC (www.ccd.gov.au) na inapatikana kwenye tovuti ya CDC (www.ccd.gov.au) na inapatikana kwenye tovuti ya CDC (www.ccdc.gov.au). Imetumika tarehe 18 Machi 2020. (Gorbachev, A.S.S.B., Barik, R.S.S. et al.) Aina ya coronavirus inayohusiana na ugonjwa mbaya wa kupumua: kuainisha 2019-nCoV na kuiita SARS-CoV-2. "Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya ""Makampuni ya""Makampuni ya ""Makampuni ya""Makampuni ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya ""Makampuni"" ya""""""""""""" 3) Wax RS, Mkristo MD. Mapendekezo ya vitendo kwa timu za utunzaji muhimu na anesthesiology zinazohudumia wagonjwa wa coronavirus mpya (2019-nCoV) J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Anaesthetics 2020: J. Int J Dent. 2020;2020:8817424. "Yu Xiao Rui, Mkurugenzi wa Utafiti wa Ugonjwa wa Ukimwi, alisema: ""Ugonjwa wa Covid-19 unaendelea kuenea kwa kasi na kwa kiasi kikubwa ni pamoja na virusi vingine vya kupumua, kama vile virusi vya homa, virusi vya homa, virusi vya homa, virusi vya homa, virusi vya homa, virusi vya homa." Uwezekano wa maambukizi ya COVID-19 na tahadhari maalum katika udaktari wa meno Jhejiang Univ  Sci B. 2020;21:361368. 8) Wizara ya Afya na Ustawi wa Familia, Serikali ya India. Miongozo ya wataalamu wa meno katika hali ya janga la COVID-19 India: Wizara ya Afya na Ustawi wa Familia, Serikali ya India; 2019 https: www.mohfw.gov.in Al-Harbie, A. Al-Harbie, S. Al-Qaidie, S. Al-Harbie, A. Al-Qaidie, S. Al-Qaidie, S. Al-Harbie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Al-Qaidie, S. Saudi Dent J. 2020;32:181186. 10) Marchini L, Ettinger RL. COVID-19 na huduma za afya ya mdomo kwa wazee Huduma ya Spec Dent. 2020;40:329331. 11). - Martins-Chavs RR, Gomes CC, Gomez RS. Wagonjwa walio na kinga dhaifu na ugonjwa wa coronavirus 2019: ukaguzi na mapendekezo kwa huduma ya afya ya meno Oral BrazRes.2020;34:e048. A. Patel, B. Ruperto, A. Diogenes, K. Hargreaves, Coronavirus 19 (COVID-19): Madhara kwa Huduma ya Matibabu ya Meno Mwisho wa Yod. 2020;46 (5):1<unk>11. 13). Guan W, Ni Z, Hu Y. Ugonjwa wa coronavirus mpya wa 2019 nchini China N J Engl Med. 2020;382:170820. 14). - (Mstari wa 14) Lee He. Athari za mbinu tofauti za kusafisha meno ya meno ya kuondoa Candida albicans kutoka kwa nyenzo ya msingi ya meno ya meno ya akriliki. J Dent Sci. 2011;6:21623 15) Guan WJ, Liang WH, Zhao Y, et al. Ugonjwa wa pamoja na athari zake kwa wagonjwa 1590 na COVID-19 nchini China: Uchambuzi wa kitaifa Eur Respir J. 2020;55:2000547. 16). - (Mstari wa 16.) Papi, DiMuro, Penna, D, Pompa, G. Mtiririko wa kazi ya prosthetic ya dijiti wakati wa janga la COVID-19 ili kupunguza hatari ya maambukizi katika mazoezi ya meno [ichapishwa mtandaoni kabla ya kuchapishwa, Mei 27, 2020]. Ugonjwa wa mdomo. "Mfano: ""Hii ni kwa ajili ya "" (https: www.doi.org 10.11.1111_odi.1342)." 17). (Mstari wa 17) Samaranayake, L.P., Reid J., Evans D. - Ufanisi wa kutengwa kwa bwawa la mpira katika kupunguza uchafuzi wa bakteria wa angahewa. ASDC (Am Soc Dent Child) J Dent Child.1989;56:442444. 18). Zimmermann, M. N. (Nkenke, E. Approaches to the Management of Patients in Oral and Maxillofacial Surgery during COVID-19 Pandemic) ni utafiti wa utafiti wa matibabu ya mdomo na mdomo katika kipindi cha janga la COVID-19. J Cranio-Maxillo-Fac Surg. 2020;48:521526 19). Bhat VS, Shetty MS, Shenoy KK. Udhibiti wa maambukizo katika maabara ya prosthodontic. J IndianProsthodont Soc. 2007;7:626