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Dental Tribune United Kingdom Edition

What went wrong? Eddie Scher previews his forthcoming lecture “ You should always learn from other people’s mis- takes, especially in surgery.” This was a favourite saying of my father’s, and it is just as true to- day. In my lecture at the Clinical Innovations Conference, I will share some of the problems that have been seen in my practice. Most of these were in patients referred to me when things have gone wrong – as of course they sometimes will. From these problem cases, I will show in my lecture first, what could be done to help the patient and solve the problem, and secondly, the lessons to be learned that will improve our own practices and help us avoid making the same mistakes. This will be in three key areas: treatment plan- ning, surgery, and prosthetic res- toration. In this article, I set out some of the questions that will be an- swered in my lecture. Errors in treatment planning The best way to avoid making er- rors in treatment planning is to know when to say ‘no’. There are some cases where implants sim- ply are not the right solution. Figure 1 might be one such example. This young lady was referred to me with a special re- quest. Something has obviously gone wrong with the implant placement. Can her smile be re- covered in time for her wedding? The answer will be yes (Fig 2), but you will have to come to my lecture to see how. Errors in surgery Every surgeon who operates in the posterior mandible is (or should be) exceptionally wary of damaging the inferior dental nerve. The damage can be done in an instant, sometimes without warning, and can be permanent. But with guided surgery, one can place an implant within one mm of the position selected using computer software. However, even when guid- ed surgery is inappropriate, a CT scan can be used. This may show, for example, serious dif- ficulties such as when the infe- rior dental nerve is at the crest of the ridge (Fig 3). As I will show, guided surgery and/or a CT scan should be combined with a de- tailed protocol of other steps to best manage risk when operating in the posterior mandible. Another nightmare scenario is losing an implant during sur- gery. This happened to the oper- ating surgeon in Figure 4. With a careful look at the x-ray you will see where the lost implant ended up: I will explain in the lecture how to get it back out. Flapless surgery can also be problematic. The patient in Figure 5 was referred to me as having had a simple extraction with no bone loss. I was asked to perform flapless surgery. What would you have done? There are also interesting diagnostic challenges raised by patients who present with unex- plained problems. For example, see Figures 6, 7, 8 and 9. What could have caused these prob- lems? (The cause of the problem in Fig 10 is obvious: the patient did not pay her bill!) The surgical part of my lec- ture will end with a fascinating study of the patient in Figure 11: what went wrong here? And what urgent steps should be taken? Errors in prosthodontics Placing implants too close to- gether is an error we will all see: Figure 12 for example is obvi- ously a difficult clinical situation. How, though, can we take an im- pression of two posts so close to- gether? Another extraordinary case is in Figure 13. What could have caused this patient’s pattern of damage? I look forward to sharing the April 25-May 1, 20118 Clinical Innovations United Kingdom Edition www.thedbg.co.uk For more information and a quote contact the DBG on 0845 00 66 112 Please Note: Errors and omissions excluded. Any prices quoted are subject to VAT. The DBG reserves the right to alter or withdraw any of their services at any time without prior notice. Are you waiting to find out when the Care Quality Commission* inspect your practice? Your compliance with Clinical Governance and Patient Outcomes will be questioned with the introduction of the Care Quality Commission*, HTM 01-05 and the increase in PCT practice inspections. Would you like to know how you would fare when your practice is inspected and have the opportunity to take corrective action? The DBG Clinical Governance Assessment is the all important experience of a practice audit visit rather than the reliance on a self audit which can lead to a false sense of compliance. The assessment is designed to give you reassurance that you have fulfilled your obligations and highlight any potential problems. We will provide help and advice on the latest guidance throughout the visit. • Your premises including access, facilities, security, fire precautions, third parties and business continuity plans. • Information governance including Freedom of Information Act, manual and computerised records, Data Protection and security. • Training, documentation and certificates. • Radiography including IRR99 and IR(ME)R2000 compliance. • Cross infection and decontamination including HTM 01-05 compliance and surgery audits. • Medical emergencies including resuscitation, drugs, equipments and protocols. • Training, documentation and certificates. • Waste disposal and documentation and storage. • Practice policies and written procedures. • Clinical audit and patient outcomes including quality measures. The assessment will take approximately four hours of your Practice Manager’s time depending on the number of surgeries and we will require access to all areas of your practice. A report will be despatched to you confirming the results of our assessment. If you have an inspection imminent then we suggest that you arrange your DBG assessment at least one month before the inspection to allow you time to carry out any recommendations if required. Following the assessment you may wish to have access to the DBG Clinical Governance Package with on-line compliance manuals. The areas the DBG assesses are: Clinical Governance including Patient Quality Measures - Is your practice compliant? Have you addressed all 28 CQC outcomes? ? *England only. 20YEARSYEARS 20 9361 DBG ClinicalGov The probe 338x244.qxd:Layout 1 1/7/10 13:39 Page 1