Surgical safety checklist for dental implant and related surgeries

Throughout the world, dental implant therapy continues as a highly successful modality for replacing missing teeth, and its popularity remains high among general dental practitioners and dental specialists. Nevertheless, as dental implant therapy includes a surgical component and is an elective procedure, clinicians must strive to provide a safe and high quality treatment for patients. With the increase in the number of clinicians performing implant surgeries, the number of complications and surgical errors is expected to increase. Some of these errors will be minor and self-resolving, but some will have serious consequences.

One method of minimizing errors in the practice of surgery is the use of perioperative surgical safety checklists.^,  Generally, perioperative refers to the 3 phases of surgery: preoperative, intraoperative, and postoperative, and separate checklists are necessary for each of the 3 phases. Such checklists have been used in the medical field for many years and have been shown to minimize surgical errors and improve patient outcomes.^,  The World Health Organization (WHO) has also developed a surgical safety checklist for use by medical surgeons worldwide. Wall-mounted surgical checklists are common practice in hospitals and are usually monitored by perioperative nurses and allied hospital staff.

In contrast, most dental implant surgeries are elective and occur in an office (out-patient), where the dentist is primarily responsible for ensuring all perioperative steps are followed. Therefore, the likelihood of procedural errors and subsequent complications may be higher and may also have medical-legal consequences. Historically, safety checklists have not been used in dental implant surgeries, probably because these surgeries were traditionally performed by a smaller group of dental specialists who might have deemed this process unnecessary. However, with the increase in the number of dentists with varying experience levels performing implant surgeries throughout the world, a surgical safety checklist may help standardize the perioperative workflow.

The present author is aware of only one safety checklist published in the peer-reviewed dental publications for implant placement. Although a Delphi panel validated this comprehensive checklist, it was broad in description and did not include the detailed surgical elements and steps often considered consequential by clinicians. Additionally, this checklist did not specifically address items related to errors of omission (failure to do something that should have been done) and errors of commission (doing something that should not have been done). Another series of treatment planning and surgical checklists was previously published in a textbook to aid the practitioner.

The purpose of this article was to describe a simplified yet detailed perioperative surgical safety checklist that could be used by clinicians with varying experience levels for straightforward and/or complex implant and related surgeries in an out-patient (dental office) setting setting, without sedation. The checklist for administering sedation is distinct and is outside the scope of the presented checklist. For many years, this author has successfully used this checklist and reduced errors and complications in several hundred implant surgeries. The surgical safety checklist is described in Table 1. The advantages of this checklist include its comprehensiveness and the incorporation of minor surgical elements in a sequential manner. It can be wall-mounted and filled by dental assistants and/or clinicians to reduce errors and can improve patients’ confidence, as well as provide the clinician with reassurance and satisfaction after implant surgery. Future clinicians will no doubt modify this checklist to suit personal preferences and incorporate emerging science and technology. Most of the items described in this surgical safety checklist are based on scientific evidence, but some items are empirical and are listed here based on practicality and common clinical practice. The disadvantages of the checklist are that adhering to it requires additional time and vigilance by the clinician and that the checklist may need to be updated and validated by future research.