Researchers use clinical audit in dental implant treatment to improve record keeping

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Researchers use clinical audit in dental implant treatment to improve record keeping

The study showed how a good clinical audit can identify inadequacies and shortcomings of clinical practice and helps to design corrective interventions to improve healthcare service.

Wed. 14 June 2023


KUALA LUMPUR, MALAYSIA: Dental implants have revolutionized the replacement of missing teeth by creating ideal outcomes with regards to aesthetics and function, however it is not without successful record keeping that surely makes them excel. We should always attempt for sustained enhancement with regards to the success rates of dental implants and standard of healthcare delivery. By performing a clinical audit, researchers led by principal investigator Dr Tanay Vijaykumar Chaubal from the School of Dentistry, International Medical University, Kuala Lumpur, Malaysia have identified the inadequacies and shortcomings of clinical practice in relation to implant dentistry. Subsequently, intervention can be executed to stimulate enhancement in providing superior healthcare service.

According to the researchers, a clinical audit is an exercise intending to upgrade quality, essentially enhancing patient care and results through a systematic analysis of care against specific standards. It is frequently considered as part of continuing professional development and, in some circumstances, is a compulsory requirement for specialist education and registration. During the audit process, inadequacies in current practice against set standards are underscored, and improvements are executed for superior service delivery and results. Identifying shortcomings is paramount if quality in care is to be tackled.

Dr. Tanay Vijaykumar Chaubal. (Image: International Medical University, Malaysia)

The study screened 534 dental implant records via an electronic practice management software system (Open Dental, USA) from January 2015 to December 2019. Each dental implant record was further assessed using a detailed audit checklist consisting of 53 parameters with respect to presurgical, surgical and prosthetic procedures of dental implant treatment based on the surgical and prosthetic safety checklist for dental implants by Bidra AS. The absence or presence of a recording of each parameter was investigated. If the parameter was not recorded, it was scored as 1; if the parameter was recorded, it was scored as 2.

The audit disclosed high precision of record keeping in gender (100%), age (99.6%), cone beam computerized tomography (CBCT) (97.8%), written consent (95.1%), dental implant placement site (94%), implant diameter (93.6%), and implant length (93.4%).

There was inferior precision of record keeping in intraoperative radiograph with guide pin to check angulation (19.7%), periodontal disease (17.4%), postoperative chlorhexidine (17.2%), smoking (15%), clean-up of residual cement for a cement-retained prosthesis (14.4%), time of placement (11.4%), preoperative antibiotics (7.9%), preoperative chlorhexidine mouth rinse (7.3%), disinfection of abutment and restoration (3.9%), hydration of bone graft particles (3.6%), preoperative analgesics (1.9%), loading protocol (1.8%), countersink drill for dense bone (0.9%), and ice pack (0%).

“The poorest recorded parameter was the advice of ice pack (0%), its usage may be incorporated during delivery of post-operative instructions, yet it is often neglected in the backdrop of post-operative instructions given to each patient. Numerous factors like time-consuming documentation and lack of reinforcement could contribute to this inadequate recording of the parameter,” principal investigator Dr Tanay Vijaykumar Chaubal, a faculty in division of restorative dentistry at the university, said in a press release.

A multi-disciplinary approach is required to replace missing teeth with dental implants to restore oral function and aesthetics. The part of patients’ records is essential to successfully disseminate information within the team. Although the appropriateness of dental care is not illustrated by superior records, these records enable dental practitioners to assess the case and contemplate enhancements, which inferior records do not. “In the present study, the significance of displaying and maintaining precise dental records is highlighted as these dental records are key for superior standard patient care and at the same time perform as a protective shield as a consequence of a malpractice claim at legal court,” Dr. Chaubal stated.

“Many clinical audits have been performed in dentistry, but I believe this is the first audit project on dental implants that utilizes a comprehensive checklist which could effectively improve patient treatment outcomes” —Dr. Tanay Vijaykumar Chaubal, International Medical University, Malaysia

“Enhancement could be attained if recognition of the value and benefits of keeping records is increased amidst the dental practitioners,” Dr. Chaubal stated.

The study, titled “Clinical audit on the quality of record keeping of dental implant treatment performed by dental professionals” was published online as early access in March 2023 in the Journal of Osseointegration.

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