Free excerpt - SAC Classification in Implant Dentistry

3 RISKS IN IMPLANT DENTISTRY

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3.1 Principles of Risk Management All interventions in health care carry some risk of failure, complications, or other suboptimal outcomes. Implant treatments are no different. The risk management cycle is a term used to define a pro- cess aimed at limiting the incidence of adverse outcomes, and their impact.

agement centers on identifying risk factors (eg, patient be- havior/diet, salivary function, oral microflora, plaque reten- tive restorations, etc) and measuring their impact. We then can focus on reducing risk by attempting to mitigate these risks through patient education and risk-reduction focused treatments. We then continue tomonitor our patient’s prog- ress and the success of our interventions. The importance or severity of a risk can be considered in terms of the likelihood of that risk being realized and the impact or significance associated with the outcome that fol- lows. These situations are often tabulated in a risk matrix, an example of which can be seen in Table 1. While we often concentrate our efforts on mitigating the risks of high-impact outcomes, like implant failure, it must also be noted that less dire outcomes that are more com- mon, such as peri-implant disease, may bemore important.

Identify

Review

Measure

Table 1 An example of a risk matrix.

IMPACT

Negligible Minor

Moderate Significant Severe

Mitigate

Educate

Verly Likely

Low Med Medium Med Hi

High

High

Fig 1. The risk management cycle.

Likely

Low

Low Med Low Med Low Med

Medium Med Hi

High

Possible

Low

Medium Med Hi

Med Hi

In general, this cycle aims to:

LIKELIHOOD

Unlikely

Low

Low Med Medium Med Hi

• Identify potential problems • Measure the incidence of these adverse outcomes and the impact that they have • Educate users about these potential problems • Develop strategies to mitigate the incidence or effect of these problems • Review the effectiveness of these mitigation strategies As indicated in Figure 1, this is a continuous process where outcomes are monitored, and refinements are made to miti- gation strategies to incrementally improveprocess outcomes. In implant dentistry, the users refer to patients and clin- icians. However, the process remains the same. Although it is not usually referenced in such terms, effective practice in most areas of health care, including implant dentistry, follow the basic principles of risk management. A common dental practice example of thismight be themanagement of dental caries. Here, our modern preventive approach to cariesman-

Very Unlikely

Low

Low Low Med Medium Medium

3.2 The SAC Classification as a Risk Management Tool

The SAC classification is essentially a tool that assists practi- tioners to identify risks so that they can educate their pa- tients about these potential problems as part of the informed consent process. Clinicians then use their understanding of these risks to plan treatments that minimize risk. Patients are then monitored after the completion of treatment to identify problems that might arise as early as possible, thus allowing intervention tominimize the impact of the problem on the ongoing quality of treatment outcomes.

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The SAC Classification in Implant Dentistry