DOSSIER SUL RAPPORTO COSTO/ QUALITA’ IN ODONTOIATRIA 3

By 29 Novembre 2016 Approfondimenti, ITA

PARTE 3- TECNOLOGIA E QUALITA’ IN ODONTOIATRIA
In quest’ultima parte analizzeremo uno degli aspetti che abbiamo visto essere responsabile dell’elevato costo delle cure, ma che di pari passo è diventato sempre più necessario: il livello di avanguardia tecnologica dello studio e il livello di qualità ( e quindi di durata) delle prestazioni prodotte.

NUOVE DIAGNOSI APPROFONDITE, PIANIFICAZIONE VIRTUALE DELL’INTERVENTO, TEMPI DI TRATTAMENTO RIDOTTI, DIMINUZIONE DEI MARGINI D’ERRORE. L’IMPLANTOLOGIA GUIDATA DAL COMPUTER

Da quando è nata l' implantologia guidata dal computer si può finalmente parlare di svolta epocale nel mondo dell'odontoiatria. Nasce in definitiva la tecnica supportata dai software che permette di velocizzare e rendere più sicure e precise le diagnosi e le terapie e quindi offrire interventi più agevoli per chi desidera avere un sorriso smagliante. Per mezzo delle più avanzate tecniche di chirurgia minimamente invasiva e dell’implantologia guidata dal computer, si offrono ai pazienti piani di trattamento capaci di trasformare i denti di una dentiera mobile, in una sola seduta, in denti fissi sostenuti da impianti, senza rischi e con la possibilità di utilizzo immediato. L’ausilio delle guide ottenute con la stereolitografia computerizzata riesce a rendere l’implantologia osteointegrata una tecnica semplice e applicabile in quasi tutte le situazioni cliniche, anche in presenza di gravi atrofie delle ossa mascellari laddove l'implantologia tradizionale, cioè effettuata a mano libera, renderebbe questi interventi molto difficili.

Si può parlare di una importante svolta per l'implantologia?
Assolutamente di sì. Bisogna prima di tutto spiegare cosa significa e a chi è rivolta questa nuova metodica. Infatti l'implantologia è la metodica dedicata ai pazienti che hanno perduto i propri denti, o sono portatori di una dentiera mobile e desiderano una nuova dentatura fissa che duri nel tempo. Un’evoluzione dell’implantologia classica è l'implantologia computer guidata. Quasi sempre la mancanza dei denti, l’utilizzo di protesi mobili e l’età avanzata, determinano atrofia delle ossa mascellari che normalmente rendono difficili o impossibili i trattamenti implantoprotesici classici. L’implantologia guidata dal computer riesce, invece, a dare risposte anche in casi estremi come questi, o in pazienti affetti da gravi parodontopatie, in quanto riesce a sfruttare anche i più minimi residui di osso.

I vantaggi di questa metodica riducono il margine d'errore e aiutano anche chi ha paura del dentista?
Esattamente. Immaginate uno studio dentistico di 20 anni fa. C’erano limiti che oggi sono praticamente inesistenti: materiali, attrezzature, strumenti e nuove metodiche, hanno fatto il loro percorso e usufruito di milioni di euro di investimento da parte delle aziende produttrici per risolvere problematiche che prima richiedevano mesi di cura. Oggi gli interventi sono di brevissima durata e garantiscono qualità e sicurezza in assoluto rispetto dei costi. Questo metodo offre enormi possibilità di successo e minima invasività chirurgica. L'esame attento delle informazioni volumetriche provenienti dalla Tac Denta-Scan e le opportunità offerte dai programmi di progettazione aumentano le opportunità di sfruttare anche volumi di osso basale molto ridotti, offrendo in tal modo al paziente la possibilità, altrimenti negata, di ricevere protesi fisse a funzione immediata. La Computer Guided Dentistry rappresenta senza dubbio, rispetto ai complessi ed invasivi interventi di ricostruzione ossea, una metodica più semplice e predicibile, valida anche in caso di severe atrofie dei mascellari. Questa, a mio parere, sarà una tecnica destinata ad essere sfruttata da un sempre maggior numero di pazienti e di dentisti. Questa metodica, associata alla sedazione cosciente, rappresenta un ausilio straordinario per abbassare le tensioni, ridurre la soglia del dolore e indurre uno stato di profondo e duraturo benessere anche nei pazienti fobici.

L’ausilio del computer è più utile in fase diagnostica o in fase di pianificazione dell’intervento?
È utilissimo in entrambe le fasi, l’una è integrata nell’altra. In passato era utilizzato solo nella fase diagnostica in quanto mancavano le applicazioni tecniche per sfruttarlo nello stadio clinico operativo. Oggi, invece, grazie alla stereolitografia, si possono applicare i suoi vantaggi a 360°. L’utilizzo dei software cosiddetti di navigazione permette di navigare virtualmente nell’anatomia del paziente. Nella fase diagnostica le immagini tridimensionali dei tessuti molli e delle ossa mascellari dei pazienti vengono esaminati nei più intimi dettagli. Questo è possibile in seguito all’acquisizione dei dati DICOM della TAC del paziente in esame. Durante questa fase diagnostica ho sul mio computer tutte le informazioni tridimensionali di cui ho bisogno per effettuare le valutazioni sui volumi, la qualità e la quantità dell’osso del paziente. Questo mi consente di effettuare un intervento virtuale con il posizionamento ideale nello spazio degli impianti, tenendo conto di tutte le corrette indicazioni. La pianificazione così ottenuta viene salvata e inviata in un file alla casa di produzione delle guide chirurgiche. Questa realizza delle mascherine guida, che indirizzeranno la fresa usata dal chirurgo per la preparazione del sito implantare nell’esatta posizione, inclinazione e profondità stabilita nella pianificazione per il corretto alloggiamento degli impianti stessi. Le guide, in resina speciale, sono realizzate con tecnica industriale e computerizzata, chiamata stereolitografia. Questa consente di replicare qualsiasi oggetto presente sul computer in tre dimensioni con massima fedeltà. Saranno perciò realizzate in resina delle repliche tridimensionali in dimensioni reali delle ossa mascellari e/o mandibolari del paziente. Inoltre si riescono a fare diagnosi difficili non solo in implantologia ma anche in tutte le branche dell’odontoiatria.

Quali vantaggi porta all’odontoiatria l’assistenza del computer?
Con l’introduzione delle nuove metodiche computerizzate in implantoprotesi, utilizzate sia in fase diagnostica che operativa, l’odontoiatria (come altre discipline) è stata rivoluzionata e lo sarà sempre più. Questa rivoluzione non riguarda i principi, ma le metodiche e i materiali. Tutto questo consente di ottenere risultati più duraturi e precisi in tempi ridotti. Il computer, in sintesi, interviene nell’ambito della realizzazione delle protesi (con i sistemi CAD-CAM) e sostituisce i metodi artigianali, con la predicibilità ed il controllo, tipici dei processi industriali di precisione».

In quali ambiti dell’odontoiatria il computer può intervenire?
Diagnosi, terapie chirurgiche implantoprotesiche e realizzazione di protesi individualizzate, ma prodotte con processi industriali. Esistono, inoltre, anche altre discipline come l’Ortodonzia e la Posturologia che si avvalgono con successo dell’uso del computer.

È una metodologia utilizzabile per qualunque paziente?
Poiché l’ implantologia guidata dal computer, o Computer Guided Implantology C.G.I., consente degli interventi minimamente invasivi, è particolarmente indicata per i pazienti normalmente considerati a rischio di insuccesso. Si tratta, quindi, di una metodologia che consente di operare in grande sicurezza e con precisione sub millimetrica accurata, accorciando di molto i tempi di trattamento e quindi adatta e consigliabile a tutti .
Anche in odontoiatria protesica, la digitalizzazione delle procedure (la tecnologia CAD CAM) ha consentito lo sviluppo di nuove tecniche e l’impiego sia di nuovi materiali cosiddetti metal-free come l’ossido di zirconio, chiamato zirconia o il disilicato di litio, che la lavorazione di alcuni metalli con tecniche di sinterizzazione e resine acriliche ad alta densità.

La tecnologia CAD CAM permette, attraverso uno scanner 3D, la lettura di un modello master, dei denti preparati o della posizione degli impianti. Effettuata la scansione, attraverso un software l’odontotecnico elabora i dati e realizza la progettazione ed la invia alla macchina utensile CAM, che realizza dal pieno il pezzo nel materiale prescelto per la ricostruzione protesica.

Concludendo possiamo affermare che il miglioramento dello standard qualitativo delle cure non può essere svincolato dall’acquisto e dall’utilizzo di tecnologie sempre più efficienti e sofisticate, ma con un costo molto elevato. Ecco perché questo parametro viene riconosciuto come una delle cause maggiori che concorrono a creare l’elevato costo delle cure dal dentista.

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