Nontechnical skills in periodontal and implant microsurgery - The hidden key factors

Periodontal and implant microsurgery demand more than technical expertise. To enhance safety and performance, mastery of nontechnical skills (NOTSS) is required. These skills encompass cognitive, social, and personal resources that complement surgical technique. NOTSS, originally developed in the aviation industry, are divided into cognitive skills, such as situation awareness (SA) and decision making; and interpersonal skills, including communication, teamwork, and leadership. In a microsurgical setup, the operator faces multiple sensorimotor challenges due to scaling difficulties, a restricted field of view, and misalignment between the physical workspace and the visual feedback plane. These factors increase cognitive workload and place greater demands on intraoperative SA, as well as its effective sharing with the chairside assistant. Because the surgeon is closely connected to the eyepieces, intraoperative nonverbal communication with team members is limited, placing much higher demands on the operator's leadership qualities. Briefings and debriefings help assign specific tasks to individual team members and distribute responsibilities, allowing execution to proceed implicitly and with minimal verbal exchange. The quality of NOTSS has a substantial impact on performance in periodontal and implant microsurgery and appears to underpin technical proficiency. KEY POINTS: Nontechnical skills for surgeons (NOTSS) include thinking skills and personal interactions that are required to accompany the appropriate level of surgical knowledge and technical competence in pursuit of surgical excellence. The NOTSS taxonomy is a generally accepted system for learning and assessing nontechnical skills in surgery. NOTSS are well documented in the scientific literature and have been shown to equip members of the surgical team with the necessary skills to reduce clinical errors, improve patient safety, and enhance final outcomes. PLAIN LANGUAGE SUMMARY: Microsurgery in periodontology and implant dentistry isn't just about steady hands and technical skills. Surgeons and their teams also need strong nontechnical skills to deliver safe and successful care. These nontechnical skills include things like: (1) accurate thinking and good judgment (cognitive skills), and (2) clear teamwork and leadership, as well as effective communication (interpersonal skills). Microsurgery presents specific challenges: Surgeons often work with small and delicate structures, deal with magnified views through microscopes, and must overcome the awkwardness between what they see and what they should finely execute with their hands. This means that surgeons must stay extremely alert during procedures and actively share relevant information with their assistants. However, because the surgeon is usually glued to the microscope, they can't easily communicate with the team using gestures or eye contact. This makes it even more important for the team to have assigned roles, discussed in advance, so everyone knows their tasks without needing lots of spoken instructions. Ultimately, how well the team uses these nontechnical skills can affect not only how the procedure goes but also the patient's outcome. In periodontal microsurgery, having technical expertise isn't enough-strong teamwork, leadership, and communication are essential for high-quality, safe patient care.