|Year : 2013 | Volume
| Issue : 1 | Page : 37-41
Present scenario of implant recycling: Where are we heading to?
GV Gayathri, Neelam Khalia, Tarun AB Kumar, Dhoom Singh Mehta
Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
|Date of Web Publication||26-Nov-2013|
G V Gayathri
Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka
Source of Support: None, Conflict of Interest: None
Implant is an object or material inserted or grafted into the body for experimental, diagnostic, therapeutic or prosthetic purposes. However, there is a total uncertainty and ambiguity about the fate of these precious metal implants after the death of a person. They are either disposed off, buried, stored or sent to landfills, which is not only a financial loss but it is also detrimental to the environment in the long run. To avoid such problems, the idea of implant recycling has come as a boon. In addition, the idea of using the income obtained from this process for charity makes this program as a "cause with noble purpose." The practical possibility of this humanitarian program requires a teamwork involving Government, crematory authorities, family members, dentists, authorities of recycling company etc. Though the implant recycling is already in practice in few developed countries, its establishment in developing countries requires a lot of support and encouragement from all the concerned parties. Despite its versatile good will, the procedure has not yet recieved sufficient attention in the scientific literature. Aim of this article is to highlight the necessity of implant recycling, its influence on health field, society and our precious environment along with the description of each participant's suggestive role and pros and cons of the process are in brief.
Keywords: Cremation, dental, environmental, implant, recycling
|How to cite this article:|
Gayathri G V, Khalia N, Kumar TA, Mehta DS. Present scenario of implant recycling: Where are we heading to?. Int J Oral Health Sci 2013;3:37-41
| Introduction|| |
The implants are commonly made up of heavy metals like titanium, which remain intact even after exposure to 1800×C for 90 min during the process of cremation and do not get decomposed even in buried state also. These cremation remnant implants are prone for exploitation if, disposed open in air. Some garbage-pickers can pick/steal them and sell in black market. Such sterilized/unsterilized metal implants can be resold with an attractive package. Consumer party being unaware of the bygone of such implants may subject them to reuse.
There are various downsides of reusing an implant. Such implants can be associated with altered micro topography due to exploitation by varied human and environmental means. Reused dental implants may also be associated with poor bio-mechanical properties and pre loading fatigue, which can increase the risk of implant failure.  They can also increase the chances of cross-infection because of improper decontamination. Therefore, such practices are highly unethical and immoral. Although, it's not a major issue but they can also have an effect on the implant industry. Hence, re-cycling of discarded implants is a definite requirement, which can also be transformed to fulfill the noble intention of serving the poor and needy people of our society by its income and keeping our eco-system balanced.
Recycling is the process of producing a new product from a recyclable material. It is a key component of modern system of waste reduction and is the third component of the "Reduce, Reuse and Recycle" waste hierarchy. It is a significant part of the ongoing green movement and has clearly become an accepted and embraced practice in our modern society. Recycling is not something, which has not been tried before, it has been done for home used products such as papers, aluminum cans etc., since past several years. However, when the recycling of implants at the crematory/cemetery level is concerned, it ranks lowest on the list, most likely due to irrational and captious way of people dealing with death.
| Process of Implant Recycling|| |
Common metal remnants found in post crematory wastes are implants (orthopedic/oral and maxillofacial/dental) or dental prosthesis such as crowns, bridges, cast partial dentures etc., The orthopedic implants are mainly hip and knee joints, bone plates, rods and screws [Figure 1] and [Figure 2].  Oral and maxillofacial implants includes mostly dynamic compression plates, miniplates, microplates, lag screws, arch bar and wire etc., while dental implants mainly comprises of various blade and screw type implants [Figure 3]. 
|Figure 2: Post cremation recovered hip and knee implants (after cleaning process)|
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Currently practicing implant re-cycling is a multi-step procedure and is carried out in several stages. The process starts with the collection of the post crematory wastes, followed by separation of metal and other remnants such as bone and ashes etc., The separated recyclable metal remnants are then transported to collection centers. Here, the ferrous and non-ferrous metals like titanium are separated by custom designed metal separating process followed by segregation of different recyclable metals. With spectrometer technology, the chemical specifications requested by medical casting industry are verified, according to which metals are melted in furnace and are poured in molds to form metal ingots. These metal ingots are then sold back to medical casting industry for fabrication of new prosthesis/implants, which can be used to treat poor and needy people to provide them a quality-life at free of cost. After these patients death, again implant reaches crematorium to subject for recycling. This way, the implant re-cycling chain continues to achieve the dual target i.e., helping the deprived people and protecting our environment [Figure 4]. 
| Pros and Cons of Implant Recycling|| |
Though implant recycling is going on in few countries but it has its own pros & cons as listed [Table 1]. 
| Present Scenario of Implant Recycling Around The World|| |
With the improvement in advanced healthcare services at corporate as well as at government level, implant therapy has become an integral part of the modern day therapeutic system. In UK, Department for Environment, Food and Rural Affairs and the Environment Agency correctly advise that, metal implants are part of the deceased person's body. But when metal prostheses become separated from their previous hosts, they become "waste" and have to be handled and disposed of according to the relevant regulations and the terms of any waste management licenses. In many crematories, the remnants are still disposed in an open space, in water or are sent to landfills without separating the metal contents due to the involvement of sensitive matters such as religion, emotional feelings and lack of awareness in these issues. These disposal practices appear very unproductive, inefficient and unethical, which may be harmful to our atmosphere and eco-system. Implant recycling process has come as a ray of hope to resolve problems associated with this type of disposal. Implant recycling is already in practice in many developed countries such as US, Japan and in many parts of Europe. Earlier, reuse of implants recruited from crematory was done for poor patients in few places across the world. However, now this practice has been replaced by implant recycling process. Initially the metal ingots obtained from implant recycling were sold to the market, which made it to become a profitable business to recycling companies. Though this process helped to be a part of "Go Green Movement," most of the time it was not accepted by decedent's family members. The reason behind the disapproval was mainly the perception of using their near and dear one's body part as a source of profitable income to some anonymous people. Now the concept of non-profit recycling program has come into the existence, in which the money obtained from implant recycling is not used for company's profit, but is used for charity purposes.
In the recent years, many developed and developing countries around the world have joined their hands in making this program successful. Environmental technology initiative, an US based project has provided a forum for stakeholders to discuss the technical and policy issues involved in metal recycling.  According to records, about 100 crematoriums have signed up to this scheme out of 250 or so in Britain. In 2009, the scheme raised £33,500 with proceeds funding work by charities such as "MacMillan Cancer Support," the "Alzheimer's Research Trust" and the "British Heart Foundation." Estimate suggest that, in Japan if 3.6 million dentures with precious metals discarded each year were recycled, it would be worthy to £34 million. As per record, USA now involves more than 2000 US Crematories nation-wide and has donated over $40,000 to more than 30 local and national US charity organizations. 
| What Role The Crematory/Cemetery Associations Can Play|| |
The crematory/cemetery associations can play a larger role in making this program effective by keeping a strict control and supervision on the disposition of remnants of cremation. Such associations can nominate Board of Directors who can give task to team of cremation industry leaders to gather available resource and information on prosthetic/implant recycling across the country.  The nominated directors can educate, motivate, train and guide the regional crematory authorities, through cremation industry leaders to recycle the implants. Even the directors can make guidelines and recommend the association to act accordingly. They can establish a charitable fund especially for this program, to receive and distribute funds on behalf of cremation industry to give the three necessities of life (food, shelter and clothing) to those who can't afford. Besides it, the fund can also be used to help the cancer patients, old, disabled helpless people and mentally and physically challenged population, either directly or indirectly by contributing to charity organizations. Finally, crematory associations can strictly supervise the activity of implant recycling company and contribute in creating an eco-friendly environment.
Responsibilities of implant recycling companies
Although implant recycling has started in few countries, but many are still out of this program [Table 2]. These countries can also join the program by taking inspiration from the already established recycling company's guidelines with few modifications of their own. Ideally, the implant-recycling program should be conducted in such a way that, it should be noble, lawful and morally accepted. Companies should follow the current and future environmental policies and guidelines of their respective nations. As far as possible, the facilities like providing container for collection and transportation to collection center should be provided to crematorium at free of cost by the company. To prevent the risk of reuse of implants, the implants should be processed first to make their original shape unrecognizable and company should be able to provide a proof of it whenever required. Company should maintain a record of type and quantity of implant materials obtained, details of money obtained out of recycling and information about its utilization. Besides recycling company should keep in mind that, occupational exposure to the company workers can occur during recycling procedure from few metals like nickel. Suitable precautions should be taken to avoid such hazards. 
The fund raised should be based on the recyclable value of different types of metals that are being recycled. Money obtained after deducting the processing expenses of recycling, should be used for noble causes such as donations and charity. Record of the details of crematorium including their location, revenue, expenses, donation history report should be maintained. There should not be any obligation of any kind for exploring the activity of the company by public or crematory association.
Responsibility of government to encourage implant recycling
Financial constraint is one of the factor, which prevents the launching of this program in many countries. If government can take initiative and provide financial help, many more can come forward to join this honorable cause. Implant recycling should be considered lawful by the government, only if the money obtained is not used by the recycling company or crematory authorities for their own turnover but is used for charity purpose.  If possible, minimal tax or tax exemption should be considered on the fund generated by this process.  Government should make some strict rules according to which, both decedent's relatives and government should be well informed about the details of recycling process and the way of utilizing the obtained money along with relevant evidences. Government can bring awareness to general public and cremation/cemetery authorities about the whole recycling program and its objective through popular public figures from film industry or sports with the help of various mass communication media like TV and radio. Both government and public sector's support is required for the establishment and evolvement of this "Go Green Movement."
| Suggestions for Green Movement|| |
In few countries, due to multi-racial and multi-religious structure, both cemetery and cremation customs are in practice. In cremation process, the metal implants will be recovered immediately after the completion of process, whereas in cemetery custom, we need to wait for a much longer time to obtain the metal remnants. In cemetery, the space used for burying dead body is given for a lease period, which can vary from a couple of years to 100 and more years. After the lease period is over, the site is either renewed or reused and the bones are moved to an ossuary. This lease duration is sufficient enough for the metal implants to cause damage to the environment. Since after surgery metal prostheses become part of the body hence after death, with the consent of relatives, the voluntary donation of implants like other body organs (eyes, kidney, liver etc.) can be encouraged. The implants can also be retrieved from the dead body without causing any disfigurement and then can be subjected to recycling. This can help to take the implant recycling one-step further in achieving our noble goal of keeping our environment free from pollution.
| Our Responsibilities as a Clinician for Establishment and Success of Implant Recycling Program|| |
Both the dental and medical practitioner can play a vital role in the establishment and success of "Implant Recycling Program." We can inform patients and their relatives about recycling program, at the time of deliverance of prosthesis itself. We can encourage them to become part of this noble cause in helping the poor and needy people of our society and also to our environment, by donating their implants after their death. Posters and videos can be displayed in the waiting room of clinics, which reveals the formalities, procedure and pros and cons of the program. Besides that, to motivate the rural and urban population, camps can be conducted, where we can highlight the positive impact of implant recycling on our environment, on preserving non-renewable resources and the help, which poor and needy people can get out of it.
| Conclusion|| |
As a Roman author Titus Livius says "better late than never." This holds very true in case of implant recycling. Despite of very higher rate of cremation rate in many developing countries, implant-recycling practice has not yet started officially. To recapitulate, all the nations where post crematory metal implants are just disposed off, this novel yet revolutionary plan of implant recycling paves a way toward betterment and benefit of both the human clan and environment.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]