Dental Surgery In Patients Research Articles

EXPERIENCE IN APPLYING OSTEOPLASTIC MATERIALS CONTAINING MULTIPOTENT MESENCHYMAL STROMAL CELLS AND HYDROXYAPATITE IN PATIENTS BEFORE THE PROCEDURE OF DENTAL IMPLANT PLACEMENT

Introduction of modern osteoplastic material into practical work is extremely important for effective filling of bone defects, restoration of lost periodontal tissue, relief of postoperative symptoms and reduction of inpatient treatment of patients after surgery. Up-to-date materials will improve regenerative and reparative properties of the bone tissue and promote its increasing volume for further successful dental implantation. Objective of the research was to determine an application effect of osteoplastic materials based on multipotent mesenchymal stromal cells of the adipose tissue and hydroxyapatite used for filling bone defects during dental surgery in patients, before dental implantation. Materials and methods. 140 patients were examined and treated by means of dental implantation. Before implantation, in order to increase the volume of the bone tissue of the cellular processes and cellular part of the corresponding jaw, various osteoplastic materials were applied during surgery. All the patients were distributed into III groups: І included 49 individuals (35,0 %), II group – 62 patients (44,29 %), and III (control) group included 29 patients (20,71 %). In I group a bone tissue substitute based on hydroxyapatite was used to restore the bone tissue of the cellular processes and the cellular pert of the corresponding jaw. In II group augmentation of bone defects was carried out by means of the suggested composition consisting of multipotent mesenchymal stromal cells of the adipose tissue, platelet-rich blood plasma and bone tissue substitute based on hydroxyapatite. In ІІІ group, the wound healed spontaneously under a blood clot. Results. After installation of dental implants, the peri-implant tissues were found to restore completely in cases where the combination of multipotent mesenchymal stromal cells of the adipose tissue, a bone substitute based on hydroxyapatite, and platelet-rich blood plasma was used for filling bone defects. Moreover, according to X-ray findings obtained 12 months later, in patients from II group the volume of the bone tissue resorption in the areas of implantation was 1,4 and 1,8 times lower than in individuals from І group, р1<0,01, and ІІІ control group, р2<0,01, respectively. Conclusions. The effectiveness of application of osteoplastic materials based on multipotent mesenchymal stromal cells of the adipose tissue and hydroxyapatite is confirmed by the values of the stability coefficient of implants. After 12 months of the research, these values were reliably higher than those of the reference, р<0,01. They were 12,43 % and 19,33 % higher than in patients from І main group and ІІІ control group.

Management of bleeding during dental implant surgery using a novel implant with an abbreviated drilling protocol: A clinical report.

Coagulopathy is a well-recognized complication in dental surgery in patients who use oral anticoagulants or some dietary supplements. Proper pre-operative diagnosis, medical consultation, timely management, and conservative treatment can decrease the incidence of such complications. Management of bleeding during dental implant surgery commonly involves conventional methods such as discontinuation of anticoagulant use, compression, styptics, and local anesthetic administration containing vasoconstrictors. This clinical report describes the successful management of a patient with a history of coagulopathy who was rehabilitated with complete arch fixed implant-supported prostheses with immediate loading. A novel implant design with a significantly abbreviated single drill protocol for osteotomy preparation was used in an outpatient setting. The novel protocol successfully decreased the overall bleeding and significantly reduced the intraoperative time for the surgical procedure. Additional considerations related to the novel implant design and osteotomy protocol, supplementary applications, and advantages of the protocol are presented in this article.

Cross‐sectional study of propofol dose during intravenous sedation for dental surgery in patients with long‐term oral benzodiazepine therapy: A secondary publication

ObjectivesThe amount of propofol required for intravenous sedation (IVS) in patients on long‐term oral benzodiazepine (BZD) therapy may be affected by drug interactions and central changes in sensitivity. However, there is no research on the effect of long‐term oral BZD use on the amount of propofol required for IVS. We aimed to clarify the difference between the total propofol dose required for IVS in patients with or without long‐term oral BZD therapy.Material and methodsAmong patients treated for 4 years, the total administered dose required for IVS with propofol alone and local anesthesia for the extraction of bilateral impacted mandibular wisdom teeth, was retrospectively compared between patients with continuous oral BZD use for ≥6 months (BZD group; n = 24) and those without such use (control group; n = 307). The aimed sedation level was the Ramsay sedation scale 3–4.ResultsThe amount of propofol required for IVS was significantly lower in the BZD group compared to the control group (4.83 ± 1.30 vs. 5.91 ± 1.25 mg/kg/h, p < .001; 95% confidence interval, −1.22 to −0.94 mg/kg/h; Cohen's d, 0.84). The required propofol dose was not influenced by preoperative oral BZD administration on the day of extraction (presence [n = 13] vs. absence [n = 11]: 4.9 ± 1.3 vs. 4.8 ± 1.7 mg/kg/h, p = .83). Long‐term oral BZD therapy remained a significant factor for a lower required propofol dose after adjusting for age with multiple linear regression analysis. The underlying mechanism cannot be an additive action process but might pertain to competitive inhibition via an enzyme involved in glucuronate conjugation or competitive albumin binding.ConclusionsClinicians should understand that patients on long‐term oral BZDs therapy might require less propofol for IVS than those not on BZDs, irrespective of whether BZDs were taken preoperatively on the day of surgery.

Evaluation of Early Changes in Troponin Levels During Dental Surgery in Patients with a History of Ischemic Heart Disease

Evaluation of Early Changes in Troponin Levels During Dental Surgery in Patients with a History of Ischemic Heart Disease

Recombinant FVIIa in elective non-orthopaedic surgery of adults with haemophilia and inhibitors: A systematic literature review.

To assess available evidence on the use of rFVIIa in non-orthopaedic surgery including dental surgery in adult patients with congenital haemophilia with inhibitors (PWHI). A systematic literature search was performed according to a prespecified search string; prespecified criteria were used to select applicable studies including PWHI ≥18years of age who underwent any non-orthopaedic surgery using rFVIIa. Thirty-three publications met the eligibility criteria, of which 26 publications - including 46 procedures in 44 patients - were selected for the qualitative analysis. Most publications were case reports or case series (21/26). Primary authors assessed rFVIIa as effective in maintaining haemostasis during and after most major surgeries (22/32). rFVIIa dose was mainly on label, with higher doses used in 4 cases, and a lower dose in 1 case. Duration of treatment was mostly 5-10days (range: 3days to 1month post-operatively). Adverse events related to rFVIIa were rare. Assessing non-orthopaedic surgery in this patient population is hampered by a paucity of published data; nevertheless, the current evidence indicates that rFVIIa is effective in achieving haemostasis in haemophilia patients with inhibitors undergoing elective non-orthopaedic or dental surgery. rFVIIa was generally well tolerated in these patients, with thrombotic events occurring rarely. These data, generated to help clinicians manage congenital haemophilia with inhibitors, highlight the need for more systematic reporting of rFVIIa and all other therapeutic agents in non-orthopaedic surgery and dental surgery in patients with congenital haemophilia and inhibitors.

Dental extraction in patients with HIV/AIDS: report of two cases

Introduction and objective: The oral health of patients with HIV infection is often compromised by caries and periodontal disease. Thus, many patients need to undergo oral surgical procedures. Case report: This article describes two cases of patients with HIV infection who had undergone exodontia due to prosthetic indications. Both patients had been hospitalized for treatment of respiratory complications from HIV infection and were referred for dental treatment. In the first case, the adult patient had generally good oral health. However, the treatment plan for the installation of a removable prosthesis required the removal of tooth 38 since it was fairly inclined to the mesial. The second patient had poor oral conditions due to advanced periodontal disease. Thus, all upper arch teeth were removed in a single session followed by the installationof an immediate total prosthesis. No postoperative complications were recorded and the healing process occurred without incident for both patients. Dental treatment of patients with asymptomatic HIV infection does not differ from that performed for any other patient in practice. Nevertheless, patients in advanced stages of disease may require special treatment and an individual treatment plan must be developed for even routine procedures. Conclusion: The dental careof these individuals often requires more rigorous clinical follow-up for maintaining oral health. The performance of dental surgery in patients with HIV infection does not require technical modifications, but does require a complete anamnesis.

Dental extraction in patients with HIV/AIDS: report of two cases

The oral health of patients with HIV infection is often compromised by caries and periodontal disease. Thus, many patients need to undergo oral surgical procedures. Case report: This article describes two cases of patients with HIV infection who had undergone exodontia due to prosthetic indications. Both patients had been hospitalized for treatment of respiratory complications from HIV infection and were referred for dental treatment. In the first case, the adult patient had generally good oral health. However, the treatment plan for the installation of a removable prosthesis required the removal of tooth 38 since it was fairly inclined to the mesial. The second patient had poor oral conditions due to advanced periodontal disease. Thus, all upper arch teeth were removed in a single session followed by the installation of an immediate total prosthesis. No postoperative complications were recorded and the healing process occurred without incident for both patients. Dental treatment of patients with asymptomatic HIV infection does not differ from that performed for any other patient in practice. Nevertheless, patients in advanced stages of disease may require special treatment and an individual treatment plan must be developed for even routine procedures. Conclusion: The dental care of these individuals often requires more rigorous clinical follow-up for maintaining oral health. The performance of dental surgery in patients with HIV infection does not require technical modifications, but does require a complete anamnesis.

Oral surgery in patients under antithrombotic therapy: perioperative bleeding as a significant risk factor for postoperative hemorrhage.

: To investigate perioperative and postoperative bleeding, complications in patients under therapy with anticoagulant or antiplatelet drugs submitted to oral surgery. To evaluate the risk of bleeding and safety for dental surgery, a retrospective chart review was performed. Medical and dental records of patients taking oral antithrombotic drugs undergoing dental surgery between 2010 and 2015 were reviewed. Results were statistically analyzed using Fisher's exact test, t test or the χ test. One hundred and seventy-nine patients underwent 293 surgical procedures. A total of eight cases of perioperative and 12 episodes of postoperative bleeding were documented. The complications were generally managed with local measures and did not require hospitalization. We found significant association of postoperative hemorrhage with increased perioperative bleeding (P = 0.043) and combination of anticoagulant and antiplatelet therapy (P < 0.001). The chance of postoperative hemorrhage for procedures with increased perioperative bleeding is 8.8 times bigger than procedures without perioperative bleeding. Dental surgery in patients under antithrombotic therapy might be carried out without altering the regimen because of low risk of perioperative and postoperative bleeding. However, patients with increased perioperative bleeding should be closely followed up because of postoperative complications risk.

A clinical analysis of minor dental surgery in patients taking new oral anticoagulant drugs

A clinical analysis of minor dental surgery in patients taking new oral anticoagulant drugs

Dental management considerations for a patient taking dabigatran etexilate: a case report

Dabigatran is a direct thrombin inhibitor approved to help prevent thrombotic events in patients with atrial fibrillation. As a rather new drug approval, information on management of bleeding during dental surgery in patients taking dabigatran is sparse. In this case report, a 67-year old male with a positive history for atrial fibrillation, coronary artery disease, intermittent angina, hypertension, type 2 diabetes and normal renal function was taking dabigatran 150 mg, 2 times daily. He underwent 8 surgical extractions, alveoloplasty and tuberosity reduction. Per guidelines prescribed by van Ryn et al., the patient's dabigatran was held the night before surgery and resumed the day after. Adverse outcomes were not observed during the procedure or in the 7-month postoperative period. This case suggests that due to its short half-life, dabigatran can be temporarily discontinued 24 h prior to elective oral surgery with consent of the physician and restarted the following day resulting in minimal complications.

160 Factors arising bleeding risk in dental surgery in patients treated with antivitamin K

In dental surgery, to take charge of heart disease patients treated with antivitamin K remains a common practice problem. To research the factors which increase bleeding after dental extractions in patients treated by acenocoumarol. Cohort study in which dental extractions are realized in heart disease patients treated by acenocoumarol, with an International Normalized Ratio (INR1) the day before the act between 2.00 and 4.50, using in all cases the local hemostatic measures : oxycellulose mesh (surgicel*) + sutures + compression gutter. The day of extraction, a pre-operative INR control (INR2) was systematic. The degree of dental traumatism corresponded to the extracted root number / session. The results are expressed with confidence intervals at 95%. 229 extraction sessions are realized in 135 patients, 50.32 + 2.12 years old with a 1.25 sex ratio, an extractions number / subject / session of 1.96 + 0.23 teeth and a degree of dental traumatism of 2.89 + 0.24. The INR1 and INR2 were respectively of 3.30 + 1.10 and 3.40 + 1.59. Bleeding complicated 9 extraction sessions (3.93%) and occurred after the 48 th hour in 4 cases (44.44%). In the bleeding group, INR2 was 3.33 + 7.02 against 3.40 + 1.64 in absence of haemorrhage, p = 0.86. The degree of dental traumatism was 4.89 + 3.11 in cases of bleeding against 2.80 + 0.22, p = 0.02. In heart disease patients treated by acenocoumarol, it's the degree of dental traumatism which was the hemorrhagic factor, not the INR pre-operative value.

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No osteonecrosis in jaws of young patients with osteogenesis imperfecta treated with bisphosphonates

Recent reports of osteonecrosis of the jaw (ONJ) after dental surgery in patients treated with second- and third-generation nitrogen-containing bisphosphonates instigated this retrospective study. As treatment with bisphosphonates in patients with osteogenesis imperfecta (OI) has become an important symptomatic therapy, especially for severe forms of the disease, we found it important to investigate whether healing after surgical exposure of jaw bone was influenced by the bisphosponate treatment in our group of children, adolescents and young adults with OI. Disodiumpamidronate was given as monthly intravenous infusion to 64 patients with OI aged 3 months to 20.9 years at the start of treatment (mean 8.1, median 7.7). During 0.5-12.5 years of treatment (mean 4.5, median 4.0), a total individual dose of 140-4020 mg/m(2) disodiumpamidronate was given (mean 1623 and median 1460). Ten patients continued with oral alendronate and two with zoledronic acid therapy. In 22 of these patients, 38 dental surgery procedures were performed at the age of 3.4-31.9 years (mean 12.2, median 12.3) after 0.03-7.9 years of treatment (mean 3.6, median 3.4). Despite long-term intravenous monthly disodiumpamidronate treatment, none of the 64 patients had any clinical signs of ONJ. The risk of ONJ in these patients must be considered so low that the patients with indications for treatment should be treated and get the chance to experience the well-documented beneficial effect for children with severe OI.

The Bleeding Myth

Myths of Dental Surgery in Patients Receiving Anticoagulant Therapy. M.J. Wahl. Journal of the American Dental Association 2000; 131: 77-81. Management of Anticoagulation in Patients with Prosthetic Heart Valves. K. Webster and J. Wilde. British Journal of Oral and Maxillofacial Surgery 2000; 38: 124-126.

MYTHS OF DENTAL SURGERY IN PATIENTS: RECEIVING ANTICOAGULANT THERAPY

Continuous anticoagulant therapy with warfarin is administered to prevent a variety of medical complications, including thromboembolisms and stroke. When patients receiving continuous anticoagulant therapy are scheduled for dental surgery, a decision must be made whether to continue or interrupt the anticoagulant therapy. The author reviewed the literature, focusing on dental surgery in patients receiving continuous anticoagulant therapy and in patients whose anticoagulant therapy was withdrawn before they underwent dental procedures. Of more than 950 patients receiving continuous anticoagulant therapy (including many whose anticoagulation levels were well above currently recommended therapeutic levels) who underwent more than 2,400 surgical procedures, only 12 (< 1.3 percent) required more than local measures to control hemorrhage. Only three of these patients (< 0.31 percent) had anticoagulation levels within or below currently recommended therapeutic levels. Of 526 patients who experienced 575 interruptions of continuous anticoagulant therapy, five (0.95 percent) suffered serious embolic complications; four of these patients died. Serious embolic complications, including death, were three times more likely to occur in patients whose anticoagulant therapy was interrupted than were bleeding complications in patients whose anticoagulant therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology. Dentists should recommend that therapeutic levels of anticoagulation be continued for patients undergoing dental surgery. Practitioners should consult with the patient's physician if necessary to determine his or her level of anticoagulation before performing dental surgery.

Dental surgery in anticoagulated patients.

Continuous oral anticoagulant therapy has been used to decrease the risk of thromboembolism for more than half a century, prolonging the lives of thousands of patients. Many physicians recommend interrupting continuous anticoagulant therapy for dental surgery to prevent hemorrhage. In reviewing the available literature, there are no well-documented cases of serious bleeding problems from dental surgery in patients receiving therapeutic levels of continuous warfarin sodium therapy, but there were several documented cases of serious embolic complications in patients whose warfarin therapy was withdrawn for dental treatment. Many authorities state that dental extractions can be performed with minimal risk in patients who are at or above therapeutic levels of anticoagulation. There are sound legal reasons to continue therapeutic levels of warfarin for dental treatment. Although there is a theoretical risk of hemorrhage after dental surgery in patients who are at therapeutic levels of anticoagulation, the risk appears to be minimal, the bleeding usually can be easily treated with local measures, and this risk may be greatly outweighed by the risk of thromboembolism after withdrawal of anticoagulant therapy.

Dental surgery in patients with severe factor XI deficiency without plasma replacement

Bleeding following dental extraction is frequently the first manifestation of severe factor XI deficiency. Safe oral surgery has previously been performed in such patients by using plasma replacement therapy with or without concomitant administration of antifibrinolytic agents. The aim of this study was to determine whether such patients can undergo safe dental extractions using only an antifibrinolytic agent. The study group consisted of 19 patients with severe factor XI deficiency (factor XI:C level less than 14 U/dl) who had previously bled following dental extractions (14 patients) or other trauma (five patients). Tranexamic acid, 1 g q.i.d., was given from 12 h before surgery, until 7 days afterwards. No excessive bleeding was observed following dental extractions. One patient had slight oozing after 3 days which ceased spontancously. Thus, plasma replacement no longer appears necessary for patients with severe factor XI deficiency requiring dental extractions.

Dental surgery in patients with severe factor XI deficiency without plasma replacement

Bleeding following dental extraction is frequently the first manifestation of severe factor XI deficiency. Safe oral surgery has previously been performed in such patients by using plasma replacement therapy with or without concomitant administration of antifibrinolytic agents. The aim of this study was to determine whether such patients can undergo safe dental extractions using only an antifibrinolytic agent. The study group consisted of 19 patients with severe factor XI deficiency (factor XI:C level less than 14 U/dl) who had previously bled following dental extractions (14 patients) or other trauma (five patients). Tranexamic acid, 1 g q.i.d., was given from 12 h before surgery, until 7 days afterwards. No excessive bleeding was observed following dental extractions. One patient had slight oozing after 3 days which ceased spontaneously. Thus, plasma replacement no longer appears necessary for patients with severe factor XI deficiency requiring dental extractions.