1
|
Babayan M, Bidra AS. Management of bleeding during dental implant surgery using a novel implant with an abbreviated drilling protocol: A clinical report. J Prosthodont 2024; 33:206-211. [PMID: 37634077 DOI: 10.1111/jopr.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Mikhail Babayan
- Former Resident, Division of Prosthodontics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Avinash S Bidra
- Division of Prosthodontics, Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| |
Collapse
|
2
|
Ono S, Ishimaru M, Yokota I, Konishi T, Okada A, Ono Y, Matsui H, Itai S, Yonenaga K, Tonosaki K, Watanabe R, Hoshi K, Yasunaga H. Risk of post-extraction bleeding with direct oral anticoagulant compared with warfarin: Retrospective cohort study using large scale claims data in Japan. Thromb Res 2023; 222:24-30. [PMID: 36563522 DOI: 10.1016/j.thromres.2022.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Comparative safety of direct oral anticoagulants vs. warfarin in patients undergoing tooth extraction remains unclear. We compared the incidence of post-extraction bleeding between patients taking warfarin and those taking direct oral anticoagulants (DOACs) using administrative claims data. MATERIALS AND METHODS We identified outpatients on anticoagulant therapy who underwent permanent tooth extraction between 2015 and 2020 and categorized them into the warfarin and DOAC groups based on medication prescribed within six months prior to tooth extraction. We used the overlap propensity score weighting method to balance the baseline characteristics between the groups and compared the incidence of post-extraction bleeding within seven days after tooth extraction. RESULTS Among 5253 eligible patients, those in the DOAC group (n = 3696) were older and less frequently prescribed antiplatelets than those in the warfarin group (n = 1557). The distribution of tooth extraction type and number of teeth extracted in a single procedure did not differ between the groups. The unadjusted incidences of post-extraction bleeding in the warfarin and DOAC groups were 35 (2.2 %) and 71 (1.9 %), respectively. Moreover, the overlap weighting analysis showed that the adjusted odds ratio of post-extraction bleeding in the DOAC group in comparison with that in the warfarin group was 0.84 (95 % confidence interval, 0.54-1.31). CONCLUSION The incidence of post-extraction bleeding in patients taking DOACs was comparable to that in patients taking warfarin. The findings suggest that dentists and physicians should exercise the same degree of caution when extracting teeth in patients on DOACs and those on warfarin in terms of post-extraction bleeding.
Collapse
Affiliation(s)
- Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Miho Ishimaru
- Department of Oral Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shunsuke Itai
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazumichi Yonenaga
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kanata Tonosaki
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Rinji Watanabe
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazuto Hoshi
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| |
Collapse
|
3
|
Yagyuu T, Furukawa S, Zaizen M, Yata S, Imada M, Nogami K, Kirita T. Peri-operative hemostatic management of tooth extraction in patients with hemophilia A, with and without inhibitors, receiving emicizumab prophylaxis. Haemophilia 2023; 29:172-179. [PMID: 36163647 PMCID: PMC10087157 DOI: 10.1111/hae.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Emicizumab treatment may allow patients with hemophilia A without (PwHA) and with inhibitors (PwHA-I) to undergo some minor surgeries, such as tooth extraction, without peri-operative factor infusions. However, criteria for determining the necessity of factor infusions before minor surgeries are unknown. AIM We report the peri-operative hemostatic management and outcomes of emicizumab-treated PwHA and PwHA-I cases who underwent tooth extractions using our institutional protocol. METHODS We retrospectively evaluated PwHA and PwHA-I who underwent tooth extraction with emicizumab prophylaxis at our institution. Local bleeding risk was assessed based on the method, number, and site of tooth extraction. Hemostasis was monitored peri-operatively by rotational thromboelastometry (ROTEM). Hemostatic agents and a mouth splint were used. RESULTS Twenty-nine extractions (17 interventions) were performed in eight PwHA and two PwHA-I. Based on ROTEM, pre-operative factor infusions were used in ten PwHA and four PwHA-I interventions. Among nine low local bleeding risk interventions, three (33.3%) each received no infusions, one dose of factor infusion pre-operatively, and pre- and post-operative factor infusions. All eight high local bleeding risk interventions involved planned factor infusions. Absorbable hemostats were used in all extractions. A mouth splint was used in 21/25 (84.0%) PwHA and in 4/4 (100%) PwHA-I extractions. No post-extraction bleeding or thrombotic events occurred. CONCLUSIONS Use of a systemic hemostatic treatment plan according to the local bleeding risk, peri-operative coagulation status assessment using ROTEM, filling the extraction socket with hemostats, and use of a mouth splint can achieve effective and safe hemostatic management in emicizumab-treated PwHA and PwHA-I.
Collapse
Affiliation(s)
- Takahiro Yagyuu
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Shoko Furukawa
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Miki Zaizen
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Sachiko Yata
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Mitsuhiko Imada
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| |
Collapse
|
4
|
Kumbargere Nagraj S, Prashanti E, Aggarwal H, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S, Hassan H. Interventions for treating post-extraction bleeding. Cochrane Database Syst Rev 2018; 3:CD011930. [PMID: 29502332 PMCID: PMC6494262 DOI: 10.1002/14651858.cd011930.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. This is an update of a review published in June 2016. OBJECTIVES To assess the effects of interventions for treating different types of post-extraction bleeding. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 24 January 2018), Embase Ovid (1 May 2015 to 24 January 2018) and CINAHL EBSCO (1937 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We searched the reference lists of relevant systematic reviews. SELECTION CRITERIA We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment. DATA COLLECTION AND ANALYSIS Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis. MAIN RESULTS We did not find any randomised controlled trial suitable for inclusion in this review. AUTHORS' CONCLUSIONS We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).
Collapse
Affiliation(s)
- Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE), ManipalDepartment of Oral Medicine and Oral RadiologyJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Eachempati Prashanti
- Faculty of Dentistry, Melaka‐Manipal Medical College, (Manipal Academy of Higher Education)Department of ProsthodonticsJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Himanshi Aggarwal
- King George's Medical UniversityDepartment of ProsthodonticsKGMU CampusLucknowUttar PradeshIndia
| | - Ashok Lingappa
- Bapuji Dental College and HospitalOral Medicine & RadiologyDavangereKarnatakaIndia
| | - Murugan S Muthu
- Faculty of Dental Sciences, Sri Ramachandra UniversityPaediatric Dentistry2C Akme Park, Pedo PlanetPaediatric Dental Centre, OPP S&S POWER LTD,PorurChennaiIndia600116
| | - Salian Kiran Kumar Krishanappa
- Faculty of Dentistry, Melaka Manipal Medical College (Manipal Academy of Higher Education)Department of ProsthodonticsJalan Batu HamparMelakaMalaysia75150
| | - Haszelini Hassan
- International Islamic University MalaysiaDepartment of Oral Maxillofacial Surgery & Oral Diagnosis, Kulliyyah of DentistryKuala LumpurMalaysia
| | | |
Collapse
|
5
|
Reuter NG, Westgate PM, Ingram M, Miller CS. Death related to dental treatment: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:194-204.e10. [PMID: 27989710 DOI: 10.1016/j.oooo.2016.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to identify factors associated with death in relation to dental care. STUDY DESIGN A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Dental and Oral Sciences Source, Web of Science, and the Cochrane database were searched, and the references of all retrieved articles were analyzed. Studies were included if death had occurred within 90 days of the dental appointment, and if the patient's age, procedure, and information regarding cause or time of death were provided. Factors associated with death were assessed by multivariate analyses and logistic regression. RESULTS Fifty-six publications, including retrospective studies and case reports/series that reported 148 fatalities, were analyzed. On average, 2.6 deaths were reported per year. The leading cause of deaths was anesthesia/sedation/medication-related complications (n = 70). Other causes were cardiovascular events (n = 31), infection (n = 19), airway-respiratory complications (n = 18), bleeding (n = 5), and others (n = 5). Age (P < .0001), disease severity (P < .02), disease stability (P < .006), dental provider characteristics (P < .05), level of consciousness/sedation (P < .02), and drug effects (P < .03) had significant associations with death. CONCLUSIONS Reports of death were rare; however, specific risk factors associated with dentistry were identified. A better understanding of these factors is important for the development of guidelines that help prevent fatalities in dentistry.
Collapse
Affiliation(s)
- Nathan G Reuter
- Department of Oral Health Practice, University of Kentucky, Lexington, KY, USA
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Mark Ingram
- Medical Library, University of Kentucky, Lexington, KY, USA
| | - Craig S Miller
- Department of Oral Health Practice, University of Kentucky, Lexington, KY, USA; Center for Oral Health Research, College of Dentistry, and University of Kentucky, Lexington, KY, USA.
| |
Collapse
|
6
|
Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S. Interventions for treating post-extraction bleeding. Cochrane Database Syst Rev 2016:CD011930. [PMID: 27285450 DOI: 10.1002/14651858.cd011930.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. OBJECTIVES To assess the effects of interventions for treating different types of post-extraction bleeding. SEARCH METHODS We searched the following electronic databases: The Cochrane Oral Health Group Trials Register (to 22 March 2016); The Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, Issue 2); MEDLINE via OVID (1946 to 22 March 2016); CINAHL via EBSCO (1937 to 22 March 2016). Due to the ongoing Cochrane project to search EMBASE and add retrieved clinical trials to CENTRAL, we searched only the last 11 months of EMBASE via OVID (1 May 2015 to 22 March 2016). We placed no further restrictions on the language or date of publication. We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov), and the WHO Clinical Trials Registry Platform for ongoing trials (http://apps.who.int/trialsearch/default.aspx). We also checked the reference lists of excluded trials. SELECTION CRITERIA We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment. DATA COLLECTION AND ANALYSIS Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis. MAIN RESULTS We did not find any randomised controlled trial suitable for inclusion in this review. AUTHORS' CONCLUSIONS We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).
Collapse
Affiliation(s)
- Kumbargere N Sumanth
- Department of Oral Medicine & Oral Radiology, Faculty of Dentistry, Melaka-Manipal Medical College, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
| | | | | | | | | | | | | |
Collapse
|
7
|
Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Kiran Kumar Krishanappa S. Interventions for managing post-extraction bleeding. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
8
|
|
9
|
Nakajima K, Tagaya A, Otonari-Yamamoto M, Seki K, Araki K, Sano T, Okano T, Nakamura M. Composition of the blood supply in the sublingual and submandibular spaces and its relationship to the lateral lingual foramen of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:e32-8. [DOI: 10.1016/j.oooo.2012.03.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/12/2012] [Accepted: 03/24/2012] [Indexed: 10/27/2022]
|
10
|
Kawashima W, Hatake K, Morimura Y, Kudo R, Nakanishi M, Tamaki S, Kasuda S, Yuui K, Ishitani A. Asphyxial death related to postextraction hematoma in an elderly man. Forensic Sci Int 2013; 228:e47-9. [PMID: 23537717 DOI: 10.1016/j.forsciint.2013.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/08/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
We here report an autopsy case of a man in his seventies who died from asphyxia due to compression of the trachea caused by postextraction bleeding after extraction of his left mandibular third molar by a dentist in private practice. On the morning after the tooth extraction, he had complained of dyspnea and became unconscious at home. Although he was brought to the emergency room by ambulance, he died 7 days later without regaining consciousness. Autopsy examination revealed that the lingual side of the alveolar bone was fractured at the extraction socket. Moreover, subcutaneous bleeding that extended from the extraction socket to the thyrohyoid ligament in the cervical region and deviation of the epiglottis due to the bleeding were observed. Histological findings revealed liver cirrhosis; there were no significant findings in other organs. On the basis of these findings, we concluded that alveolar bone fracture occurred during the extraction and that the bleeding spread to the cervical region. Thus, the patient had died from asphyxia resulting from airway obstruction caused by cervical subcutaneous bleeding derived from postextraction bleeding. We emphasize that tooth extraction may cause fatal complications in patients with bleeding tendencies, particularly in the elderly.
Collapse
Affiliation(s)
- Wataru Kawashima
- Department of Legal Medicine, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
An increasing death rate as a result of violence constitutes a large group in medicolegal autopsies. Specially, deaths due to asphyxia are one of the most important causes in violence deaths. During the 21-year period from January 1984 to October 2004, there were 134 asphyxial deaths autopsied by the Department of Forensic Medicine, Trakya University, Edirne, Turkey. Asphyxial deaths comprise 15.7% of all forensic autopsies; 20.8% of the cases are aged between 30 and 39 years, and the average age was 41.9 years. Males constitute 79.8% of all the cases. The most frequent method of asphyxiation death is hanging (56 cases, 41.8%), followed by drowning (30.5%) and carbon monoxide poisoning (8.2%). More violent methods, such as ligature or manual strangulations, constitute 2.9% and 2.3% of all asphyxial deaths, respectively. Although it was varying according to the methods of asphyxiation, suicide was found to be the manner of death in the majority of the cases.
Collapse
Affiliation(s)
- Derya Azmak
- Department of Forensic Medicine, Trakya University, Medical Faculty, Edirne, Turkey
| |
Collapse
|
12
|
Reich W, Maurer P, Schubert J. [Intraoperative adverse events in minor oral surgery. Risk analysis]. MUND-, KIEFER- UND GESICHTSCHIRURGIE : MKG 2005; 9:369-76. [PMID: 16142458 DOI: 10.1007/s10006-005-0640-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY The aim of this prospective study was to evaluate oral surgical procedures performed as day surgery under local anesthesia. We examined patients' general condition, and besides checking for intraoperative complications we analyzed postoperative bleeding in patients with hemostatic disorders. PATIENTS The patient population consisted of 1540 patients (797 female, 743 male), who underwent a total of 2055 minor oral surgical procedures over a 5-year period (1998-2002). Before the treatment started a data file was made for each patient, which contained information on his or her past medical history, concomitant medication, why the operation was indicated, premedication, anesthetic and surgical techniques applied, and postoperative treatment. RESULTS Systemic pathologies influencing surgical decisions were found in 316 patients (20.5%), affecting 676 interventions (32.9%). In 109 patients (5.3% of the 2055) altered hemostasis was found. The surgical procedures recorded were: (operative) tooth extraction (n=394), interventions for surgical conservation of teeth (n=272), treatment for cysts (n=140), surgical revisions (n=46) and preprosthetic surgery (n=19). Passing complications, mostly systemic in nature, occurred during 27 sessions of local anesthesia (1.3%). There were 87 adverse events intraoperatively (4,2%), most of which were confined to the surgical field; specifically 15% of these complications took the form of hemorrhage. We observed no significant correlation between the occurrence of intraoperative complications and patients' gender, predisposing systemic pathologies including bleeding disorders, or age. Postoperative hemorrhage was observed significantly more frequently in patients with impaired hemostasis and required admission to hospital for inpatient treatment in 2 cases. CONCLUSION According to our investigation, oral surgery can be performed in patients with compromised general condition with as few intraoperative complications as in patients with no general medical problems. However, in individual cases specific risk factors can be present and oral surgery may be temporarily contraindicated, at least as day surgery.
Collapse
Affiliation(s)
- W Reich
- Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Saale.
| | | | | |
Collapse
|
13
|
Kalpidis CD, Konstantinidis AB. Critical Hemorrhage in the Floor of the Mouth During Implant Placement in the First Mandibular Premolar Position: A Case Report. IMPLANT DENT 2005; 14:117-24. [PMID: 15968182 DOI: 10.1097/01.id.0000165028.89434.99] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although dental implantation is considered to be a safe surgical procedure, this report focuses on a critical hemorrhaging episode associated with implant placement in the first mandibular premolar position. Excessive bleeding and formation of massive lingual, sublingual, and submandibular hematomas were the result of arterial trauma that occurred during the osteotomy preparation. The vascular injury was induced through a perforation of the lingual mandibular cortex. Critical bleeding was conservatively controlled and the case was further handled efficiently with an expectant airway management in a hospital environment. Similar case reports are reviewed in an attempt to draw attention to this rare but potentially life-endangering risk of implant dentistry. Common causes of severe hemorrhage in the floor of the mouth, anatomical considerations, bleeding control measures, and related airway issues are also discussed.
Collapse
Affiliation(s)
- Christos D Kalpidis
- Department of Periodontology, Preventive Dentistry and Implant Biology, Aristotle University School of Dentistry, Thessaloniki, Greece
| | | |
Collapse
|
14
|
Kalpidis CDR, Setayesh RM. Hemorrhaging Associated With Endosseous Implant Placement in the Anterior Mandible: A Review of the Literature. J Periodontol 2004; 75:631-45. [PMID: 15212344 DOI: 10.1902/jop.2004.75.5.631] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The placement of endosseous dental implants is largely considered a safe surgical procedure. However, upper airway obstruction secondary to severe bleeding in the floor of the mouth has been occasionally reported as a rare but potentially fatal complication of implant surgery. This review presents critical hemorrhagic episodes, related to dental implantation in the anterior segments of the mandible, published to date. Massive internal bleeding in the highly vascularized region of the floor of the mouth is the result of an arterial trauma induced by instrumentation, usually through a perforation of the lingual cortical plate. Depending on the clinical situation, hemorrhage may commence immediately or with some delay after the vascular insult. The progressively expanding lingual, sublingual, submandibular, and submental hematomas have the tendency of displacing the tongue and floor of the mouth to obstruct the airway. Because the course of airway deterioration to complete occlusion may be rapid, ensuring a patent airway is of highest priority. Even though upper airway obstruction is potentially life-threatening, a secure airway was successfully established in all patients without fatal consequences. In most cases, resolution of hemorrhage required a surgical intervention for ligation of the bleeding vessels and hematoma evacuation. To reduce the probability of such a grave complication, preventive and precautionary measures to be taken before, during, and after implant placement in the anterior mandible are presented. Issues related to the level of surgical experience, fine regional arterial anatomy, radiographic and clinical evaluation of the osseous morphology, angulation and length of implants, and timing of hemorrhage onset are discussed. In addition, airway and bleeding management strategies are provided.
Collapse
Affiliation(s)
- Christos D R Kalpidis
- Department of Periodontology and Oral Biology, Boston University, Goldman School of Dental Medicine, Boston, MA, USA.
| | | |
Collapse
|
15
|
|
16
|
Kaynar AM, Bhavani-Shankar K, Mushlin PS. Lingual hematoma as a potential cause of upper airway obstruction. Anesth Analg 1999; 89:1573-5. [PMID: 10589652 DOI: 10.1097/00000539-199912000-00050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A M Kaynar
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | | | | |
Collapse
|