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Papadiochos I, Strantzias P, Bourazani M, Derila A, Petsinis V. A "Tie-Over" Hemostatic Approach in Emergency Department: An Alternative Option for Recurrent Episodes of Postoperative Intraoral Hemorrhage. J Maxillofac Oral Surg 2024; 23:402-408. [PMID: 38601246 PMCID: PMC11001844 DOI: 10.1007/s12663-023-01983-8] [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: 04/07/2022] [Accepted: 07/23/2023] [Indexed: 04/12/2024] Open
Abstract
Objective This case series aimed to describe a hemostatic technique that has been applied in patients admitted to emergency department (ED) of a tertiary hospital due to recurrent episodes of intraoral hemorrhage (IOH) after various dentoalveolar operations. The "tie-over" approach involved the intraoral use of Xeroform® gauze (as compressive bolster dressing) and the oral rinsing with a liquid mixture of hemostatic agents. Materials and Methods Between February 1, 2014, and July 31, 2017, we retrospectively reviewed the medical data and records of patients in ED who chiefly complained about IOH. The inclusion criteria were cases secondary to dentoalveolar surgeries that have been exclusively treated by tie-over bolster approach. Data such as frequency and severity of hemorrhage episodes, pain, and discomfort were assessed pre- and postoperatively. Results The presented technique was applied in 23 patients, but 20 of them complied with follow-up evaluation. The mean age of those patients was 60.57 years (15-82 years) with a mean follow-up time of 5.05 days. Eighteen patients were taking antithrombotic medications, either per os (oral antiplatelets and anticoagulants-OAA group) or subcutaneously (heparin group). One patient from OAA group and 2 from heparin group experienced in total 4 bleeding events postoperatively. Three of those events were recorded as minimal (oozing) and did not last over 20 min. All the patients declared satisfaction about the non-bleeding oral status. Conclusions In addition to its compelling outcomes, we advocate that this approach conferred physiological benefits on patients who visited ED with symptoms of anxiety and malaise, secondary to multiple, lasting, or uncontrolled episodes of IOH related to extensive surgical trauma. The presence of the gauze intraorally was short-term and created minimal discomfort.
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Affiliation(s)
- Ioannis Papadiochos
- Clinic of Oro-Maxillofacial Surgery, “Attikon” University General Hospital of Athens, Chaidari, Greece
- OMFS Department, “Genimatas” Athens General Hospital, Athens, Greece
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Minervini G, Franco R, Marrapodi MM, Di Blasio M, Cicciù M, Ronsivalle V. The effectiveness of chitosan as a hemostatic in dentistry in patients with antiplatelet/anticoagulant therapy: systematic review with meta-analysis. BMC Oral Health 2024; 24:70. [PMID: 38200485 PMCID: PMC10782677 DOI: 10.1186/s12903-023-03568-w] [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: 09/25/2023] [Accepted: 10/23/2023] [Indexed: 01/12/2024] Open
Abstract
Hemorrhage control is a crucial aspect of dental procedures, and achieving efficient hemostasis remains a key challenge. The advent of hemostatic dressings has revolutionized the field of dentistry by providing effective and convenient solutions for managing bleeding in vari-ous dental scenarios. This article aims to provide an overview of hemostatic dressings, their mechanisms of action, and their diverse applications in dentistry. We applied the following Pop-ulation, Exposure, Comparator, and Outcomes (PICO) model to assess the document eligibility. A literature search was performed on major search engines, using keywords. At the end of the search, 3 articles were selected that matched the PICO. Three items were selected after the screen-ing process, and bleeding times were analyzed between the control group and the study group. The overall effect showed a substantial and statistically significant difference with bleeding time in favour of HDD-treated patients, showing that this garrison is very useful in controlling bleed-ing for patients taking anticoagulants and antiplatelets (Mean difference - 5.61; C.I. -5.70, - 5.52); Overall, hemostatic dressings have revolutionized the management of bleeding in dentistry, offering a promising solution to achieve optimal hemostasis, improve treatment outcomes, and enhance patient care, particularly Hemcon.
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Affiliation(s)
- Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Napoli, 81100, Italy
| | - Rocco Franco
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, 00100, Italy.
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, 80121, Italy.
| | - Marco Di Blasio
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Via Gramsci 14, Parma, Province of Parma, 43126, Italy.
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
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Mahardawi B, Jiaranuchart S, Arunjaroensuk S, Tompkins KA, Somboonsavatdee A, Pimkhaokham A. The effect of different hemostatic agents following dental extraction in patients under oral antithrombotic therapy: a network meta-analysis. Sci Rep 2023; 13:12519. [PMID: 37532770 PMCID: PMC10397210 DOI: 10.1038/s41598-023-39023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
This network meta-analysis was done to thoroughly evaluate the available literature on the use of different hemostatic agents for dental extraction in patients under oral antithrombotic therapy, aiming to identify the agent with the best/worst performance in bleeding control. Considering that such patients have a higher risk of bleeding, choosing the right hemostatic is essential. Twenty-three randomized clinical trials articles were included after completing the literature search. Cyanoacrylate tissue adhesive showed a reduction in the odds of postoperative bleeding events compared with conventional methods (i.e., gauze/cotton pressure, sutures), with a tendency toward a statistical significance (OR 0.03, P = 0.051). Tranexamic acid was the only agent that demonstrated a significantly lower risk of developing postoperative bleeding events (OR 0.27, P = 0.007). Interestingly, chitosan dental dressing and collagen plug had the shortest time to reach hemostasis. However, they ranked last among all hemostatic agents, regarding bleeding events, revealing higher odds than conventional measures. Therefore, it is concluded that the use of cyanoacrylate tissue adhesive and tranexamic acid gives favorable results in reducing postoperative bleeding events following dental extractions. Although chitosan dental dressing and collagen exhibited a faster time to reach hemostasis, they led to a higher occurrence of bleeding events.
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Affiliation(s)
- Basel Mahardawi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirimanas Jiaranuchart
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirida Arunjaroensuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Kevin A Tompkins
- Office of Research Affairs, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Anupap Somboonsavatdee
- Department of Statistics, Chulalongkorn Business School, Chulalongkorn University, Bangkok, Thailand
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand.
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Boccatonda A, Frisone A, Lorusso F, Bugea C, Di Carmine M, Schiavone C, Cocco G, D’Ardes D, Scarano A, Guagnano MT. Perioperative Management of Antithrombotic Therapy in Patients Who Undergo Dental Procedures: A Systematic Review of the Literature and Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5293. [PMID: 37047909 PMCID: PMC10093975 DOI: 10.3390/ijerph20075293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The surgical dental treatment of subjects admitted for anticoagulants therapy represents a consistent risk for peri-operative bleeding. The aim of the present study was to investigate the clinical findings of dental surgery operative management of the patients under anticoagulants drugs protocol. METHODS The literature screening was performed using Pubmed/Medline, EMBASE and Cochrane library, considering only randomized clinical trials (RCTs) papers. No limitations about the publication's period, follow-up time or clinical parameters were considered. RESULTS A total of eight RCTs were included for the qualitative synthesis. No thromboembolic complications were reported in any studies. Several bleeding episodes associated with anticoagulant drugs in dental surgery were mild and generally happened on the first day after the treatment. CONCLUSIONS The use of local haemostatic measures is generally effective for bleeding control with no further pharmacological drug management or suspension.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy
| | - Alessio Frisone
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Calogero Bugea
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Maristella Di Carmine
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Giulio Cocco
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Damiano D’Ardes
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
- Department of Oral Implantology, Dental Research Division, College Ingà, UNINGÁ, Cachoeiro de Itapemirim 29312, ES, Brazil
| | - Maria Teresa Guagnano
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
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Pan J, Xue Y, Zhao J, Zhou Q, Zou D, Chen S, Han B, Cui N, Liu X, Wang L, Hu K. Experts' consensus on perioperative management of tooth extractions in patients receiving oral antithrombotic treatment. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2022; 40:255-263. [PMID: 38597004 PMCID: PMC9207789 DOI: 10.7518/hxkq.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/15/2022] [Indexed: 04/11/2024]
Abstract
Thromboembolic diseases, which comprise venous thromboembolic diseases and arterial thromboembolic diseases, have become the number one cause of death worldwide. To prevent or treat thrombosis, patients with thromboembolic diseases need to take antithrombotic drugs, which would increase the risk of bleeding during and after surgery. Tooth extraction is the most common operation in oral and maxillofacial surgery clinics. Although patients given oral antithrombotic drugs do not need to undergo drug withdrawal, the perioperative management of such patients remains confusing to most clinicians. Moreover, the potential risk factors for bleeding warrant further study. To improve the clinicians' knowledge of perioperative management for patients subjected to tooth extractions with oral antithrombotic drugs, experts have drafted this consensus focusing on preoperative bleeding risk assessment, intraoperative operating norms, and postoperative care to summarize the points needing attention.
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Affiliation(s)
- Jian Pan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yang Xue
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases & Dept. of Oral Surgery, School of Stomatology, Fourth Military Medical University, Xi'an 710032, China
| | - Jihong Zhao
- Dept. of Oral Surgery, Hospital of Stomatology, Wuhan University, Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan 430079, China
| | - Qing Zhou
- Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang 110001, China
| | - Duohong Zou
- Dept. of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Songling Chen
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Bing Han
- Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Nianhui Cui
- Dept. of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & National Health Commission Research Center of Engineering and Technology for Computerized Dentistry & National Medical Products Administration Key Laboratory for Dental Materials, Beijing 100081, China
| | - Xian Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Liao Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Kaijin Hu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases & Dept. of Oral Surgery, School of Stomatology, Fourth Military Medical University, Xi'an 710032, China
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Elsabahy M, Hamad MA. Design and Preclinical Evaluation of Chitosan/Kaolin Nanocomposites with Enhanced Hemostatic Efficiency. Mar Drugs 2021; 19:md19020050. [PMID: 33499020 PMCID: PMC7911196 DOI: 10.3390/md19020050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
In the current study, hemostatic compositions including a combination of chitosan and kaolin have been developed. Chitosan is a marine polysaccharide derived from chitins, a structural component in the shells of crustaceans. Both chitosan and kaolin have the ability to mediate a quick and efficient hemostatic effect following immediate application to injury sites, and thus they have been widely exploited in manufacturing of hemostatic composites. By combining more than one hemostatic agent (i.e., chitosan and kaolin) that act via more than one mechanism, and by utilizing different nanotechnology-based approaches to enhance the surface areas, the capability of the dressing to control bleeding was improved, in terms of amount of blood loss and time to hemostasis. The nanotechnology-based approaches utilized to enhance the effective surface area of the hemostatic agents included the use of Pluronic nanoparticles, and deposition of chitosan micro- and nano-fibers onto the carrier. The developed composites effectively controlled bleeding and significantly improved hemostasis and survival rates in two animal models, rats and rabbits, compared to conventional dressings and QuikClot® Combat Gauze. The composites were well-tolerated as demonstrated by their in vivo biocompatibility and absence of clinical and biochemical changes in the laboratory animals after application of the dressings.
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Affiliation(s)
- Mahmoud Elsabahy
- Science Academy, Badr University in Cairo (BUC), Cairo 11829, Egypt
- Science Park, Misr University for Science and Technology, Giza 12566, Egypt
- Correspondence: (M.E.); (M.A.H.); Tel.: +20-1000607466 (M.E.); +20-1222438186 (M.A.H.)
| | - Mostafa A. Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Correspondence: (M.E.); (M.A.H.); Tel.: +20-1000607466 (M.E.); +20-1222438186 (M.A.H.)
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Jones M, Kujundzic M, John S, Bismarck A. Crab vs. Mushroom: A Review of Crustacean and Fungal Chitin in Wound Treatment. Mar Drugs 2020; 18:E64. [PMID: 31963764 PMCID: PMC7024172 DOI: 10.3390/md18010064] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/13/2022] Open
Abstract
Chitin and its derivative chitosan are popular constituents in wound-treatment technologies due to their nanoscale fibrous morphology and attractive biomedical properties that accelerate healing and reduce scarring. These abundant natural polymers found in arthropod exoskeletons and fungal cell walls affect almost every phase of the healing process, acting as hemostatic and antibacterial agents that also support cell proliferation and attachment. However, key differences exist in the structure, properties, processing, and associated polymers of fungal and arthropod chitin, affecting their respective application to wound treatment. High purity crustacean-derived chitin and chitosan have been widely investigated for wound-treatment applications, with research incorporating chemically modified chitosan derivatives and advanced nanocomposite dressings utilizing biocompatible additives, such as natural polysaccharides, mineral clays, and metal nanoparticles used to achieve excellent mechanical and biomedical properties. Conversely, fungi-derived chitin is covalently decorated with -glucan and has received less research interest despite its mass production potential, simple extraction process, variations in chitin and associated polymer content, and the established healing properties of fungal exopolysaccharides. This review investigates the proven biomedical properties of both fungal- and crustacean-derived chitin and chitosan, their healing mechanisms, and their potential to advance modern wound-treatment methods through further research and practical application.
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Affiliation(s)
- Mitchell Jones
- School of Engineering, RMIT University, Bundoora East Campus, P.O. Box 71, Bundoora VIC 3083, Australia
| | - Marina Kujundzic
- Institute of Material Chemistry and Research, Polymer and Composite Engineering (PaCE) Group, Faculty of Chemistry, University of Vienna, Währinger Straße 42, 1090 Vienna, Austria
| | - Sabu John
- School of Engineering, RMIT University, Bundoora East Campus, P.O. Box 71, Bundoora VIC 3083, Australia
| | - Alexander Bismarck
- Institute of Material Chemistry and Research, Polymer and Composite Engineering (PaCE) Group, Faculty of Chemistry, University of Vienna, Währinger Straße 42, 1090 Vienna, Austria
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Effectiveness of local hemostatic measures after tooth extraction in patients on antithrombotic therapy. Clin Oral Investig 2019; 24:515. [PMID: 31673856 DOI: 10.1007/s00784-019-03080-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
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Anticoagulation Use prior to Common Dental Procedures: A Systematic Review. Cardiol Res Pract 2019; 2019:9308631. [PMID: 31275643 PMCID: PMC6589257 DOI: 10.1155/2019/9308631] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/28/2019] [Accepted: 05/09/2019] [Indexed: 11/27/2022] Open
Abstract
Currently, the number of patients on oral anticoagulation is increasing. There is a paucity of data regarding maintaining oral anticoagulation (especially novel oral anticoagulants) around the time of specific dental procedures. A dentist has three options: either to stop anticoagulation, to continue it, or to bridge with heparin. A systematic review of 10 clinical trials was conducted to address this issue. It was found that continuing anticoagulation during dental procedures did not increase the risk of bleeding in most trials. Although none of the studies reported a thromboembolic event after interruption of anticoagulation, the follow-up periods were short and inconsistent, and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature. Heparin bridging was associated with an increased bleeding incidence. We recommend maintaining oral anticoagulation with vitamin K antagonists and novel oral anticoagulants for the vast majority of dental procedures along with the use of local hemostatic agents.
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Marini L, Rojas MA, Sahrmann P, Aghazada R, Pilloni A. Early Wound Healing Score: a system to evaluate the early healing of periodontal soft tissue wounds. J Periodontal Implant Sci 2018; 48:274-283. [PMID: 30405935 PMCID: PMC6207797 DOI: 10.5051/jpis.2018.48.5.274] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/21/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose Numerous indices have been proposed to analyse wound healing in oral soft tissues, but each has specific shortcomings. A new method of analysis, the Early Wound Healing Score (EHS), was evaluated in the present study. The aim was to assess more accurately early healing by primary intention of surgical incisions in periodontal soft tissues. Methods Twenty-one patients were treated with different surgical procedures comprising 1 or 2 vertical releasing incisions as part of a surgical access flap. Twenty-four hours after surgery, early wound healing at the vertical releasing incisions was assessed using the EHS. This score assessed clinical signs of re-epithelialization (CSR), clinical signs of haemostasis (CSH), and clinical signs of inflammation (CSI). Since complete wound epithelialization was the main outcome, the CSR score was weighted to be 60% of the total final score. Accordingly, a score of 0, 3, or 6 points was possible for the assessment of CSR, whereas scores of 0, 1, or 2 points were possible for CSH and CSI. Higher values indicated better healing. Accordingly, the score for ideal early wound healing was 10. Results Thirty vertical releasing incisions were assessed in 21 patients. At 24 hours after incision, 16 vertical releasing incisions (53.33%) received the maximum score of CSR, while 6 cases (20%) received an EHS of 10. None of the cases received 0 points. Conclusion The EHS system may be a useful tool for assessing early wound healing in periodontal soft tissue by primary intention after surgery.
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Affiliation(s)
- Lorenzo Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Mariana Andrea Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Philipp Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Rustam Aghazada
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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