Miranda M, Bollero P, D'Ovidio N, Marsango V, Barlattani A
Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.
Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Oral Implantol (Rome). 2014 Dec 27;7(2):51-6. eCollection 2014 Apr-Jun.
This work aims to assess the risks both thromboembolic that bleeding of a management protocol "non-conservative" in patients on oral anticoagulant therapy (OAT) to be undergoing implant surgery.
We decided to take a surgical "non-conservative" protocol, to insert four implants in the aesthetic zone, without using flapless surgery and the surgical template. In accordance with the hematologist, the value of INR is lowered and warfarin was replaced with heparin low molecular weight, to have a better coagulation's control.
The modern guidelines impose a protocol of conservative management in patients with OAT, with minimally invasive surgery, flapless, and use of surgical template to reduce the risk of uncontrolled bleeding. This, thanks to the team-work between dentist and hematologist, thanks to careful adjustment of INR and the use of local haemostatic agents, were not encountered any problems with bleeding or intra or postoperative.
Surgical treatment of patients with OAT is a real problem for the oral surgeon, to treat every time in association with the hematologist. Applying this type of surgical procedure, different from today's guidelines, in our experience there were no post-operative complications (bleeding or bleeding); osseointegration has not been compromised and the prosthetic rehabilitation was completed successfully.
本研究旨在评估接受植入手术的口服抗凝治疗(OAT)患者采用“非保守”治疗方案时发生血栓栓塞和出血的风险。
我们决定采用手术“非保守”方案,在美学区域植入4颗种植体,不采用无瓣手术和手术模板。根据血液科医生的建议,降低国际标准化比值(INR)的值,并用低分子肝素替代华法林,以更好地控制凝血。
现代指南要求对OAT患者采用保守治疗方案,进行微创手术、无瓣手术并使用手术模板,以降低出血失控的风险。由于牙医和血液科医生之间的团队合作,以及对INR的仔细调整和局部止血剂的使用,术中及术后均未出现出血问题。
对于口腔外科医生而言,OAT患者的手术治疗是一个实际问题,每次治疗都需要与血液科医生合作。应用这种与当今指南不同的手术方法,根据我们的经验,术后未出现并发症(出血或渗血);骨整合未受影响,义齿修复成功完成。