Bacci Christian, Cerrato Alessia, Zanette Gastone, Pasca Samantha, Zanon Ezio
Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy.
Department of Cardiac Thoracic and Vascular Sciences, Haemophilia Centre Unit of Coagulopathies, University Hospital of Padua, Padua, Italy.
TH Open. 2021 Mar 16;5(1):e104-e106. doi: 10.1055/s-0041-1722866. eCollection 2021 Jan.
This study aimed to describe the first case of regenerative surgery in haemophiliac implant. Patients with haemophilia often present dental problems. A multidisciplinary approach is suggested in case of dental surgeries to reduce the high bleeding risk. A 41-year-old male patient with mild haemophilia A (FVIII 8.4%), presenting previous epistaxis, noncomplicated tooth extractions and traumatic haemartroses, all treated with single infusions of coagulation factor concentrates, was referred to the dental clinic of the Padua University Hospital based on the recommendation of his attending dentist. At first dental visit the patient reported intense pain in the right lower second molar, with impaired chewing function. After an endodontic unsuccessful treatment the element was judged as no longer recoverable. In agreement with the patient the dental element was then extracted, after a combined administration of recombinant factor VIII 3000 IU (35 IU/kg), and tranexamic acid 1,000 mg. The extraction was performed under local anaesthesia, paraperiosteal and truncular, moderate sedation, elevation of an envelope flap. After extraction, a preservation of the alveolus was carried out with bovine matrix bone graft covered with a resorbable membrane. Three months after the surgery a flapless implant was placed after a single infusion of factor VIII 2000 IU, tranexamic acid 1,000 mg, and a local para-periostal anaesthesia, without any complication. Oral surgeon and haematologist expert in coagulation diseases must therefore collaborate together to define a shared protocol for managing surgery in those patients.
本研究旨在描述血友病患者植入物再生手术的首例病例。血友病患者常出现牙齿问题。对于牙科手术，建议采用多学科方法以降低高出血风险。一名41岁男性患者，患有轻度甲型血友病（FVIII 8.4%），既往有鼻出血、无并发症的拔牙及创伤性血肿病史，均通过单次输注凝血因子浓缩物进行治疗，根据其主治牙医的建议，转诊至帕多瓦大学医院牙科诊所。首次牙科就诊时，患者报告右下第二磨牙剧痛，咀嚼功能受损。在牙髓治疗失败后，该牙齿被判定无法恢复。经与患者协商，在联合给予重组因子VIII 3000 IU（35 IU/kg）和氨甲环酸1000 mg后，拔除了该牙齿。拔牙在局部麻醉（骨膜下和干槽）、中度镇静、掀起信封式皮瓣的情况下进行。拔牙后，用牛基质骨移植覆盖可吸收膜对牙槽窝进行了保存。术后三个月，在单次输注因子VIII 2000 IU、氨甲环酸1000 mg及局部骨膜下麻醉后，植入了一枚无瓣种植体，未出现任何并发症。因此，口腔外科医生和凝血疾病血液学专家必须共同协作，为这些患者制定共同的手术管理方案。
