Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India.
Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India.
J Craniomaxillofac Surg. 2023 May;51(5):316-320. doi: 10.1016/j.jcms.2023.05.003. Epub 2023 May 23.
Dental extraction in hemophiliacs can be complicated by perilous bleeding. Although developments in local hemostatics and factor replacement have made outpatient extraction feasible, there is no standard protocol for preventing hemorrhagic exigency. Low-level laser therapy (LLLT) has firmly established role in hemostasis due to its ability to seal vessels, but this function has not been conclusively established in hemophiliac patients. The objective of our study was to evaluate the effectiveness of LLLT as compared with the standard protocol alone in achieving post-extraction hemostasis. A prospective interventional cohort study was designed and consisted of 60 patients with hemophilia A or B, who reported to the Maulana Azad Institute of Dental Sciences, New Delhi between October 2021 and March 2022. These were divided equally into test and control groups, both following the standard protocol. In the test group, extraction sockets were exposed to LLLT. The study assessed time required, instance of rebleeding, and additional methods employed for hemostasis in each group. The results showed a 22.42% reduction in average time taken to achieve hemostasis in the test group as compared with the control group. The tranexamic acid pack was replaced in two cases in both groups after 60 min of procedure. Three cases in the control group required suturing, and one case required cauterization. Rebleeding occurred in four cases in the test group and in 13 cases among the controls. Postoperative factor was infused in three and 12 cases in the test and control groups, respectively. The authors believe that perioperative use of LLLT should be encouraged because it demonstrated a significantly reduced time for hemostasis among hemophilia patients.
在血友病患者中进行拔牙可能会导致危险的出血。尽管局部止血和因子替代的发展使得门诊拔牙成为可能，但目前还没有预防出血急症的标准方案。由于能够封闭血管，低水平激光疗法（LLLT）在止血方面已经确立了牢固的地位，但在血友病患者中，其这一功能尚未得到明确证实。我们的研究目的是评估与单独使用标准方案相比，LLLT 在实现拔牙后止血方面的效果。设计了一项前瞻性干预性队列研究，纳入了 2021 年 10 月至 2022 年 3 月期间在新德里 Maulana Azad 牙科科学研究所就诊的 60 名血友病 A 或 B 患者，将其分为实验组和对照组，两组均采用标准方案。实验组的拔牙窝暴露于 LLLT 下。该研究评估了每组所需的时间、再出血的情况以及为止血而采用的其他方法。结果显示，实验组平均止血时间比对照组缩短了 22.42%。两组中各有 2 例在 60 分钟后更换了氨甲环酸包。对照组中有 3 例需要缝合，1 例需要烧灼。实验组中有 4 例出现再出血，对照组中有 13 例。实验组中有 3 例和对照组中有 12 例在术后输注了凝血因子。作者认为，应鼓励围手术期使用 LLLT，因为它可显著缩短血友病患者的止血时间。
