The role of hemostatic agents after tooth extractions: A systematic review and meta-analysis

Perioperative/Periprocedural Antithrombotic Management in Oral Health Procedures. A Prospective Observational Study

Background/Objectives: This paper evaluates the incidence of thrombotic and/or hemorrhagic adverse events within 30 days after oral health procedures (OHPs) in patients taking antithrombotic agents. Secondary objectives were to determine proper antithrombotic management and its association with adverse events. Methods: As part of a multicenter multispecialty prospective observational study (ReQXAA), individuals with antithrombotic therapy and receiving at least one OHP were selected. Before OHP, participants were referred to their medical doctors to indicate the antithrombotic therapy management. Adverse events were evaluated thirty days after OHP by phone call. Proportions and odds ratios (ORs) were generated applying Fisher's exact test, chi-square tests and multiple regression models. Results: A total of 138 patients underwent 144 OHPs. Fifteen adverse events (10.5%) were registered, among which the most frequent was slight bleeding (n = 13), which was followed by bleeding that required suspension of the antithrombotic agent (n = 1) and a myocardial infarction (n = 1). Antithrombotic management was appropriate in 122 (84.7%) cases. In 15.3% of the cases it was inappropriate, the main reason being the unnecessary interruption of the antithrombotic medication (n = 11; 50%). Inadequate management was associated with a higher incidence of adverse events (OR = 4.7; 95% confidence interval [1.3, 16.3]; p = 0.016) after adjusting for confounding factors. Conclusions: The incidence of adverse events 30 days after OHPs was low (10.5%). An inappropriate perioperative/periprocedural antithrombotic management occurred in 15.3% of the cases and was associated with a higher incidence of adverse events (OR = 4.7).

The quantified method for blood clot detection in the extraction socket

Background

Currently, there is no objective and quantified measurement for detecting blood clots during extraction socket hemostasis. It has relied solely on clinical observation, even when conducting clinical research by using extraction sockets as samples. This study aimed to assess the in vitro reliability and clinical-relevant validity of a new objective measurement providing quantified data called blood clot detection (BCD) using a standard capillary tube.

Methods

The in vitro part of the study was conducted using surplus blood samples from ten healthy participants. Two identical sets of blood samples in simulation reservoirs mimicking bleeding sockets were prepared for reliability tests. Then, the capillary tubes were concurrently placed in the reservoirs. The blood-filled distances were measured. The part of clinical-relevant validity study was conducted in sixteen extraction sockets from each healthy participant. Clinical observation and BCD measurement were evaluated by two calibrated assessors. The total duration of the assessment was a 30-minute.

Results

The distances of the blood-filled capillary tube were decreased by time. Test and retest reliability analysis of the BCD measurement showed an excellent intraclass correlation coefficient of 0.980 (0.968 to 0.988). The medians of blood-filled distance categorized by clinical observation into active bleeding, sluggish oozing, and clot formation were 13.0 mm (Q1 = 11.7, Q3 = 13.8), 5.6 mm (Q1 = 4.3, Q3 = 7.0), and 0.9 mm (Q1 = 0.5, Q3 = 1.3), respectively. The blood-filled distance of the clot formation group was significantly less than the active bleeding and sluggish oozing (p<0.001). Therefore, the BCD measurement also significantly indicated the completion of extraction socket hemostasis.

Conclusions

A distance of blood-filled in capillary tube of 0.9 mm from the BCD measurement significantly ensured complete clot formation. The BCD measurement proved to be a quantified tool for objectively measuring hemostasis of bleeding socket.

Hemostasis and Gingival Healing-Polyurethane Adhesive Postextraction Under Rivaroxaban Therapy in a Rodent Model

Objectives: At 31%, the risk of postoperative bleeding after tooth extraction is particularly high in patients who receive rivaroxaban therapy. The aim of this rodent study was to compare the hemostyptic properties and gingival healing between novel polyurethane-based adhesive VIVO and gelatin sponge (GESP) under ongoing rivaroxaban therapy over a period of 10 days. Materials: In total, 120 extractions of the first upper molar were proceeded in rodents treated with rivaroxaban. Of these, 60 postextraction sites were treated with VIVO and 60 with GESP. The duration of the surgical procedure and the clinical parameters of postoperative bleeding and wound evaluation score were recorded. In vivo fluorescence imaging and laser Doppler flowmetry and tissue spectrophotometry (LDF-TS) were performed. Results: GESP provided a faster procedure at 1:06 ± 0:17 min, but postoperative bleeding time was significantly shorter in VIVO sockets at 1:39 ± 0:03 min. Nonsignificant mild bleeding events and comparable wound evaluation scores were recorded in both treatments. LDF-TS showed a significant increase in mean oxygen saturation SO2 (%) and mean blood flow (AU) for both treatments. Only GESP showed a significant increase in relative hemoglobin (rHb). Conclusion: In the context of a rodent study, VIVO showed favorable hemostasis and promising gingival healing properties postextraction under ongoing rivaroxaban therapy.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives.

Antimicrobial and Hemostatic Diatom Biosilica Composite Sponge

The 3D nanopatterned silica shells of diatoms have gained attention as drug delivery vehicles because of their high porosity, extensive surface area, and compatibility with living organisms. Tooth extraction may result in various complications, including impaired blood clotting, desiccation of the root canal, and infection. Therapeutic sponges that possess multiple properties, such as the ability to stop bleeding and kill bacteria, provide numerous advantages for the healing of the area where a tooth has been removed. This study involved the fabrication of a composite material with antibacterial and hemostatic properties for dental extraction sponges. We achieved this by utilizing the porous nature and hemostatic capabilities of diatom biosilica. The antibiotic used was doxycycline. The gelatin-based diatom biosilica composite with antibiotics had the ability to prevent bleeding and release the antibiotic over a longer time compared to gelatin sponge. These properties indicate its potential as a highly promising medical device for facilitating rapid healing following tooth extraction.

Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis

OBJECTIVE

Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery.

MATERIALS AND METHODS

Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023.

RESULTS

Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively.

CONCLUSIONS

The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports.

CLINICAL RELEVANCE

The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

The effect of different hemostatic agents following dental extraction in patients under oral antithrombotic therapy: a network meta-analysis

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.