Risk of dentoalveolar surgery postoperative bleeding in patients taking direct oral anticoagulants and vitamin K antagonists: A prospective observational study

The aim of this study was to evaluate whether direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA) increase the risk of postoperative bleeding after dentoalveolar surgery. Patients were classified into two groups: one taking DOAC and the other taking VKA with a therapeutic INR range. The control group comprised non-anticoagulated subjects. Participants were matched regarding dentoalveolar procedure. The primary predictor was anticoagulant status. The primary outcome was postoperative bleeding. The DOAC group comprised 77 patients, while the VKA group and control group each consisted of 103 participants. In each group, 103 dentoalveolar surgical procedures were conducted. Postoperative bleeding was recorded in 3/103 (2.9%), 5/103 (4.8%), and 1/103 (0.97%) occasions in the DOAC, VKA, and control groups, respectively, without significant difference (χ2; p = 0.54). The fully adjusted odds ratio for postoperative bleeding was 0.14 (CI 0.01-1.61; p = 0.05) for patients taking DOAC and 0.19 (CI 0.02-1.65; p = 0.285) for those taking VKA compared with non-anticoagulated controls. In conclusion, there was no increase in risk for clinically significant postoperative bleeding after dentoalveolar surgery in patients taking DOAC or VKA compared with non-anticoagulated subjects. Dentoalveolar surgery in patients taking DOAC and VKA can be performed safely without therapy cessation. The study was registered at Clinicaltrials.gov (NCT04505475).

Biocompatibility of mesoporous SBA-16/hydroxyapatite nanocomposite and dentin demineralized particles on human dental pulp stem cells

In the present work, a biomaterial (SBA-16/HA) based on the growth of hydroxyapatite (HA) particles within an organized silica structure SBA-16 (Santa Barbara Amorphous-16) was developed to evaluate its application to act as a porous microenvironment promoting attachment and viability of human dental pulp stem cells of healthy deciduous teeth (SHED). First, SHED were isolated and their phenotypes were evaluated by flow cytometry. The samples of SBA-16/HA were characterized by X-ray diffraction (XRD), small and wide angle X-ray scattering (SWAXS), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM) equipped with energy dispersive spectra detector (EDS). Afterward, cells were cultured in the eluates of the above-mentioned biomaterial aged for 24 hr, 7. and 14 days. Bio-Oss® and dentin particles are involved for comparison and cells are cultured in the eluates of these two materials also. Thiazolyl Blue Tetrazolium bromide assay-MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide assay) was used for the determination of cell viability. The results obtained by all aforementioned characterization methods of SBA-16/HA, revealed a uniform spherical mesoporous structure, an intrinsic characteristic of this material. This material displayed excellent biocompatibility on SHEDs, and even proliferative potential, indicating that SBA-16/HA could potentially serve as a suitable substrate for bone regeneration. Contrary to SBA-16/HA, dentin particles showed low cytotoxicity at all time points, compared to control and Bio-Oss®groups. Our results substantiate the idea that SBA-16/HA has a beneficial effect on SHEDs, thus paving the way toward developing new material for bone replacement.

Scanning electron microscopy analysis of marginal adaptation of mineral trioxide aggregate, tricalcium silicate cement, and dental amalgam as a root end filling materials

The aim of this research was to examine marginal adaptation of three root end filling materials mineral trioxide aggregate (MTA), Biodentine and amalgam. Ninety single-rooted extracted human teeth of the maxillary intercanine sector were used in the study. After the endodontic treatment and retrograde preparation, teeth were divided into three groups, depending on the root-end filling material. Teeth were cut in longitudinal manner. Measurements of the total width of the marginal gap in micrometers were performed using scanning electron microscopy. The results showed that MTA and Biodentine have better marginal adaptation compared to amalgam expressed through the mean value of the measured edge crack, however without significant difference (p > .05). Mean value of the measured edge crack in Group 1 (MTA) was 8.17 μm, in Group 2 (Biodentine) 8.53 μm, and in Group 3 (amalgam) 9.13 μm. All tested materials show a satisfactory degree of marginal adaptation, but MTA and Biodentine proved to be superior to amalgam.

Multidisciplinary Treatment of Complicated Crown-Root Fractures: A Case Study

Traumatic dental injuries usually occur among children and adolescents, with maxillary central incisors as the most often affected teeth. Complicated crown-root fractures are particularly challenging for esthetic and functional rehabilitation and often require a multidisciplinary approach. A 21-year-old male patient came to the Dental Clinic due to fractured maxillary incisors caused by trauma during a sporting activity. Clinical examination revealed horizontal fractures of teeth 7, 8, and 9, initiating in the labial cervical third and extending subgingivally on the palate, with exposed pulp tissues. On provisional repositioning and splinting the fragments, root canal treatment was performed. Definitive repositioning was accomplished by raising a full-thickness gingival flap, using fiber-reinforced composite posts, by an endodontist and an oral surgeon. Reattachment was accomplished under surgical conditions to ensure precise positioning of fragments by exposing the palatal aspect of the fracture lines and providing a dry operating field. Definitive composite resin veneers were performed after seven days.

Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial?

The aim of this study was to investigate the safety of local infiltration techniques and the inferior alveolar nerve block (IANB) in dental patients taking oral anticoagulants. A total of 352 patients were given a total of 560 injections of local anaesthetic (119 IANB and 441 others). The study group comprised 279 patients with therapeutic international normalised ratios (INRs), and the control group 73 patients who were taking oral anticoagulants but had subtherapeutic INR on the day of operation. Blood was aspirated 7 times (7.3%) during the IANB in the study group. However, there were no clinical signs of prolonged haemorrhage into the medial pterygoid muscle or pterygomandibular space after 96 IANB, including those from whom blood had been aspirated. Only two minor haematomas developed after multiple infiltrations in the lingual sulci. The results suggest that bleeding as a result of the use of local anaesthesia in patients with therapeutic INR is unlikely, provided that the IANB is done correctly.