Is L-PRF an effective hemostatic agent in single tooth extractions? A cohort study on VKA and DOAC patients

Objectives: The aim of this clinical observational study was to assess the efficacy of L-PRF as a hemostatic agent in patients under treatment with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Materials and methods: Patients under oral anticoagulant therapy (VKA or DOACs) who needed a single simple tooth extraction were enrolled. L-PRF plug was positioned inside the alveolus and secured with non-absorbable sutures. Surgical time, pain-VAS, paracetamol intake, intra-operative, post-operative biological complications, and bleeding events have been registered. Results: A total of 112 patients (59 patients for DOAC and 53 for VKA group) were enrolled. Post-operative bleeding was recorded in nine patients (17%) for VKA group and nine patients (15.3%) for DOACs group. None of the patients needed a medical support for managing of bleeding. Seven days after surgery, no cases of post-extractive complications occurred. Conclusions: The use of L-PRF resulted in limited mild late post-operative bleedings without the need of medical intervention. Clinical relevance: The use of L-PRF can be adopted for an uneventful post-operative curse in anticoagulated patients without chasing their therapy for single tooth extraction

Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study

Objectives: The aim of this prospective comparative clinical study was to evaluate the effect of oral anticoagulants on peri- and post-operative bleeding during simple single tooth extractions, comparing patients in treatment with vitamin K antagonists (VKAs) and patients assuming direct oral anticoagulants (DOACs). Materials and methods: Patients under oral anticoagulant therapy needing dental extraction were eligible for entering the study; patients were enrolled following inclusion and exclusion criteria and divided into VKAs and DOAC group according to the anticoagulation therapy. Included patients underwent a simple single dental extraction with elevators and forceps with a maximum surgical time of 15 minutes, without anticoagulation therapy discontinuation. All participants were assessed pre-operatively, during surgery, 30 min minutes and 7 days after surgery. Biological complications were registered and post-extraction bleeding was clinically defined according to Iwabuchi classification. Parametric and non-parametric tests were used to evaluate the variables between the groups. Results: Sixty-five patients per group were enrolled and 130 teeth were extracted. The two groups were comparable for pre-, peri-, and post-operative variables. Only 1 patient of DOAC group and 2 patients for VKA group needed medical evaluation for post-extractive bleeding. No statistically significant difference resulted in post-operative bleeding events between the groups (p = 0.425). Conclusions: DOAC and VKA patients showed the same incidence of bleeding complications after simple single tooth extraction. Bleeding events were not statistically significant and not clinically relevant. Clinical relevance: Patients assuming DOACs can be treated similarly to patients in VKAs therapy with INR index between 2 and 3. Non-ceasing of DOAC therapy seems to be appropriate for simple single dental extractions. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature

Gingival overgrowth caused by Olmesartan Medoxomil: Observational study

Objective: Olmesartan Medoxomil is a type 1 receptor antagonist an antagonist of type 1 receptor (AT1) of angiotensin II (A-II) that inhibits numerous actions of A-II in the renin-angiotensin-aldosterone system (RAAS). A-II is a significant and multifunctional peptide involved in the pathophysiology of blood hypertension and for this reason it represents the main target in several classes of drugs used to treat and control arterial hypertension, such as angiotensin converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARB) and renin direct inhibitors. The aim of the study is to evaluate whether the two drugs that have as an active principle Olmesartan Medoxomil, with and without the diuretic hydrochlorothiazide, are able to determine gingival overgrowth. Study Design: 108 subjects were examined and divided into three groups: G1, subjects treated with Olmesartan Medoxomil and hydrochlorothiazide (n=60); G2, subjects received only Olmesartan Medoxomil (n=24); G3, control group without pharmacological therapies (n=24). The plaque index (IP) and the gingival overgrowth index (OI) were recorded, considering the vertical and horizontal components. Results: Vertical overgrowth averaged between 0.17 \ub1 0.15 (G3) and 0.34 \ub1 0.26 (G2) showing statistically significant differences (p <0.05) compared to the other groups. Horizontal overgrowth ranged from 0.18 \ub1 0.26 (G3) to 0.49 \ub1 0.35 (G2) showing statistically significant differences (p <0.05). Conclusions: antihypertensive agents as Olmesartan Medoxomil may result in mild gingival overgrowth in the upper and lower frontal dental elements not related to other etiological factors

Chairside CAD/CAM Materials: Current Trends of Clinical Uses

Restorative materials are experiencing an extensive upgrade thanks to the use of chair- side Computer-aided design/computer-assisted manufacturing (CAD/CAM) restorations. There- fore, due to the variety offered in the market, choosing the best material could be puzzling for the practitioner. The clinical outcome of the restoration is influenced mainly by the material and its handling than by the fabrication process (i.e., CAD/CAM). Information on the restorative materials performances can be difficult to gather and compare. The aim of this article is to provide an over- view of chairside CAD/CAM materials, their classification, and clinically relevant aspects that en- able the reader to select the most appropriate material for predictable success

Influence of Maxillary Sinus Width on New Bone Formation After Transcrestal Sinus Floor Elevation: A Proof-of-Concept Prospective Cohort Study

PURPOSE: Graft maturation in the maxillary sinus requires adequate angiogenesis and osteoprogenitor cells migration from the surrounding bony walls: the aim of this study was to analyze the correlation between sinus cavity dimensions and new bone formation after transcrestal sinus floor elevation (tSFE). METHODS: Patients needing maxillary sinus augmentation (residual crest height 64 4 mm) were treated with tSFE using xenogeneic granules. Six months later, bone-core biopsies were retrieved for histological analysis in the implant insertion sites. Buccopalatal sinus width (SW) was evaluated on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were quantified by means of linear regression analysis. RESULTS: Eight consecutive patients underwent tSFE procedures: at 6 months, average percentage of newly formed bone resulted 24.2% \ub1 7.9%. Statistical analysis showed a strong inverse correlation between SW and new bone formation (R = 0.88), and a strong direct correlation between the number of exposed bone walls and new bone formation (R = 0.82). CONCLUSION: Within the limitations of this proof-of-concept study, in which a restricted number of patients were analyzed, tSFE showed more predictable results in narrow than in large sinuses, in terms of new bone formation

Parotid Gland Edema After Chlorhexidine Mouthrinse: Case Report and Literature Review

Introduction: Parotid gland swelling, caused by many pathological conditions, has also been reported to be a possible side effect of the use of chlorhexidine mouthwash. This adverse reaction to chlorhexidine mouthwash is, however, extremely rare and very few cases of parotid gland swelling due to chlorhexidine mouthwash have been reported in the literature. Case Description: This report describes the clinical management of unilateral parotid swelling caused by chlorhexidine mouthwash. Methods: A patient presented with left parotid gland swelling after using chlorhexidine mouthwash for three days following sinus augmentation on the contralateral side of the maxilla. Diagnosis of parotid gland swelling due to rinsing with chlorhexidine was formulated after anamnesis, clinical examination, radiographs and ultrasound of the gland excluded other pathological conditions. The patient was subsequently advised to stop rinsing. However, on the evening of the same day, swelling increased and the patient presented to an emergency department where a single intravenous dose of methylprednisolone was administered. Results: After seven days, parotid swelling decreased significantly and after three weeks had completely disappeared. Conclusion: Although unilateral or bilateral parotid gland swelling related to the use of chlorhexidine mouthwash is an uncommon adverse event, it must be suspected after other organic or infective conditions have been excluded. The precise pathogenic mechanism has not yet been determined and further studies should be carried out to better understand the pathophysiology of this uncommon phenomenon

Reliability of a Novel CBCT-Based 3D Classification System for Maxillary Canine Impactions in Orthodontics: The KPG Index

The aim of this study was to evaluate both intra- and interoperator reliability of a radiological three-dimensional classification system (KPG index) for the assessment of degree of difficulty for orthodontic treatment of maxillary canine impactions. Cone beam computed tomography (CBCT) scans of fifty impacted canines, obtained using three different scanners (NewTom, Kodak, and Planmeca), were classified using the KPG index by three independent orthodontists. Measurements were repeated one month later. Based on these two sessions, several recommendations on KPG Index scoring were elaborated. After a joint calibration session, these recommendations were explained to nine orthodontists and the two measurement sessions were repeated. There was a moderate intrarater agreement in the precalibration measurement sessions. After the calibration session, both intra- and interrater agreement were almost perfect. Indexes assessed with Kodak Dental Imaging 3D module software showed a better reliability in z-axis values, whereas indexes assessed with Planmeca Romexis software showed a better reliability in x- and y-axis values. No differences were found between the CBCT scanners used. Taken together, these findings indicate that the application of the instructions elaborated during this study improved KPG index reliability, which was nevertheless variously influenced by the use of different software for images evaluation