Implant placement in patients under treatment with rivaroxaban: A retrospective clinical study

The management of patients under treatment with Direct Oral Anticoagulants (DOACs) has led clinicians to deal with two clinical issues, such as the hemorrhagic risk in case of non-interruption or the risk of thromboembolism in case of suspension of the treatment. The primary aim of this retrospective study was to evaluate the incidence of perioperative bleeding events and healing complications in patients who were under treatment with Rivaroxaban and who received dental implants and immediate prosthetic restoration. Patients treated with Rivaroxaban (Xarelto 20 mg daily) and who needed implant rehabilitation were selected. Four to six implants were placed in mandibular healed sites or fresh extraction sockets. All patients, in agreement with their physicians, interrupted the medication for 24 h and received implants and immediate restorations. Twelve patients and 57 implants were analyzed in the study. No major postoperative bleeding events were reported. Three patients (25%) presented slight immediate postoperative bleeding controlled with compression only. The implant and prosthetic survival rate were both 100% after 1 year. Within the limitations of this study, multiple implant placement with an immediate loading can be performed without any significant complication with a 24 h discontinuation of Rivaroxaban, in conjunction with the patient’s physician

Consensus Report by the Italian Academy of Osseointegration on the Use of Graft Materials in Postextraction Sites

Purpose: After tooth extraction, a modeling and remodeling phase of bone and soft tissues occurs. It has been fully demonstrated that bone resorption as high as 50% can take place regarding ridge width and a variable amount concerning ridge height, making it difficult to perform implant surgery. Materials and Methods: Active members of the Italian Academy of Osseointegration (IAO) participated in this Consensus Conference, and three systematic reviews were conducted before the meeting to provide guidelines on alveolar ridge preservation procedures. The systematic reviews covered the following topics: (1) What material best preserves the dimensions of the ridge horizontally and vertically?; (2) what material favors the formation of the highest quantity of new bone?; (3) which technique would best seal the socket?; and (4) what effect does alveolar ridge preservation have on soft tissues? Results: The main conclusions reached by the assembly were that alveolar ridge preservation is advisable after dental extraction, particularly in esthetic areas, in proximity of anatomical structures (ie, maxillary sinus, inferior alveolar nerve, and mental foramen), whenever the treatment plan requires delayed placement, and whenever patients ask to postpone implant insertion for various reasons. Socket debridement is advised before the use of a “regenerative material,” and xenograft is considered the gold standard material to maintain ridge dimensions. Another indication is antibiotic therapy, which is recommended in the case of alveolar ridge preservation (amoxicillin 2 g 1 hour before the intervention and 1 g every 12 hours for 6 days). A membrane or autologous soft tissue should be used to seal the socket and protect the regenerative material, and the indicated reentry time (implant insertion) is 4 to 6 months. Conclusion: This Consensus Conference agreed that the adoption of alveolar ridge preservation can effectively prevent physiologic bone loss, especially in esthetic areas. It is recommended to cover the xenograft material with a membrane or autologous soft tissue, and antibiotic therapy is advisabl