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1.
Comparison of suture and sutureless techniques on postoperative complications after third molar surgery: a systematic review
Falci, S. G. M., Guimarães, MtbÁ, Canarim, N. M., Falci, S. E., Martins, O. B. L., de Souza, G. M., Galvão, E. L.
Clinical oral investigations. 2024;28(1):115
Abstract
OBJECTIVE To compare, among patients undergoing third molar surgeries, whether the use or omission of sutures improves postoperative clinical parameters. METHOD A systematic literature review was conducted to identify randomized clinical trials in humans. The steps of this review were conducted following the PRISMA protocol. The risk of bias assessment was performed using the revised Cochrane tool (RoB 2). The RevMan software was employed for meta-analyses, and the quality of evidence was evaluated using GRADE. RESULT A total of seven articles were included in the systematic review; however, only one article quantitatively measured bleeding, rendering meta-analysis for this outcome unfeasible. The group of patients in whom sutures were not used presented lower pain and edema on the first day (respectively: MD - 1.08; 95% CI - 1.35 to - 0.81; MD - 1.23; 95% CI - 2.34 to - 0.11) and second day (respectively: MD - 0.50; 95% CI - 0.83 to - 0.17; MD - 10.66; 95% CI - 1.16 to - 0.16) postoperatively, compared to the group where sutures were employed. The group of patients who received sutures exhibited increased trismus on the first day postoperatively (MD 1.04; 95% CI 0.67 to 1.41). CONCLUSION The omission of postoperative sutures in third molar surgeries appears to favor pain and edema outcomes within the first 24 h after the procedure, as well as trismus within the same timeframe. CLINICAL RELEVANCE Despite the suture being the standard conduct in tooth extractions. The omission of sutures in third molar extractions may favor inflammatory outcomes of pain, edema, and trismus in the immediate postoperative period.
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2.
Efficacy of Tranexamic Acid in Preventing Alveolar Osteitis in Post-extraction Sockets of First Premolars
Nagaja, S. A., John, R. S., Krishnan, M.
Cureus. 2024;16(1):e51816
Abstract
OBJECTIVES The present study is a randomized trial for comparing the effectiveness of tranexamic acid as an antifibrinolytic agent in preventing alveolar osteitis in the post-extraction period in patients receiving orthodontic therapy that requires extraction. METHODOLOGY This research was carried out in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, India. A total of 40 patients were considered subjects for the research. Patients undergoing orthodontic treatment referred to the Department of Oral and Maxillofacial Surgery for the therapeutic extractions of the first premolars were considered for this study. Randomization was done to split the population into study and control. After the atraumatic extraction of the first premolars under local anesthesia using 2% lignocaine with 1:80000 adrenaline, a tranexamic acid solution of 500 mg soaked gauze over the extraction sockets was used as the intervention in the study group, and plain gauze was used on the control group. Patients were asked to hold the gauze in place for one hour. Participants were reviewed after three days for the incidence of alveolar osteitis and pain severity and healing of the extraction sockets. Results: The prevalence of Alveolitis sicca dolorosa was found to be 5% in the research group and 15% in the control group. Patients in the control group showed more pain than the patients in the research group. The period taken for healing ranged from 7 days to 10 days in the control group and 10 days to 12 days in the study group. Conclusion: This study gives an edge that tranexamic acid can be used as a local hemostatic agent in preventing fibrinolysis of clots and preventing alveolar osteitis.
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3.
The effectiveness of chitosan as a hemostatic in dentistry in patients with antiplatelet/anticoagulant therapy: systematic review with meta-analysis
Minervini, G., Franco, R., Marrapodi, M. M., Di Blasio, M., Cicciù, M., Ronsivalle, V.
BMC oral health. 2024;24(1):70
Abstract
Hemorrhage control is a crucial aspect of dental procedures, and achieving efficient hemostasis remains a key challenge. The advent of hemostatic dressings has revolutionized the field of dentistry by providing effective and convenient solutions for managing bleeding in vari-ous dental scenarios. This article aims to provide an overview of hemostatic dressings, their mechanisms of action, and their diverse applications in dentistry. We applied the following Pop-ulation, Exposure, Comparator, and Outcomes (PICO) model to assess the document eligibility. A literature search was performed on major search engines, using keywords. At the end of the search, 3 articles were selected that matched the PICO. Three items were selected after the screen-ing process, and bleeding times were analyzed between the control group and the study group. The overall effect showed a substantial and statistically significant difference with bleeding time in favour of HDD-treated patients, showing that this garrison is very useful in controlling bleed-ing for patients taking anticoagulants and antiplatelets (Mean difference - 5.61; C.I. -5.70, - 5.52); Overall, hemostatic dressings have revolutionized the management of bleeding in dentistry, offering a promising solution to achieve optimal hemostasis, improve treatment outcomes, and enhance patient care, particularly Hemcon.
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4.
Effectiveness of Tranexamic Acid in Orthognathic Surgery: A Systematic Review of Systematic Reviews
AlQahtani, F. A., Kuriadom, S. T., Varma, S., AlAnzy, H., AlOtaibi, S.
Journal of stomatology, oral and maxillofacial surgery. 2023;:101592
Abstract
PURPOSE This study aimed to review the currently available evidence on the effectiveness of administering tranexamic acid (TXA) to patients undergoing orthognathic surgery. METHODS A study protocol was developed in accordance with the Preferred Reporting Guideline for Overviews of Reviews (PRIOR) and registered on the International Prospective Register of Systematic Reviews (PROSPERO) under Registration No. CRD42021232931. Furthermore, the reporting of the present systematic review was performed based on the PRISMA checklist. RESULTS The search strategy yielded a total of 50 articles. After reading the abstracts, 28 articles were excluded, and the English full texts of the remaining 22 studies were separately examined for eligibility by two authors; 15 articles were excluded because they did not meet the inclusion criteria. Finally, seven systematic reviews and meta-analysis satisfied the criteria for inclusion and were processed for critical review evaluation. CONCLUSIONS Within the limits of the present study and the reviews of the 7 articles included, it is observed that TXA is able to reduce the amount of intraoperative blood loss and the amount of irrigation fluids required. However, it does not influence postoperative levels of hemoglobin or hematocrit, nor does it affect the requirement for blood transfusions. It was interestingly discovered that TXA could increase the quality of the surgical site. These data imply that TXA may be an effective adjuvant in lowering bleeding during orthognathic surgery. As a result, the potential risk of problems related with considerable blood loss may be minimized.
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5.
A Systematic Review of the Efficacy and Safety of Tranexamic Acid in Facelift Surgery
Al-Hashimi, M., Kaur, P., Charles, W., Bhasta, M., Nahai, F., Khajuria, A.
Aesthetic surgery journal. 2023
Abstract
Tranexamic acid (TXA) has become widely utilized in different specialities including facelift surgery. To robustly evaluate the quality of available evidence on the efficacy and safety of TXA use in facelift surgery. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, Google Scholar, Science Citation Index and LILAC databases for randomized controlled trials (RCTs), and observational studies. Primary outcomes were blood loss, post-operative hematoma, ecchymosis, and swelling, in addition to technical considerations and complications. We assessed reviews quality using the AMSTAR 2 tool, studies quality using GRADE, and risk of bias using Cochrane's Risk of Bias tool for RCTs and ROBINS-I for non-randomized studies. Of the 368 articles, a total of three studies including 150 patients met the inclusion criteria. The RCT reported a significant reduction in postoperative serosanguineous collections in the TXA group (p < 0.01), and the surgeon rated postoperative ecchymosis and bruising. The prospective cohort study reported reduced drainage output in first 24 hours in the TXA group (P < 0.01). The retrospective cohort study reported lower intraoperative blood loss, mean POD1 drain output, percentage of drain removal on POD1 and number of days to drain removal the TXA group (all, p < 0.01). The quality of studies was moderate, and this review was the highest rated compared to previous reviews, as per the AMSTAR2 tool. Based on limited literature, TXA improves clinical outcomes regardless of the route of administration. Topical TXA is an emerging route, expediting drain removal and reducing blood loss. Future Level I high-quality studies are required.
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6.
Efficacy of a New Hemostatic Dental Sponge in Controlling Bleeding, Pain, and Dry Socket Following Mandibular Posterior Teeth Extraction-A Split-Mouth Randomized Double-Blind Clinical Trial
Mahmoudi, A., Ghavimi, M. A., Maleki Dizaj, S., Sharifi, S., Sajjadi, S. S., Jamei Khosroshahi, A. R.
Journal of clinical medicine. 2023;12(14)
Abstract
AIMS: This study aimed to clinically evaluate of a novel gelatin-based biodegradable sponge after mandibular posterior teeth extraction to assess its abilities in controlling bleeding, pain, and dry socket compared a commercial sponge. TRIAL DESIGN In this study, 26 patients who needed the extraction of two mandibular molar teeth were selected and, in each patient, after tooth extraction, the prepared gelatin sponge was used in the test group and the commercial sponge was used in the control group in the form of a randomized, double-blind, split-mouth clinical trial. The sterile gauzes were used on top of each sponge to absorb the extra blood (unabsorbed blood of sponges) to assess the blood absorption amount. Also, the amount of bleeding was recorded for 1 and 4 h after extraction for two groups. The amount of pain was measured for 12, 24, and 48 h after tooth extraction by Visual Analogue Scale (VAS). All patients also returned for examination four days after extraction to assess the occurrence of dry socket. RESULTS The results showed that the average weight of absorbed blood by sterile gauze in the control group (6.32 ± 1.06 g) was higher than in test group (3.97 ± 1.1 g), e.g., the bleeding control was better for the test group (p < 0.05). Bleeding was observed to be significantly reduced in the test group within 1 h (p = 0.003), within 1-4 h (p = 0.002), and after 4 h (p = 0.042) post-operatively in comparison to the control group. The average pain decreased significantly over time in both groups and the reduction of the pain was significantly higher for the test group (p < 0.05). Just one dry socket case occurred in the control group. CONCLUSION The prepared sponge is recommended for use in dental surgeries because of its abilities in bleeding, pain, and dry socket control.
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7.
Tissue Sealants for Facial Rhytidectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Chien, W. Y., Huang, Y. L., Chiu, W. K., Kang, Y. N., Chen, C.
Facial Plastic Surgery & Aesthetic Medicine. 2023;25(2):90-96
Abstract
Background: The aging face can be surgically treated with a face-lift (rhytidectomy); however, bleeding and hematoma are complications that surgeons seek to prevent. Objective: To compare the drainage volume and rate of hematoma in studies of rhytidectomy among those having tissue sealants and those without. Methods: This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD42022325404). We included randomized controlled trials (RCTs) that the enrolled participants undergoing rhytidectomy and used tissue sealants as the intervention. We calculated the mean and standard deviation for the drainage volume; risk ratios (RRs) were used for hematoma incidents. Results: Seven RCTs were included. The drainage volume was significantly lower in the tissue sealant group than in the control group (mean difference [MD]: -11.01, confidence interval [95% CI]: -18.39 to -3.63, p < 0.00001). As for hematomas, the incidence was also lower in the tissue sealant group (RR: 0.29, 95% CI: 0.08-0.99, p = 0.05). Conclusion: This study suggests that tissue sealants can be effective in reducing drainage volume and hematoma in face-lift; however, autologous and homologous tissue sealants can be further compared in future RCTs.
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8.
Comparison between two different local hemostatic methods for dental extractions in patients on dual antiplatelet therapy: a within-person, single-blind, randomized study
Guardieiro, B., Santos-Paul, M. A., Furtado, R. H. M., Dalçóquio, T., Salsoso, R., Neves, I. L. I., Neves, R. S., Cavalheiro Filho, C., Baracioli, L. M., Nicolau, J. C.
The journal of evidence-based dental practice. 2023;23(3):101863
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Editor's Choice
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) provides additional risk reduction of ischemic events compared to aspirin monotherapy, at cost of higher bleeding risk. There are few data comparing new techniques for reducing bleeding after dental extractions in these patients. PURPOSE This study investigated the effectiveness of the HemCon Dental Dressing (HDD) compared to oxidized cellulose gauze. MATERIALS AND METHODS This randomized study included 60 patients on DAPT who required at least two dental extractions (120 procedures). Each surgical site was randomized to HDD or oxidized regenerated cellulose gauze as the local hemostatic method. Intra-oral bleeding time was measured immediately after the dental extraction and represents our main endpoint for comparison of both hemostatic agents. Prolonged bleeding, platelet reactivity measured by Multiplate Analyser (ADPtest and ASPItest) and tissue healing comparison after 7 days were also investigated. RESULTS Intra-oral bleeding time was lower in HDD compared with control (2 [2-5] vs. 5 [2-8] minutes, P=0.001). Prolonged postoperative bleeding was observed in 7 cases (11.6%), all of them successfully managed with local sterile gauze pressure. More HDD treated sites presented better healing when compared with control sites [21 (36.8%) vs. 5 (8.8%), P=0.03]. There was poor correlation between platelet reactivity and intra-oral bleeding time. CONCLUSIONS In patients on DAPT, HDD resulted in a lower intra-oral bleeding time compared to oxidized cellulose gauze after dental extractions. Moreover, HDD also seems to improve healing conditions.
PICO Summary
Population
Patients on dual antiplatelet therapy requiring at least two dental extractions (n= 60, 120 procedures).
Intervention
HemCon Dental Dressing (HDD), (n= 60).
Comparison
Oxidized cellulose gauze (n= 60).
Outcome
Intra-oral bleeding time was lower in HDD compared with control (2 [2-5] vs. 5 [2-8] minutes). Prolonged postoperative bleeding was observed in 7 cases (11.6%), all of them successfully managed with local sterile gauze pressure. More HDD treated sites presented better healing when compared with control sites [21 (36.8%) vs. 5 (8.8%)]. There was poor correlation between platelet reactivity and intra-oral bleeding time.
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The Efficacy of Tranexamic Acid in Craniomaxillofacial Surgery: A Systematic Review of Randomized Controlled Trials
Zhao, M., Luo, Y., Guo, Z., Mu, L., Lu, J.
The Journal of craniofacial surgery. 2023
Abstract
This study aimed to evaluate the use of tranexamic acid in craniomaxillofacial surgery by meta-analysis. A comprehensive search was performed for randomized controlled trials (RCTs) mainly in 3 electronic databases (PubMed, EMBASE, and Cochrane Library) before August 2022. We collected and managed data for weighted mean difference of intraoperative blood loss, transfusion requirement, and operation time for the study. A total of 13 randomized controlled trials were included in the analysis. Compared with the control group, the tranexamic acid group showed a reduction in intraoperative blood loss of 198.67 ml (95% CI: -258.84 to -138.50 ml, P<0.00001), with blood transfusion requirement decreased by 7.77 ml/kg (95% CI: -10.80 to -4.73, P<0.0001) and less operation time (weighted mean difference= -10.39 min; 95% CI: -16.49 to -4.30 min, P=0.0008).
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10.
Evaluation and comparison of the efficacy of autologous fibrin glue with 4-0 silk sutures in periodontal flap closure and wound healing - A split mouth randomized controlled trial
Pradhan, N., Anup Belludi, S., R, S., Hr, V., James, R.
Journal of biomaterials applications. 2023;:8853282231191862
Abstract
BACKGROUND Fibrin glue has shown to be a pioneering remedy to overcome the inconvenience of suturing. Autologous products reduce the risk of contamination and immunological responses compared to commercial fibrin glue. Hence using autologous fibrin glue (AFG) as a tissue sealant in periodontal flap closure would be of added value for a predictable outcome. OBJECTIVE To evaluate and compare the efficacy of AFG with 4-0 silk sutures in periodontal flap closure and healing. MATERIAL AND METHODS Total of 17 patients diagnosed with generalized periodontitis in the age group of 18 to 60 years with probing pocket depth of ≥ 6 mm and clinical attachment level of ≥5 mm in at least two quadrants were categorized into test group (AFG) and control group (4-0 silk sutures). Primary outcome measures [modified gingival index (MGI), early wound index (EHI) and interleukin 1 beta (IL-1ß) and secondary outcome measures (oral hygiene index, plaque index and visual analog scale (VAS) were recorded at baseline, 1, 2, 3 and 4 weeks. RESULTS A statistically significant reduction of IL-1ß value (p =.005); MGI (p = .02); EHI (p = .004), VAS scores (p < .001) and a positive Spearman's correlation (rho = 0.15) was seen between EHI scores & IL-1ß levels in test group at 1week period in comparison to control group. CONCLUSION AFG showed promising results as an alternative to sutures. The use of AFG significantly improved clinical parameters and reduced the levels of pro-inflammatory cytokines making it an effective adhesive with healing properties in the era of suture-less periodontal flap surgery.