Standing Intraoral Extraction of the Right Mandibular Third Molar Tooth in a Cow Utilizing Tooth Sectioning

A 2-year-old Holstein heifer presented to a university teaching hospital with an apical tooth infection of the right mandibular third molar. A standing oral extraction technique was attempted for tooth removal; however, the molar could not be delivered intact. A tooth sectioning technique was performed, and the affected molar was successfully delivered. Three months postextraction, the heifer had fully recovered, and the extraction site had healed. To the authors’ knowledge, this is the first description of a tooth extraction in a cow using a tooth sectioning technique. This case describes an alternative technique for tooth removal in cattle with an apical tooth infection. The clinical, diagnostic, and therapeutic features of this case may be helpful to clinicians when they approach similar cases in the future.

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

The main factors of the odontogenic maxillary sinuses inflammation are perforation of the maxillary sinus bottom during teeth removal, anatomical and physiological features of the maxillary sinus structure when the root or roots are located in the cavity of the maxillary sinus, which is independent of the dental surgeon in any case, a perforation of the maxillary sinus bottom during teeth removal, as well as more complex chronic processes in periodontium, which form resorption of bone tissue within the bottom of the maxillary cavity, and clinical cases with the root penetrating the cavity of the maxillary sinus or the foreign body penetrating the genyantrum. Difficulties appear in the operation of removing the upper jaw teeth, which are located near the bottom of the maxillary cavity or in the genyantrum cavity, and in the presence of inflammation, accompanied by bone resorption. Therefore, in order to prevent complications of perforated sinusitis, there is a need to develop new non-invasive methods of prevention and treatment of perforation of the bottom of the maxillary cavity. One can state with certainty that traditional traumatic surgical interference, such as Caldwell-Luc radical antrostomy, is less frequently used in clinical practice. Nowadays many authors offer less traumatic methods for treating perforations and maxillary sinus fistula. We also offer our options of surgical interference using the domestic bone and plastic material (Kergap), GAP “Biomin”. In the case of the foreign body penetrating the maxillary sinus cavity, under the conduction anesthesia, a mucosal flap from the vestibular side is formed, and, if necessary, another one may be formed from the palatine side. We extend the bone hole to the necessary size so that it is possible to get the foreign body out through it, use a curettage spoon to remove the pathologically altered mucous membrane of the maxillary cavity till a healthy bone, then cover the bone hole with the osteoplastic material and cover it with the mu- cous flap, fix it and suture with the “Vikril 3,0” material. In case of maxillary cavity perforation during teeth removal operation, which roots break through the bottom of the maxillary sinus, which does not depend on the experience and qualifications of the dental sur- geon, the edges of the perforated hole are smoothed with a cutter or bone forceps in such a way that there are no sharp perforation eminences. Be sure to wash the sinus with a warm solution of antiseptic. We cover the bone joint between the maxillary and the oral cavity (with Kergap), GAP Biomin. After that, cover the maim with the cut bone flap and suture with the “Vikril 3.0” material. In more complex clinical cases, such as chronic long-term inflammatory processes without exacerba- tion of pathological processes in the genyantrum sinus of odontogenic origin, when a foreign body pene- trates the maxillary cavity, we decided to modify extreme maxillary sinusotomy using the Caldwall-Luc method, which became the goal of our research. Description of surgical interference: under local anesthesia, we simultaneously carry out an operation for removing the causative tooth and make a trapezoidal incision in the area of the maxillary sinus transi- tional wall. After that, we make a bone hole on the anterior wall of the maxillary sinus, do not sculpt the pathologically altered mucus, remove the foreign body through the bone hole. Antiseptic treatment is carried out during surgical interference. If there is a route between the maxillary sinus and the lower nasal passage, we do not form another one. After applying antiseptic, we put the bone flap onto the place and fixed with non-absorbing sutures, sew the removed tooth well with a pre-closed perforation aperture using osteoplastic material (Kergap), GAP Biomin. After that, we irradiate the surgical wound with a helium-neon laser, which provides a gentler healing period of the wound after surgery. Seams are removed on the 8th-12th day after surgery. The patients were examined both in the short term and in the long-term, after a year or more. No relapses of the oronasal route were found, bone wound healed in the period of 6-8 months, and contrast Rg-scans showed no regression of polyposis and granulation dilatations. In our opinion, this is the result of etiopathological treatment aimed at eliminating the cause. Thus, according to our research treatment and prevention of perforated sinusitis requires etiopathological treatment. The formation of an oronasal route during the causative tooth removal of odontogenic sinusitis re- quires the closure of this route with osteoplastic material (Kergap), GAP Biomin, while suturing the tooth. In the case of a foreign body entering the maxillary cavity, the traditional method opens the maxillary cavity in order to remove the foreign body through the anterior wall of the maxillary sinus and treats it with the solution of antiseptics without making a route with the lower nasal passage. It can be combined with the causative tooth removal and the tight suturing of the mucous flaps, which is less a traumatic surgical interference than the extreme Caldwall-Luc method of sinusotomy. Eliminating the inflammation cause of the maxillary sinus in combination with the osteoplastic closure of the oronasal route with tight suturing is a thorough treatment compared to the traditional technique. The regularities discovered as a result of clinical and X-ray quality assessment of non-invasive surgical methods for the treatment of chronic perforated sinusitis require further long-term studies and evaluation of other factors that influence the success of chronic perforated sinusitis treatment.

Magnetic mallets – A stroke of luck in implantology: A review

Magnetic mallet was introduced in dentistry by Bonwill in 1873. It was introduced with the aim of increasing the efficacy of hammered gold fillings. Magnetic mallet is a magnetodynamical handpiece with an ergonomical design. It comprises central control with force adjustment, sterilizable handpiece with different replaceable tips, and pedal control. It comes with an entire range of bone expanders/osteotomes, cutter, and other instruments. It is applicable for procedures such as tooth and root extraction, impacted tooth removal, delayed implant placement, bone manipulating and sinus lifting procedures, root apex resection, removal of crowns, bridges, and implant part. The use of magnetic mallet is said to provide with better clinical advantage.

Management of anticoagulated patients in dentoalveolar surgery: a retrospective study comparing bridging with heparin versus unpaused vitamin K antagonist medication

Background The aim of this study was to investigate the occurrence of postoperative bleeding following dentoalveolar surgery in patients with either continued vitamin K antagonist medication or perioperative bridging using heparin. Methods A retrospective study was performed analyzing patients who underwent tooth extraction between 2012 and 2017. Patients were retrospectively allocated into two comparative groups: un-paused vitamin K antagonist medication versus bridging using heparin. A healthy, non-anticoagulated cohort with equivalent surgery served as a control group. Main outcome measures were: the occurrence and frequency of postoperative bleeding, the number of removed teeth, the surgical technique of tooth removal (extraction/osteotomy/combined extraction and osteotomy) and the prothrombin time. Results In total, 475 patients were included in the study with 170 patients in the group of un-paused vitamin K antagonist medication VG, 135 patients in the Bridging group BG and 170 patients in the control group CG. Postoperative bleeding was significant: CG versus VG p = 0.004; CG versus BG p < 0.001, BG versus VG p < 0.001. A significant correlation of number of the extracted teeth in the BG (p = 0.014) and no significance in VG (p = 0.298) and CG (p = 0.210) and in the BG versus VG and CG with p < 0.001 in terms of surgical intervention extraction. No difference observed in terms of prothrombin time. Conclusions Bridging with heparin increases the risk for bleeding compared to un-paused vitamin K antagonist medication. The perioperative management of anticoagulated patients requires a well-coordinated interdisciplinary teamwork to minimize or at best avoid both: postoperative bleeding and thromboembolic incidences.

Management of anticoagulated patients in dentoalveolar surgery: a retrospective study comparing Bridging with heparin versus unpaused vitamin K antagonist medication.

Background: The aim of this study was to investigate the occurrence of postoperative bleeding following dentoalveolar surgery in patients with either continued vitamin K antagonist medication or perioperative bridging using heparin. Methods: A retrospective study was performed analyzing patients who underwent tooth extraction between 2012 and 2017. Patients were retrospectively allocated into two comparative groups: un-paused vitamin K antagonist medication versus bridging using heparin. A healthy, non-anticoagulated cohort with equivalent surgery served as a control group. Main outcome measures were: the occurrence and frequency of postoperative bleeding, the number of removed teeth, the surgical technique of tooth removal (extraction/ osteotomy/ combined extraction and osteotomy) and the prothrombin time. Results: In total, 475 patients were included in the study with 170 patients in the group of un-paused vitamin K antagonist medication VG, 135 patients in the Bridging group BG and 170 patients in the control group CG. Postoperative bleeding was significant: CG vs.VG p=0.004; CG vs. BG p<0.001, BG vs.VG p<0.001. A significant correlation of number of the extracted teeth in the BG (p=0.014) and no significance in VG (p=0.298) and CG (p=0.210) and in the BG vs. VG and CG with p<0.001 in terms of surgical intervention extraction. No difference observed in terms of prothrombin time. Conclusion: Bridging with heparin increases the risk for bleeding compared to un-paused vitamin K antagonist medication. The perioperative management of anticoagulated patients requires a well- coordinated interdisciplinary teamwork to minimize or at best avoid both: postoperative bleeding and thromboembolic incidences. Key words:

Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study

BackgroundPatients using antiplatelet drugs following infarctions, acute coronary syndrome (ACS) or stroke pose a significant clinical problem if it is necessary to perform surgery, including dental surgery, since they are at risk of prolonged or secondary post-extraction bleeding. Discontinuation of this therapy is associated with a high risk of serious thromboembolic complications. The purpose of this study was to assess the effectiveness of TachoSil fibrin-collagen patches in stopping and preventing of secondary post-extraction bleeding in patients undergoing chronic antiplatelet therapy.MethodsThe study was conducted through retrospective examination of the medical records of 153 patients using chronic antiplatelet therapy and those qualified for tooth extraction. The largest group comprised 74 patients using aspirin and clopidogrel as dual platelet antiaggregation therapy; in this group 75 tooth extractions were carried out. In all of the patients TachoSil fibrin-collagen patches and stiches were applied to the wounds resulting from tooth removal. ResultsFollowing tooth extraction, primary bleeding was stopped in all the patients and their wounds closed via coagulation within 20-30 minutes. In eight cases, accounting for 4.9% of the patients, secondary bleeding occurred and was successfully stopped only by applying a pressure dressing soaked in tranexamic acid. Secondary bleeding occurred in three patients on the second day and in five patients on the third day following tooth removal. ConclusionTopical application of TachoSil patches following tooth removal in patients using single or dual antiplatelet therapy effectively stopped bleeding and prevented secondary bleeding after tooth extraction.