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CC BY 4.0 · TH Open 2021; 05(01): e104-e106
DOI: 10.1055/s-0041-1722866
Case Report

Regenerative Surgery with Dental Implant Rehabilitation in a Haemophiliac Patient

Christian Bacci 
1   Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
,
Alessia Cerrato
1   Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
,
Gastone Zanette
1   Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
,
Samantha Pasca
2   Department of Cardiac Thoracic and Vascular Sciences, Haemophilia Centre Unit of Coagulopathies, University Hospital of Padua, Padua, Italy
,
Ezio Zanon
2   Department of Cardiac Thoracic and Vascular Sciences, Haemophilia Centre Unit of Coagulopathies, University Hospital of Padua, Padua, Italy
› Author Affiliations Funding None.
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Abstract

This study aimed to describe the first case of regenerative surgery in haemophiliac implant. Patients with haemophilia often present dental problems. A multidisciplinary approach is suggested in case of dental surgeries to reduce the high bleeding risk. A 41-year-old male patient with mild haemophilia A (FVIII 8.4%), presenting previous epistaxis, noncomplicated tooth extractions and traumatic haemartroses, all treated with single infusions of coagulation factor concentrates, was referred to the dental clinic of the Padua University Hospital based on the recommendation of his attending dentist. At first dental visit the patient reported intense pain in the right lower second molar, with impaired chewing function. After an endodontic unsuccessful treatment the element was judged as no longer recoverable. In agreement with the patient the dental element was then extracted, after a combined administration of recombinant factor VIII 3000 IU (35 IU/kg), and tranexamic acid 1,000 mg. The extraction was performed under local anaesthesia, paraperiosteal and truncular, moderate sedation, elevation of an envelope flap. After extraction, a preservation of the alveolus was carried out with bovine matrix bone graft covered with a resorbable membrane. Three months after the surgery a flapless implant was placed after a single infusion of factor VIII 2000 IU, tranexamic acid 1,000 mg, and a local para-periostal anaesthesia, without any complication. Oral surgeon and haematologist expert in coagulation diseases must therefore collaborate together to define a shared protocol for managing surgery in those patients.

Keywords

dental implant - haemophilia - ridge preservation - local anaesthesia


Publication History

Received: 11 November 2020

Accepted: 16 December 2020

Article published online:
16 March 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Laino L, Cicciù M, Fiorillo L. et al. Surgical risk on patients with coagulopathies: guidelines on hemophiliac patients for oro-maxillofacial surgery. Int J Environ Res Public Health 2019; 16 (08) 1386
    CrossrefPubMedGoogle Scholar
  • 2 Hewson ID, Daly J, Hallett KB. et al. Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders. Aust Dent J 2011; 56 (02) 221-226
    CrossrefPubMedGoogle Scholar
  • 3 Brewer A, Correa ME. Guidelines for dental treatment of patients with inherited bleeding disorders. World Federation of Hemophilia Treatment of Hemophilia Monograph; 2006. . Accessed May 2020 at: http://www.wfh.org
    Google Scholar
  • 4 Escobar MA, Brewer A, Caviglia H. et al. Recommendations on multidisciplinary management of elective surgery in people with haemophilia. Haemophilia 2018; 24 (05) 693-702
    CrossrefPubMedGoogle Scholar
  • 5 Gornitsky M, Hammouda W, Rosen H. Rehabilitation of a hemophiliac with implants: a medical perspective and case report. J Oral Maxillofac Surg 2005; 63 (05) 592-597
    CrossrefPubMedGoogle Scholar
  • 6 Calvo-Guirado JL, Romanos GE, Delgado-Ruiz RA. Infected tooth extraction, bone grafting, immediate implant placement and immediate temporary crown insertion in a patient with severe type-B hemophilia. BMJ Case Rep 2019; 12 (03) e229204
    CrossrefPubMedGoogle Scholar
  • 7 Rosen H, Gornitsky M. Cementable implant-supported prosthesis, serial extraction, and serial implant installation: case report. Implant Dent 2004; 13 (04) 322-327
    CrossrefPubMedGoogle Scholar
  • 8 Manani G, Bacci C, Zanette G, Facco E. Contemporary state of sedation in dentistry. Dent Cadmos 2012; 80 (07) 357-369
    PubMedGoogle Scholar
  • 9 Zanon E, Martinelli F, Bacci C, Zerbinati P, Girolami A. Proposal of a standard approach to dental extraction in haemophilia patients. A case-control study with good results. Haemophilia 2000; 6 (05) 533-536
    CrossrefPubMedGoogle Scholar
  • 10 Gupta A, Epstein JB, Cabay RJ. Bleeding disorders of importance in dental care and related patient management. J Can Dent Assoc 2007; 73 (01) 77-83
    PubMedGoogle Scholar