Journal of Oral Implantology May 2013 - (Page 264)

CASE REPORT Flapless Dental Implant Surgery for Patients on Oral Anticoagulants—The ‘ WarLess Procedure’’: A Report of 2 Cases Hamad Al Zoman, BDS, MDSc1 Samer Al Jetaily, BDS, PhD1 Asirvatham Alwin Robert, MSc, MPhil2 Jagan Kumar Baskaradoss, BDS, MPH1 Abdulaziz Al-Suwyed, BDS, MDDs3 Sebastian Ciancio, DDS4 Sultan Al Mubarak, BDS, MDSc5* Patients with prosthetic heart valves are maintained on lifelong oral anticoagulant therapy. The optimal anticoagulant management of such patients during surgical dental procedures has been debated for a long time. Compared with conventional dental implant placement, a minimally invasive flapless approach has the potential to reduce bleeding and minimize surgical time, postoperative pain, soft tissue inflammation, and crestal bone. The purpose of these case reports is to show the clinical predictability of dental implant placement using a minimally invasive flapless approach without reducing the dosage of anticoagulants for patients on lifelong anticoagulant therapy. In this study, a 45-year-old woman and a 58-year-old man who had undergone cardiac surgery and were currently under a full therapeutic level of anticoagulation therapy (warfarin) were treated with flapless dental implant surgery without reducing their anticoagulant dosage. Postoperative clinical and radiographic assessment showed no abnormality, minimal signs of inflammation, and excellent healing. The combination of minimally invasive flapless dental implant surgery with no interruption in the normal dose of the anticoagulant medications could be an improved method for placing dental implants in patients on long-term anticoagulant therapy. Key Words: dental implants, oral anticoagulants, warfarin, flapless implant surgery INTRODUCTION 1 College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Research Center, Medical Affairs, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia. 3 College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, NGHA, Abdulaziz Medical City, Riyadh, Saudi Arabia. 4 Department of Periodontics and Endodontics, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY. 5 Research Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. * Corresponding author, e-mail: salmubarak@kfshrc.edu.sa DOI: 10.1563/AAID-JOI-D-11-00105 2 264 Vol. XXXIX /Special Issue /2013 A dult patients on oral anticoagulant therapy, like their healthy counterparts, may have a missing tooth or teeth as a normal result of a periodontal problem and/or decay. Warfarin, a competitive inhibitor of vitamin K, is a commonly prescribed oral anticoagulant shown to reduce the risk of thromboembolism in patients with mechanical heart valves, deep vein thrombosis, and other hypercoagulable states. Its principle, the adverse effect is bleeding. The international normalized ratio

Table of Contents for the Digital Edition of Journal of Oral Implantology May 2013

Implantology: Inter-Dependent Worldwide Relationships
Use of Osteotomes for Implant Bed Preparation-Effect on Material Properties of Bone and Primary Implant Stability
The Effects of a Static Magnetic Field on Bone Formation Around a Sandblasted, Large-Grit, Acid-Etched-Treated Titanium Implant
Effect of Platelet-Rich Plasma on the Outcome of Early Loaded Dental Implants: A 3-Year Follow-up Study
Flapless Dental Implant Surgery for Patients on Oral Anticoagulants-The "WarLess Procedure": A Report of 2 Cases
Radiographic Evaluation of Narrow-Diameter Implants After 5 Years of Clinical Function: A Retrospective Study
Histomorphometry of 2 Immediately Loaded Mini Implants Retrieved From Human Mantible After 3 Months: A Light and Scanning Electron Microscopy Report
Splinted Zirconia Fixed Partial Denture Supported by Small Diameter (Mini Implants) in the Posterior Mandible: A Case Letter

Journal of Oral Implantology May 2013