Management of excessive bleeding before or during surgery

Surgical Hemostatics = Styptics
1- Physical Methods: Pressure , Cold , Cautery.
2- Vasoconstrictors: Adrenaline.
3- Astringents: Tannic Acid & Alum (They Precipitate Blood Proteins Causing Contraction)
4- Local Coagulants. (To Be Discussed)
5- Systemic Coagulants. (To Be Discussed)

:: Local Coagulants ::
1- Thromboblastin. (Coagulin)
2- Thrombin.
3- Fibrin Glue.
4- Human Fibrin Foam.
5- Absorbable Gelatin Sponge.
6- Oxyce. (Oxidized Cellulose)

:: Systemic Coagulants ::
1- Fresh blood transfusion to restore blood volume and to supply coagulation factors.
2- IF DUE TO capillary fragility. Vit C + Vit P
3- IF DUE TO HEMOPHILIA. (Anti-Hemophilic Globulin Factor 8) or (Tranexamic Acid)
4- IF DUE TO FIBRINOLYRIC THERAPY. (Tranexamic Acid)
5- IF DUE TO ANTICOAGULANT THERAPY. (If heparin give protamine sulphate) , (If warfarian give vit K)

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Dental Management of Patients taking Digitalis

Definition:

Digitalis is a Cardiac Glycoside drug prescribed for patients with Congestive Heart Failure (CHF) Or Atrial Fibrillation.

Mechanism of action of Digitalis:
- It binds and Inhibits the Magnesium and Adenosine Triphosphate Dependent Na+ and K+ ATPase.
- The increase the influx of calcium ions.
- Then it Enhances the myocardial contractility.

Contraindications:
- Local Anesthesia with Epinephrine.
- Aspirin (As it decreases Digitalis absorption and displaces it at the protien binding sites).
- NSAIDs (As they decrease renal clearance of Digitalis).
- Macrolides and Tetracycline (As they increase the serum levels of digitalis causing toxicity).

What is safe with Digitalis .... ?
- Anesthesia: Mepivacaine.
- Analgesics: Acetaminophen (Alone, with Codeine, with Hydrocodone Or with Oxycodone)
- Antibiotics: Penicillins, Cephalosporins and Clindamycin.

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Precision Attachment

- Definition:
It's part of a Dental Prosthetic Design that aims to connect a partial denture to fixed bridgework. can be used to restore arches where there are not enough teeth for fixed bridgework.

- Parts:
The Precision Attachment consists of two parts, Female and Male parts, the male part is attached to the partial denture, while the female part is soldered to fixed crowns or bridgework.

- Advantages:
1- Cosmetic Appearance.
2- Maintainable Periodontal Health.
3- Longevity of Abutment Teeth.
4- Patient Comfort.
5- Questionable Teeth can be saved in a way that does not affect case.
6- Longevity if they are lost in the future.
7- Natural Tooth and/or Implant Abutments can Be Used.
8- Can Be Adapted to Compensate for Future Changes in the Mouth.

- Function:
- There is no mechanical locking in the design of the Precision Attachment.
- A good precision attachment partial denture will not dislodge during normal function.
- The path of insertion of the male part inside the female part is different from the pull of the muscles and the action of the tongue and gravity, so that dislodging does not happen.
- It can move in a "vertical direction" slightly to release the forces instead of passing along them to the abutment teeth, The result is "physiologic stimulation" of the abutment teeth and the edentulous ridges.

- Requirements:
- All the teeth that support bridgework are prepared with full shoulder preparations in three-dimensions.
- Any defects must be corrected surgically, to create as healthy environment as possible.
- Minimize occlusal forces by: narrow occlusal (biting surface) diameters, adequate room for hygiene, proper length and anatomy, solid and passive fit, and adequate occlusion (bite) at the correct jaw relationship.
- Must be used in a precise manner in order to maintain a high percentage of longevity.
- Precision attachment cases must fit with precision.
- The abutments must be stable.
- The frameworks must fit properly without rock.
- Steps should be followed accurately without dismissing to avoid complications.

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Clinical Periodontology and Implant Dentistry, 2008, 5th Edition, By Jan Lindhe

Description

The fifth edition of Clinical Periodontology and Implant Dentistry brings to its readers another iteration of the unrivalled, unparalleled work on the specialty of periodontics. The editors have brought together contributions from experts all over the world to provide the reader with a comprehensive, cohesive text that fuses scholarship and science with clinical instruction and pragmatism. With an increase in length of approximately 25% and 15 new chapters, the new edition of Clinical Periodontology and Implant Dentistry runs the gamut of sub-disciplines and topics within periodontics and implant dentistry, supporting an intellectually and internationally inclusive approach.

Review

“With so many excellent aspects of implant dentistry covered in such great detail, it should be easy to see why I therefore recommend this fine textbook as a ‘must reference’ for any practitioner involved with the placement and/or restoration of implants. The editors are to be commended for their studious and detailed fine work.” (Implant Dentistry, April 2009)

"I would highly recommend this book to undergraduates, postgraduates, clinicians and researchers … .Who will no doubt refer to this text time and time again." (Dental Update, November 2008)

"This is a comprehensive textbook … it is useful to those at all stages of their under-graduate career." (British Dental Journal, August 2008)

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Clinical Periodontology and Implant Dentistry, 2003, 4th Edition, By Jan Lindhe

Description

This fourth edition of Clinical Periodontology and Implant Dentistry is the ultimate resource on periodontics. The editors are joined by over 50 expert contributors to address the full spectrum of periodontal issues. The book’s coverage extends logically from the anatomy of the periodontium through to treatment options, and elucidates the relationship between periodontal and restorative dental therapies. The section dedicated to implants in the periodontally-compromised patient reflects the increasing importance of this form of oral rehabilitation. This section includes new chapters on implant placement in the esthetic zone and issues related to supportive therapy in the implant patient.

With an approximate 25% increase in length, the fourth edition keeps pace with the level of interest and growth of research in periodontology. Chapters included in previous editions have been updated and many new chapters added, including modifying factors in periodontal disease, risk assessment, and genetics in relation to periodontitis.

The remarkable scholarship evident in the text is matched only by the quality of the illustrations, which guide the reader through the wealth of material detailed in the book. These features combine to make essential reading for the discerning student and practitioner and an asset to the faculty or practice library.

Key Features

Includes fourteen new chapters

Features 2000 illustrations, with over 1500 in color

Distills significant and original research findings

Includes detailed case reports

Editors and contributors provide an international perspective

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