Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Apr 16;8(1):20.
doi: 10.1186/s40729-022-00418-2.

Bleeding disorders in implant dentistry: a narrative review and a treatment guide

Paul Römer #  1 , Diana Heimes #  2 , Andreas Pabst  3 , Philipp Becker  3 , Daniel G E Thiem  1 , Peer W Kämmerer  1
Affiliations
Review

Bleeding disorders in implant dentistry: a narrative review and a treatment guide

Paul Römer et al. Int J Implant Dent. .

Abstract

Purpose: Considering a high prevalence of congenital and especially acquired bleeding disorders, their heterogeneity and the multitude of possible treatments strategies, a review of the scientific data on this topic is needed to implement a treatment guide for healthcare professionals.

Methods: A selective literature review was performed via PubMed for articles describing oral surgery / dental implant procedures in patients with congenital and acquired bleeding disorders. Out of the existing literature, potential treatment algorithms were extrapolated.

Results: In order to assess the susceptibility to bleeding, risk stratification can be used for both congenital and acquired coagulation disorders. This risk stratification, together with an appropriate therapeutic pathway, allows for an adequate and individualized therapy for each patient. A central point is the close interdisciplinary cooperation with specialists. In addition to the discontinuation or replacement of existing treatment modalities, local hemostyptic measures are of primary importance. If local measures are not sufficient, systemically administered substances such as desmopressin and blood products have to be used.

Conclusions: Despite the limited evidence, a treatment guide could be developed by means of this narrative review to improve safety for patients and practitioners. Prospective randomized controlled trials are needed to allow the implementation of official evidence-based guidelines.

Keywords: Anticoagulant; Antiplatelet drug; Bleeding disorder; Factor deficiency; Hemophilia; von Willebrand disease.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Exemplary treatment scheme for noninvasive dental treatments. No risk (blue) and low risk (green) (acc. to [2]). TXA: tranexamic acid
Fig. 2
Fig. 2
Exemplary treatment scheme for slightly invasive dental treatments. Low risk (green) and moderate risk (yellow) (acc. to [2]). TXA tranexamic acid, DDAVP desmopressin
Fig. 3
Fig. 3
Exemplary treatment scheme for moderate-risk dental treatments. Moderate risk (yellow) (acc. to [2]). TXA: tranexamic acid; DDAVP: Desmopressin
Fig. 4
Fig. 4
Exemplary treatment scheme for highly invasive dental treatments. High risk (red) (acc. to [2]). TXA: tranexamic acid; DDAVP: Desmopressin
Fig. 5
Fig. 5
Clinical recommendations for oral surgery in patients treated with vitamin K antagonists
Fig. 6
Fig. 6
Clinical recommendations for oral surgery in patients treated with direct oral anticoagulants
Fig. 7
Fig. 7
Clinical recommendations for oral surgery in patients treated with antiplatelet therapy
See this image and copyright information in PMC

References

    1. Israels S, Schwetz N, Boyar R, McNicol A. Bleeding disorders: characterization, dental considerations and management. J Can Dent Assoc. 2006;72(9):827. - PubMed
    1. Peyvandi F, Garagiola I, Young G. The past and future of haemophilia: diagnosis, treatments, and its complications. Lancet. 2016;388(10040):187–197. doi: 10.1016/S0140-6736(15)01123-X. - DOI - PubMed
    1. Mannucci PM, Duga S, Peyvandi F. Recessively inherited coagulation disorders. Blood. 2004;104(5):1243–1252. doi: 10.1182/blood-2004-02-0595. - DOI - PubMed
    1. Heimes D, Kämmerer PW. Gretchenfrage: Blutgerinnungshemmer vor der Operation absetzen oder nicht? der junge Zahnarzt. 2020;6.
    1. Rasaratnam L, Chowdary P, Pollard D, Subel B, Harrington C, Darbar UR. Risk-based management of dental procedures in patients with inherited bleeding disorders: development of a Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT) Haemophilia. 2017;23(2):247–254. doi: 10.1111/hae.13122. - DOI - PubMed

Publication types

MeSH terms

Substances