The study deals with the question of minor oral surgery procedures, dental extractions especially, in patients suffering from haemocoagulation disorder. The aim of this study was 1) the clinical attestation of the risk of bleeding that may follow the dental extraction in patients with non-interrupted oral administration of drugs with the anticoagulant and antiplatelet effects and 2) suggestion of the schedules of surgical procedures suitable for this kind of patients and for the realization in the standard dental office. The opening theoretical part analyses the principle of haemocoagulation, the surway of individual inherited and acquired bleeding disorders and the main principles of treatment of bleeding patients in dental offices with the emphasis on the local security of the surgical wound. In the proper study we present the observation and evaluation of bleeding complications after the standard dental extractions in 3 groups of persons (age range, 19 to 93 years). In all patients, one or more extractions were performed. 99 patients were treated with oral anticoagulant therapy without any interruption and underwent 199 extractions. 149 patients, treated with antiplatelet therapy (acetylsalicylic acid) without interruption, underwent 347 extractions. 160 healthy subjects with 316 extractions served as a...

The study deals with the question of minor oral surgery procedures, dental extractions especially, in patients suffering from haemocoagulation disorder. The aim of this study was 1) the clinical attestation of the risk of bleeding that may follow the dental extraction in patients with non-interrupted oral administration of drugs with the anticoagulant and antiplatelet effects and 2) suggestion of the schedules of surgical procedures suitable for this kind of patients and for the realization in the standard dental office. The opening theoretical part analyses the principle of haemocoagulation, the surway of individual inherited and acquired bleeding disorders and the main principles of treatment of bleeding patients in dental offices with the emphasis on the local security of the surgical wound. In the proper study we present the observation and evaluation of bleeding complications after the standard dental extractions in 3 groups of persons (age range, 19 to 93 years). In all patients, one or more extractions were performed. 99 patients were treated with oral anticoagulant therapy without any interruption and underwent 199 extractions. 149 patients, treated with antiplatelet therapy (acetylsalicylic acid) without interruption, underwent 347 extractions. 160 healthy subjects with 316 extractions served as a...

Ziel: Das Ziel dieser Studie war es den Zusammenhang zwischen Zahnextraktionen und Patientenfaktoren in 3 Deutschen Zahnarztpraxen zu untersuchen. Material & Methoden: In einer retrospektiven Auswertung aller Patientenkarten von 3 deutschen Zahnarztpraxen wurden Extraktionsfälle ab Januar 2007 (Praxis 1), Mai 2010 ( Praxis 2) und Januar 2010 ( Praxis 3 ) auf Extraktionen hin durchsucht, bis in jeder Praxis jeweils 100 Extraktionspatienten gefunden wurden, die die Einschlusskriterien erfüllten. Alle Patienten ohne Extraktionen die innerhalb dieses Zeitraumes behandelt wurden und die die Einschlusskriterien erfüllten, dienten als Kontrollgruppe. Es wurden nur Patienten eingeschlossen (Fall und Kontrollgruppe), von denen die spezifischen Patientendaten zur Verfügung standen. Alle Patientendaten wurden in einem „Case-Report-Form\"-Formular (CRF) erfasst. Die individuellen Parameter der Patienten der Fallgruppe und der Kontrollgruppe wurden verglichen. Mittels schrittweiser logistischer Regressionsanalyse konnten die Faktoren für ein Extraktionsrisiko bestimmt werden. Ergebnisse: Insgesamt wurden 2174 Patientenakten untersucht (Fallgruppe 300; Kontrollgruppe 1874). Die Gesamtsumme der Zähne vor der Extraktionstherapie betrug 54316. In der Fallgruppe wurden insgesamt 459 Zähne extrahiert. Die Patienten der Fallgruppe waren im Schnitt mehr als 6,7 Jahre älter als die Patienten der Kontrollgruppe(52,4/45,7 Jahre (P< 0,001)), sie waren zu einem größeren Anteil männlich. (58/ 52%) ,es gab eine höhere Zahl an Rauchern, es gab vermehrt Patienten mit einer Kalziumkanalblocker Medikation [15/8 % (p<0,001)] und der parodontale Befund festgestellt mittels PSI der Fallgruppe war schlechter als der der Kontrollgruppe [PSI 2,5/1,8 , (p<0,001)]. Das Risiko einer Zahnextraktion im Allgemeinen und in Folge von Parodontalerkrankungen waren assoziiert mit Kalziumkanalblockermedikation, (OR 1,49/1,65) aktivem Rauchen (OR 1,35/1,71), Alter (10Jahre) OR 1,13/1,37 , Praxis Nr.1 (1,48/1,99) und der Anzahl der Sextanten mit dem PSI Code 4 (1,33/1,76) (p<0,001). Schlussfolgerung: Kalziumkanalblockermedikation, aktives Rauchen, Alter, Zahnarzt und die Anzahl der Sextanten mit einem PSI Wert 4 sind Risikoindikatoren für Zahnextraktionen. Nutzen : Kalziumkanalblockermedikation kann das Extraktionsrisiko erhöhen. Zahnverlust zieht in den meisten Fällen Zahnersatz nach sich, welcher in aller Regel aufwändig ist, den Patienten zusätzliche Belastungen abverlangt und die Kosten einer Therapie erhöht. Die Information über die Einnahme von Kalziumkanalblockern ist ein leicht zu erfassender Parameter und könnte als Indikator genutzt werden, um Betreuungsintervalle zu verkürzen. Es muss jedoch noch geprüft werden, ob eine intensivere Betreuung dieser Patienten deren Zahnextraktionsrate tatsächlich verringern kann.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / As más oclusões de Classe I com biprotrusão dentária são caracterizadas pela projeção dos incisivos superiores e inferiores e podem ser corrigidas com extrações de primeiros pré-molares, permitindo reposicionar os incisivos, usando como ancoragem os dentes posteriores. Esse trabalho teve como objetivo comparar, por meio de superposição de modelos tridimensionais, a movimentação de molares e de incisivos com duas técnicas para fechamento de espaços. Foram selecionados, tomografados (T0) e distribuídos, aleatoriamente em dois grupos, seis pacientes com indicação de exodontia de quatro primeiros pré-molares. No grupo 1 (n=3) foi feito o fechamento dos espaços das extrações em uma única etapa (fechamento em massa) e no grupo 2 (n=3), em duas etapas (distalização de caninos seguida da retração de incisivos). Após o completo fechamento dos espaços foi solicitada nova tomografia (T1). Os modelos tridimensionais em T0 e T1 para os dois grupos foram superpostos para descrever e quantificar a movimentação ocorrida nos primeiros molares. A retração de incisivos foi avaliada de maneira bidimensional. Os molares superiores e inferiores do grupo 1 sofreram movimentação mesial de translação, enquanto os do grupo 2, apresentaram deslocamento de coroa maior do que de ápice radicular, demonstrando movimento de inclinação mesial de coroa. Ao se comparar o movimento mesial dos molares entre os dois grupos, observou-se que no grupo 1 houve maior movimentação mesial da raiz mésio-vestibular dos molares superiores (p=0,009). No entanto, em ambos os grupos os molares superiores giraram sobre a raiz palatina. No arco inferior verificou-se maior movimento mesial de coroa para o grupo 2 (p=0,015). A análise da movimentação dos incisivos apresentou variações semelhantes para as medidas lineares e angulares dos incisivos superiores nos dois grupos. Já, para as medidas angulares dos incisivos inferiores, observou-se que o grupo 1 apresentou menor controle de torque. O tempo de tratamento de todos os pacientes da amostra foi superior a 30 meses, exceto um paciente que apresentou tempo de tratamento inferior a 24 meses. Pôde-se concluir que a perda de ancoragem ocorreu por movimento de translação no fechamento de espaços em massa, e por inclinação mesial no fechamento de espaços em duas etapas, para ambos os arcos. Parece haver maior movimentação mesial radicular nos molares superiores no fechamento em massa e maior movimento mesial de coroa dos molares inferiores para o fechamento em duas etapas. Sugere-se que não há diferença na retração dos incisivos superiores e maior retroinclinação dos incisivos inferiores no fechamento de espaços em duas etapas. / Class I malocclusions with dental biprotrusion are characterized by the projection of upper and lower incisors and can be corrected with extractions of four first premolars, allowing incisor retraction using the posterior teeth as anchorage. The purpose of this research was to compare the movement of molars and incisors, by superimpostions of three-dimensional models, with two space closure techniques. Six patients with indication for four first premolar extractions were selected, tomographed (T0) and randomly assigned to two groups. For Group 1 (n=3) premolar extraction space closure was performed in one-stage (en masse retraction) and for group 2 (n=3) in two stages (canine retraction followed by incisor retraction). After complete space closure, a new tomograph was taken (T1). The three-dimensional models, in T0 and T1, for both groups were superimposed to describe and quantify first molar movement. Incisor retraction was evaluated in two dimensions. The upper and lower molars in group 1 presented bodily mesial movement, while those in group 2, presented greater crown than root movement, demonstrating mesial crown tipping. When the amount of mesial molar movement was compared between the two groups, a greater mesial root movement was observed for upper molars in group 1 (p=0.009). However, in both groups the upper molars rotated aroung the palatal root. In the lower arch, a greater mesial crown movement was observed in group 2 (p=0.015). Incisor movement analysis presented similar variations for linear and angular measurements for upper incisors in both groups. In contrast, the angular measurements for the lower incisors demonstrated more torque control in group 2. The treatment time for all patients in the sample was greater than 30 months, with the exception of one patient, who presented treatment time smaller than 24 months. In conclusion, anchorage loss ocurred by bodily movement in en masse space closure and by mesial crown tipping in two-stage space closure, in both arches. In addition, there might be greater mesial root movement for upper molars in en masse space closure and greater mesial crown movement in two-stage space closure. It can also be suggested that there are no differences in upper incisor retraction and there is greater lower incisor uprighting in two-stage space closure.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / As más oclusões de Classe I com biprotrusão dentária são caracterizadas pela projeção dos incisivos superiores e inferiores e podem ser corrigidas com extrações de primeiros pré-molares, permitindo reposicionar os incisivos, usando como ancoragem os dentes posteriores. Esse trabalho teve como objetivo comparar, por meio de superposição de modelos tridimensionais, a movimentação de molares e de incisivos com duas técnicas para fechamento de espaços. Foram selecionados, tomografados (T0) e distribuídos, aleatoriamente em dois grupos, seis pacientes com indicação de exodontia de quatro primeiros pré-molares. No grupo 1 (n=3) foi feito o fechamento dos espaços das extrações em uma única etapa (fechamento em massa) e no grupo 2 (n=3), em duas etapas (distalização de caninos seguida da retração de incisivos). Após o completo fechamento dos espaços foi solicitada nova tomografia (T1). Os modelos tridimensionais em T0 e T1 para os dois grupos foram superpostos para descrever e quantificar a movimentação ocorrida nos primeiros molares. A retração de incisivos foi avaliada de maneira bidimensional. Os molares superiores e inferiores do grupo 1 sofreram movimentação mesial de translação, enquanto os do grupo 2, apresentaram deslocamento de coroa maior do que de ápice radicular, demonstrando movimento de inclinação mesial de coroa. Ao se comparar o movimento mesial dos molares entre os dois grupos, observou-se que no grupo 1 houve maior movimentação mesial da raiz mésio-vestibular dos molares superiores (p=0,009). No entanto, em ambos os grupos os molares superiores giraram sobre a raiz palatina. No arco inferior verificou-se maior movimento mesial de coroa para o grupo 2 (p=0,015). A análise da movimentação dos incisivos apresentou variações semelhantes para as medidas lineares e angulares dos incisivos superiores nos dois grupos. Já, para as medidas angulares dos incisivos inferiores, observou-se que o grupo 1 apresentou menor controle de torque. O tempo de tratamento de todos os pacientes da amostra foi superior a 30 meses, exceto um paciente que apresentou tempo de tratamento inferior a 24 meses. Pôde-se concluir que a perda de ancoragem ocorreu por movimento de translação no fechamento de espaços em massa, e por inclinação mesial no fechamento de espaços em duas etapas, para ambos os arcos. Parece haver maior movimentação mesial radicular nos molares superiores no fechamento em massa e maior movimento mesial de coroa dos molares inferiores para o fechamento em duas etapas. Sugere-se que não há diferença na retração dos incisivos superiores e maior retroinclinação dos incisivos inferiores no fechamento de espaços em duas etapas. / Class I malocclusions with dental biprotrusion are characterized by the projection of upper and lower incisors and can be corrected with extractions of four first premolars, allowing incisor retraction using the posterior teeth as anchorage. The purpose of this research was to compare the movement of molars and incisors, by superimpostions of three-dimensional models, with two space closure techniques. Six patients with indication for four first premolar extractions were selected, tomographed (T0) and randomly assigned to two groups. For Group 1 (n=3) premolar extraction space closure was performed in one-stage (en masse retraction) and for group 2 (n=3) in two stages (canine retraction followed by incisor retraction). After complete space closure, a new tomograph was taken (T1). The three-dimensional models, in T0 and T1, for both groups were superimposed to describe and quantify first molar movement. Incisor retraction was evaluated in two dimensions. The upper and lower molars in group 1 presented bodily mesial movement, while those in group 2, presented greater crown than root movement, demonstrating mesial crown tipping. When the amount of mesial molar movement was compared between the two groups, a greater mesial root movement was observed for upper molars in group 1 (p=0.009). However, in both groups the upper molars rotated aroung the palatal root. In the lower arch, a greater mesial crown movement was observed in group 2 (p=0.015). Incisor movement analysis presented similar variations for linear and angular measurements for upper incisors in both groups. In contrast, the angular measurements for the lower incisors demonstrated more torque control in group 2. The treatment time for all patients in the sample was greater than 30 months, with the exception of one patient, who presented treatment time smaller than 24 months. In conclusion, anchorage loss ocurred by bodily movement in en masse space closure and by mesial crown tipping in two-stage space closure, in both arches. In addition, there might be greater mesial root movement for upper molars in en masse space closure and greater mesial crown movement in two-stage space closure. It can also be suggested that there are no differences in upper incisor retraction and there is greater lower incisor uprighting in two-stage space closure.

Ziel: Das Ziel dieser Studie war es den Zusammenhang zwischen Zahnextraktionen und Patientenfaktoren in 3 Deutschen Zahnarztpraxen zu untersuchen. Material & Methoden: In einer retrospektiven Auswertung aller Patientenkarten von 3 deutschen Zahnarztpraxen wurden Extraktionsfälle ab Januar 2007 (Praxis 1), Mai 2010 ( Praxis 2) und Januar 2010 ( Praxis 3 ) auf Extraktionen hin durchsucht, bis in jeder Praxis jeweils 100 Extraktionspatienten gefunden wurden, die die Einschlusskriterien erfüllten. Alle Patienten ohne Extraktionen die innerhalb dieses Zeitraumes behandelt wurden und die die Einschlusskriterien erfüllten, dienten als Kontrollgruppe. Es wurden nur Patienten eingeschlossen (Fall und Kontrollgruppe), von denen die spezifischen Patientendaten zur Verfügung standen. Alle Patientendaten wurden in einem „Case-Report-Form\"-Formular (CRF) erfasst. Die individuellen Parameter der Patienten der Fallgruppe und der Kontrollgruppe wurden verglichen. Mittels schrittweiser logistischer Regressionsanalyse konnten die Faktoren für ein Extraktionsrisiko bestimmt werden. Ergebnisse: Insgesamt wurden 2174 Patientenakten untersucht (Fallgruppe 300; Kontrollgruppe 1874). Die Gesamtsumme der Zähne vor der Extraktionstherapie betrug 54316. In der Fallgruppe wurden insgesamt 459 Zähne extrahiert. Die Patienten der Fallgruppe waren im Schnitt mehr als 6,7 Jahre älter als die Patienten der Kontrollgruppe(52,4/45,7 Jahre (P< 0,001)), sie waren zu einem größeren Anteil männlich. (58/ 52%) ,es gab eine höhere Zahl an Rauchern, es gab vermehrt Patienten mit einer Kalziumkanalblocker Medikation [15/8 % (p<0,001)] und der parodontale Befund festgestellt mittels PSI der Fallgruppe war schlechter als der der Kontrollgruppe [PSI 2,5/1,8 , (p<0,001)]. Das Risiko einer Zahnextraktion im Allgemeinen und in Folge von Parodontalerkrankungen waren assoziiert mit Kalziumkanalblockermedikation, (OR 1,49/1,65) aktivem Rauchen (OR 1,35/1,71), Alter (10Jahre) OR 1,13/1,37 , Praxis Nr.1 (1,48/1,99) und der Anzahl der Sextanten mit dem PSI Code 4 (1,33/1,76) (p<0,001). Schlussfolgerung: Kalziumkanalblockermedikation, aktives Rauchen, Alter, Zahnarzt und die Anzahl der Sextanten mit einem PSI Wert 4 sind Risikoindikatoren für Zahnextraktionen. Nutzen : Kalziumkanalblockermedikation kann das Extraktionsrisiko erhöhen. Zahnverlust zieht in den meisten Fällen Zahnersatz nach sich, welcher in aller Regel aufwändig ist, den Patienten zusätzliche Belastungen abverlangt und die Kosten einer Therapie erhöht. Die Information über die Einnahme von Kalziumkanalblockern ist ein leicht zu erfassender Parameter und könnte als Indikator genutzt werden, um Betreuungsintervalle zu verkürzen. Es muss jedoch noch geprüft werden, ob eine intensivere Betreuung dieser Patienten deren Zahnextraktionsrate tatsächlich verringern kann.