Assessment of immediate clotting after flapless extraction using piezosurgery or turbine handpiece in patients receiving dual antiplatelet therapy.

PURPOSE: This study aimed to investigate the efficacy of piezosurgery (PI) in promoting immediate clotting after flapless extraction in patients undergoing dual antiplatelet therapy (DAPT). METHODS: In this randomized controlled trial, 80 DAPT patients were equally divided into the PI and turbine handpiece (TH) groups. Accordingly, flapless extraction of a single tooth using PI or TH was performed on each patient, and the immediate clotting status was evaluated. The results of the preoperative hematological examinations, surgery-related variables and postoperative complications were recorded for analysis. RESULTS: Both groups presented with low platelet aggregation and similar coagulation functions. The PI group exhibited a higher proportion of patients with normal intra-alveolar clotting (≤30 min) (70% vs. 40%, P = 0.007) and fewer intraoperative complications (25% vs. 47.5%, P = 0.036) than that in the TH group. Logistic regression analysis indicated that the applied instrument was an independent risk factor for prolonged immediate bleeding (odds ratio = 3.10, 95% confidence interval: 1.20-8.00, P = 0.019). Intergroup differences were insignificant in terms of the other surgery-related variables and postoperative complications, except for the longer surgical duration in the PI group. CONCLUSION: The application of PI may contribute to better immediate clotting in DAPT patients after flapless extraction compared with the use of TH.

[Axial split osteotomy of free fibular flap for mandibular angle reconstruction: a clinical study].

PURPOSE: To introduce an axial split osteotomy of free fibular flap for mandible angle reconstruction and discuss its indications and surgical technique. METHODS: 16 patients underwent axial split osteotomy of free fibular flap(12 males and 4 females, aged from 23 to 62). 11 patients with benign tumors (8 ameloblastomas and 3 odontogenic keratocyst), 3 patients with osteoradionecrosis, and 2 patients with secondary mandibular deformity were included. The length of free fibular flap ranged from 10-17 cm (mean 14.6 cm). The length of the vascular pedicel ranged from 5-11 cm (mean 8.2 cm). The fibular flap harvested was performed in routine manner. After elevating the periosteum and performing minimal dissection at osteotomy site only, axial splitting was performed using an oscillating saw. The first osteotomy was made on the external surface of the fibula, perpendicular to the main axis of the bone down to the level of the medullary canal. The second osteotomy was made along the main axis of the bone. The length of this osteotomy was between 2 and 3 cm. The last osteotomy was made perpendicular to the internal surface at one junction of the anterolateral and posteromedial surfaces down to the medullary canal, as was done for the first osteotomy. Then the harvested flap was contoured, which was achieved by raising the two bone segments and fitting them together. The angulation was 120 degrees. RESULTS: 16 flaps were monitored by Doppler ultrasound postoperatively and examined by colored ultrasound 3 months, 6 months after operation. The results revealed that the recipient sites healed primarily without complications. CONCLUSIONS: Axial split osteotomy is a reliable technique with maximum contact surface for bone union, and less bone loss, which can lengthen the transplanted bone to a certain extent. It is suitable especially for reconstruction of the defect of the angle of the mandible.