Prospective observational study on the clinical behaviour of dental implants in patients with haemophilia. Preliminary results.

Haemophilia is a recessive congenital hereditary haemorrhagic disorder characterised by the decrease in, or absence of, the functional activity of factor VIII (Haemophilia A) or factor IX (Haemophilia B). The haematological medical treatment for these patients is systemic replacement therapy with factor VIII or factor IX concentrates. Dental implants are considered the gold standard for the replacement of missing teeth. There is no evidence or safe protocol for their use in patients with haemophilia. The objective of this study was to evaluate the clinical osseointegration and the incidence of postoperative bleeding in patients with haemophilia. The patients included in this study were over 18 years old with a diagnosis of haemophilia. A surgical implant protocol was implemented, supported by systemic and local haemostatic measures. Age, type of haemophilia, pre- and post-factor levels, gingival index, surgical duration, oedema, and pain were recorded for each case. In the event of haemorrhage, the bleeding index was determined. At four months, the success of the implant was evaluated using the absence of pain, suppuration, and clinical mobility as parameters. Fifteen surgeries were performed and 21 implants were placed in 10 patients. All the implants were successful in terms of the evaluated parameters. Among the 15 surgeries performed, bleeding was detected in three. The preliminary results found in this study seem to establish that the proposed surgical implant and haemostatic protocol is a predictable treatment for the placement of dental implants in patients with haemophilia.

Effect of bismuth subgallate (a hemostatic agent) on bone repair; a histologic, radiographic and histomorphometric study in rats.

Bismuth subgallate (BS) is a hemostatic agent used for soft tissue surgery in otorhinolaryngology and dermatology. Its effect on bone repair has not been studied. The present study undertook a quantitative and qualitative evaluation of post-extraction bone healing in the presence of BS. Under intraperitoneal anesthesia, forty male Wistar rats, 80+/-5g body weight, underwent the extraction of both lower first molars. BS was placed in the right post-extraction socket (group E) and the contralateral socket served as control (group C). The animals were killed in groups immediately, 7, 14 and 30 days post-extraction. The mandibles were resected, radiographed and processed for embedding in paraffin. The mesial socket was sectioned along the bucco-lingual axis and stained with hematoxylin-eosin. Total tissue volume and trabecular bone volume of the apical third of the sockets were determined histomorphometrically. At 14 and 30 days post-extraction, group E exhibited bone tissue that resembled that of group C. Histomorphometric analyses showed no statistically significant differences between groups C and E. Bismuth subgallate did not interfere with post-extraction bone healing. Further studies will analyze the effect of this hemostatic agent on bone repair in aniticoagulated rats.

Haemophilic pseudotumour of the mandible: report of three cases.

A haemophilic pseudotumour is basically an encapsulated haematoma. It is an infrequent complication, estimated to affect 1-2% of severe haemophiliacs, although it has also been reported in patients with mild and moderate haemophilia. A history of trauma is reported in most cases, and the onset of symptoms varies from months to years. The majority of haemophilic pseudotumours are seen in adults and occur in long bones (femur, pelvis, tibia). Here are reported three cases of pseudotumour of the mandible in young patients with mild haemophilia A.