Effectiveness of Biphasic Calcium Sulfate Cement for the Prevention of Local Bleeding After Oral Surgery in Patients on Anticoagulants

INTRODUCTION AND AIM: Anticoagulant therapy with dihydroxycoumarin derivatives (DD) is often related to local bleeding during oral surgery. The purpose of this study was to determine whether 3D Bond® (Augma Biomaterials, Katzir, Israel), a biphasic calcium sulfate regenerative bone cement, allows for the management of bleeding during and after oral surgery without discontinuation of anticoagulant therapy. The aim of the study was to investigate whether 3D Bond® biphasic calcium sulfate cement is effective in supporting local hemostasis and wound healing in patients using chronic anticoagulant therapy (dihydroxycoumarin derivatives, DD). METHODS: The study was divided into a control group and a study group. Disorders of plasma coagulation parameters were confirmed in both groups one day prior to surgery by a standard international normalized ratio (INR) test. The control group consisted of 20 patients with cardiovascular diagnoses who were discontinued on their anticoagulation therapy before extractions of erupted teeth, impacted teeth, and roots. In the study group, 20 patients with various cardiological disorders underwent extractions of erupted teeth, impacted teeth, and roots without anticoagulant treatment discontinuation. 3D Bond® was used topically with a single suture and applied compression in the study group. In the control group, standard collagen sponge compression was utilized. Sutures were removed seven to 10 days after tooth extraction. The visual assessment of bleeding was performed five times within 10 days after surgery. Wound healing and pain following surgery for 10 days were also evaluated in both groups. RESULTS: Clinical evaluation of the study group revealed no local bleeding in 19 patients (95%) during follow-up. Local bleeding was observed in one patient (5%) at day three; however, it was residual. In the control group, no local bleeding was noted in 16 patients (80%) during follow-up. Local bleeding was observed in four patients (20%) in the control group at day three. All wounds were properly healed, except for the four patients with local bleeding (20%) in the control group. CONCLUSIONS: 3D Bond®, which consists of 100% biphasic calcium sulfate bone cement, is effective in inhibiting localized bleeding following oral surgery without requiring discontinuation of dihydroxycoumarin derivative medication. In addition, the clinical effectiveness of 3D Bond® in socket preservation of post-extraction alveolar sockets was observed and is comparable with other biphasic calcium sulfate cements. CLINICAL RELEVANCE: Many patients are prescribed anticoagulants by their physician as part of their ongoing health management. This often leads to bleeding during and following dental surgery, such as extractions, soft-tissue procedures, and implant-related treatment. Discontinuing or decreasing the patient's anticoagulants poses potential medical risks. Utilization of 3D Bond®, a biphasic calcium sulfate regenerative bone cement, allows management of bleeding during and after those dental procedures that may cause bleeding while continuing the patient on the prescribed anticoagulants.