The use of fibrin glue as an operative sealant in dental extraction in bleeding disorder patients

Abstract

Controlling haemorrhage by using a celluloid splint as an adjunctive therapy in patients with bleeding disorders is very beneficial in dental extraction. However, this technique still requires specific replacement therapy. The use of fibrin glue as a local treatment in dental extraction, without the use of any blood product replacement, recommended to improve efficiency in controlling haemorrhage during dental extraction. This method was modified using a combination of celluloid splint and fibrin glue for use in dental extraction in bleeding disorder patients. It was found that this method was effective in controlling bleeding, was cost effective, did not require replacement therapy and posed no risk of viral transmission.

Optimising local therapy during oral surgery in patients with von Willebrand disease: effective results from a retrospective analysis of 63 cases

“…In our study, a single application of FG was used during oral surgery in 15 patients who met the criteria selected, and was effective in most of the cases. In those two cases who had bleeding after oral surgery despite preventive local (FG) and systemic (vWFc) therapy and mouthwashes with TA, a second application of FG was able to stop bleeding without any other therapy, so we confirm that FG is very useful during oral surgery in vWD as shown by earlier studies [ 14, 16, 18].…”

“…More recently, the idea of the use of local therapy with antifibrinolytic agents (epsilon aminocaproic and tranexamic acid) has been reconsidered by several authors [ 15, 17] especially after the introduction of the novel local approach offered by FG [ 14, 16, 18]: by actively increasing local haemostasis, the rate of any systemic therapy could be significantly reduced.…”

“…As described above, we decided to add FG only in case of three or more dental extractions or in case of an extensive curettage, following the experience of others [ 14, 16, 18]. FG is risk‐free and its cost per extraction is reasonable, i.e.…”

“…Recently, a specific review article about vWD, with recommendations for a close collaboration between oral surgeons and haematologists, has been published [ 9]: however, large retrospective or prospective studies are not available until now. Generally, two main approaches have been followed to provide correct haemostasis in congenital Haemophilia A and vWD: the first is based on the use of systemic replacement therapy with DDAVP or FVIII/vWF concentrates; the second is based on improvement of haemostasis at the sites of oral bleeding through local applications of tranexamic acid (TA) and fibrin glue (FG), mainly in addition to or, less frequently, instead of replacement therapy [ 10–18]. We here describe our experience with a standard local prophylactic regimen during oral surgery in 63 consecutive patients with a wide spectrum of vWD types, including the most severe forms of type 1, 2 and 3, over a period of four years.…”

A single high dose of recombinant factor VIIa combining adjuvant therapy for controlling bleeding episodes in haemophiliacs with inhibitors

“…In this study, a single dose of rFVIIa was more effective in preventing the bleeding at the procedure sites than treating the bleeds in the muscles and joints. Additionally, the application of fibrin glue and a dental splint is an effective local measure for ascertaining haemostasis [9]. In addition, oral tranexamic acid has shown an efficacy in dental procedures.…”