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Er:yag Laser assisted Endodontic Surgery in the Era of New Antithrombotic Treatments

Sharonit Sahar Helft*,Adam Stabholtz,David Polak,Mordechai Findler

Background and Objective: The effectiveness of lasers and their use in many fields of dentistry have been reported. To our knowledge, lasers have not been employed to prevent operative bleeding and maintain a sterile surgical field in patients treated with antithrombotics. Furthermore, new generation anticoagulant and antiplatelet treatments have led to a significant increase in the number of individuals under antithrombotic medications, leading to increased risk for bleeding during treatment as well as post-operative hematomas and infections. Our aim was to review current surgical protocols and clinical guidelines for the management of patients using antithrombotic during minor oral surgery, and determine whether lasers may offer an advantage in the clinical management of such cases.
Methods: A literature search for protocols and clinical guidelines for the management of patients treated with antithrombotic medications and its association with excessive bleeding during minor oral surgery was done. Publications which clear relevance to the topic of the current review were included.
Results: 794 relevant publications were identified, of which 29 were with clinical guidelines and 9 were evidence based studies. Relevant information and guidelines from the publications were extracted and summarized. Furthermore, evidence of bleeding and infection control by laser therapy was reviewed to address the possible advantage of such approach in anti-thrombotic treated patients.
Conclusions: Using lasers during intra-oral surgery seems to be beneficial in patients medicated with antithrombotics. The clinical guidelines indicate that anti-thrombotic treatment should not be interrupted for minor oral surgical procedures.