CDA Essentials 2017 • Volume 3 • Issue 4

S upporting Y our P ractice discontinuation, limiting any conclusion regarding the effectiveness of these agents in preventing postoperative bleeding as stated in the American College of Chest Physicians’ guideline. 10 The 2 studies that evaluated warfarin continuation versus discontinuation 2 days before extractions 17,22 did not report any significant difference in postoperative bleeding between the groups, supporting the conclusion that dental extractions can be performed safely without alteration of warfarin dose if INR is within the therapeutic range. Whether to discontinue warfarin therapy is a question of balancing the risk of thromboembolism associated with stopping warfarin with the risk of bleeding associated with continuing warfarin. The perceived risk of bleeding has caused many clinicians, including dentists, to interrupt warfarin therapy before surgical interventions. 30,31 However, the results of this systematic review indicate that the risk of postoperative bleeding is not significant after dental extractions. In the reviewed studies, most bleeding occurred within 1 week of dental extraction, was minor in nature and was successfully treated with local measures. In addition, no thromboembolic event was reported in any of the included studies. Fatal or non-fatal thromboembolic events after a short-term withdrawal of warfarin have been reported in several past studies; the incidence of such events varied from 0.02% to 1% and the duration of withdrawal varied from 2 to 30 days or was unknown. 30-36 Finally, this review is limited to patients who were taking warfarin only and does not consider the new generation of oral anticoagulants (e.g., dabigatran, rivaroxaban and apixaban), which are more effective than warfarin, have fewer side effects and are increasingly used to prevent thromboembolism. 37-39 In contrast to warfarin, these medications do not require regular INR monitoring and do not have an antidote in case of bleeding. 39 Conclusion The results indicate that a patient whose INR is within the therapeutic range can safely continue taking the regular dose of warfarin. Local hemostatic agents were not significantly different in reducing the risk of postoperative bleeding, except for gelatin sponges, which appear superior to histoacryl glue. There is no evidence to support or reject the superiority of local hemostatic agents to warfarin discontinuation. a T h e l e a d e r i n m a T r i x s y s T e m s Ultra Adaptive Wedges Combining Soft-Face ™ adaptive materials, a firm inner core and advanced mechanical features to produce a wedge that truly works. Every time. A real softie 3D Fusion’s Soft-Face over-mold allows the wedge to do what no other wedge can truly do – actually adapt to interproximal irregularities. Get a grip The universal gripping block gives you absolute control of the wedging process whether you’re using a cotton pliers, hemostat or “pin” tweezers. Use what you like – 3D Fusion has you covered. Fins with serious function Soft retentive fins smoothly fold down during wedge insertion and then spring back when clear of the interproximal space. Wedge back- out is a thing of the past. No pain – all gain The upturned ski-like tip and soft radius edges glide over the rubber dam or papilla for trauma free insertion. Tough on the inside The firm inner skeleton allows for easy insertion and tooth separation just like a traditional wedge. Keep it clean (and dry!) 3D Fusion’s patent pending design easily follows the contours of the teeth sealing things up nice and tight while preventing overhangs. FXK4-M 3D Fusion Wedge Kit — $152 © 2016 Garrison Dental Solutions, LLC NEW! ADCDAEssentials16 Toll-free 888.437.0032 Fax 616.842.2430 ORDER TODAY! 888.437.0032 or contact your authorized Garrison Dealer.