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Adis posted an update
Extracted root tip #22, did 3-4mm of Alveoloplasty in lower incisor area and placed 2 implants yesterday. Uneventful procedure, not really excessive bleeding. 50Ncm for both implants so I placed locator attachments and did a Mucropren Soft liner in relief holes.
On postop call last night and he said after he ate he took his denture out and couldn’t get it back in. Then proceeded to have hot coffee and now he was bleeding…*/a!aadfakl. I told him to apply pressure and sleep with head elevated. And to avoid chewing and especially hot coffee!
He shows up at 8am this morning after he went to the ER at midnight. They did not do anything there except tell him that his Eliquis should have been stopped before dental surgery. This is the first time he told us he is on a blood thinner, not marked on any paperwork and never mentioned otherwise.
Here’s what he looked like. It was mostly oozing next to the #23 locator. I infiltrated with some LA and swaped the locator for a healing abutment with composite to make it thicker – stopped the bleed instantly. Kept him for an extra 15min to make sure it stopped and he was good to go take a nap.
Jedediah, Cayleen and 2 others7 Comments-
DUDE this is enough to give me some instant grey hair. Sounds like this one was the perfect storm. I am glad that you managed it really well. Were you nervous? Sounds like you handled that like a pro. How is the patient now?
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Not really nervous, it was just oozing out around the locator. I probably would have been if it was filling his mouth with blood.
I just thought of what is the simplest fix, pressure wasn’t working, infiltration with LA epi wasn’t working, so I thought of a thickened healing abutment. Next I probably would’ve talked to his PCP about stopping Eliquis and maybe called for advice by OS or posted on here…glad it worked. I check on him last night and no bleeding since the appointment.
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Way to go. Sounds like you handle it very well. Always something to learn from this for all of us to get better for our own patients and others. I’m always skeptical of the medical history that it’s accurate, so I always ask my own questions, in addition, such as if they smoke or diabetic, or on any medication’s. Always a good habit to get into. Well done.
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I’m also skeptical of patients following post op instructions. I’ve had people tell me that the non-resorbable membrane I placed raises up when they put their fingernail under it…*&#$#$JEP#HR#IUH
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🤦♂️🤦♂️🤦♂️
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Do u have issues going straight to healing abutment and pt chewing on their abutments?
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Not that I’m aware of. For me it all depends on the initial stability and quality of bone. If it’s the anterior mandible and there’s plenty of bone around I think some stimulus during osseointegration actually helps – hence the soft liner that stays soft for locator cases. And for dentate cases the healing abutment is well below the plane of occlusion so whatever pressure gets to it I’m not too worried about. I do always instruct patients to not mess with it with their tongue and to not flick it with their finger – you never know with people…
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