Restoring screw-retained implant prostheses

Based on a review of the literature, I conclude that there is no need to withdraw continuous anticoagulant therapy for non-surgical or surgical dental procedures if the patient's anticoagulation level is within the currently recommended therapeutic range. Dental practitioners should prescribe prophylactic or therapeutic antibiotics only when absolutely necessary for patients, particularly those receiving continuous anticoagulant therapy. Concomitantly administered antibiotics may interact with continuously administered anticoagulants, thus increasing patients' level of anticoagulation. This is especially true with multidose antibiotic therapy, Practitioners should consult with the patient's physician if necessary to determine his or her most recent INR before dental surgery is performed; the INR should not exceed 4.0 or the PTR 2.2. If the patient's anticoagulation level exceeds the therapeutic range, the physician may recommend withdrawing the anticoagulant therapy or reducing the dosage until the level is within the therapeutic range so that dental surgery can proceed safely. Because physicians probably are not familiar with many dental procedures and their associated bleeding risks, it is important for dentists to educate them and supply data that support the continuation of anticoagulant therapy. Dentists have an obligation to their patients to advise continuation of therapeutic levels of anticoagulation, but if the patient and physician insist, then it should be the physician who withdraws the anticoagulant therapy and the dentist who performs the dentistry. Similarly, if more than local measures are required to control bleeding after dental surgery, the physician should administer treatments such as vitamin K. Good surgical technique and appropriate local measures to control bleeding are important for all dental patients, especially those receiving continuous anticoagulant therapy.