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Updated: Jan 23, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
MIDAS (Minimally Invasive Drilling And Styptic) protocol - A modified approach to treating patients under therapeutic
Yazad Gandhi1, Neel Bhatavdekar2
1Oral & Maxillofacial Surgeon, Saifee Hospital, Mumbai, India.
Abstract:
Patients with cardiac or allied medical conditions mandating long term oral anticoagulant therapy form a sizeable database in an implant practice today. The management of such patients during surgical and dental procedures has always been debatable. Literature has documented evidence that indicates towards stopping the anticoagulant for a finite period. However, discontinuing anticoagulants is not always possible, given the risks of greater significance than the edentulous state. In such patients a minimally invasive flapless approach is preferred, having the potential to reduce bleeding, surgical time and postoperative edema. The purpose of this case series is to show a possible modified approach for dental implant placement using a CAD-CAM stent guided flapless approach without stopping of therapeutic anticoagulant medication.
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