Hemorrhagic diatheses–adapted from Vezeau [15] and Goswami et al. [16].
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"2134",leadTitle:null,fullTitle:"Oxidative Stress and Diseases",title:"Oxidative Stress and Diseases",subtitle:null,reviewType:"peer-reviewed",abstract:"The development of hypothesis of oxidative stress in the 1980s stimulated the interest of biological and biomedical sciences that extends to this day. The contributions in this book provide the reader with the knowledge accumulated to date on the involvement of reactive oxygen species in different pathologies in humans and animals. The chapters are organized into sections based on specific groups of pathologies such as cardiovascular diseases, diabetes, cancer, neuronal, hormonal, and systemic ones. A special section highlights potential of antioxidants to protect organisms against deleterious effects of reactive species. This book should appeal to many researchers, who should find its information useful for advancing their fields.",isbn:null,printIsbn:"978-953-51-0552-7",pdfIsbn:"978-953-51-5282-8",doi:"10.5772/2535",price:159,priceEur:175,priceUsd:205,slug:"oxidative-stress-and-diseases",numberOfPages:626,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"dfa7002beaf617a62594a235a9fe5dfd",bookSignature:"Volodymyr I. Lushchak and Dmytro V. 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Lushchak graduated from Lomonosov Moscow State University (Soviet Union) in 1982. In 1986 he defended Ph.D. and in 2002 D.Sc. dissertations, and in 2004 obtained full professor title. In 1987-1998 he worked in Southern Seas Biology Institute of Academy of Sciences of Ukraine, and in 1998 joined Vassyl Stefanyk Precarpathian National University in Ivano-Frankivsk (Ukraine), where currently he is a head of Department of Biochemistry and Biotechnology. He also worked at Universities of Canada, Brazil, United Kingdom, Finland, Poland, Sweden and Germany. The scientific interests of Dr. Lushchak are related to effects of environmental conditions and molecular aspects of adaptive responses in bacteria, fungi, plants and animals. Although interested in general aspects of metabolism regulation, his interests are mainly focused on the homeostasis of reactive species of oxygen, nitrogen and carbon.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Vasyl Stefanyk Precarpathian National University",institutionURL:null,country:{name:"Ukraine"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"115540",title:"Dr.",name:"Dmytro V.",middleName:null,surname:"Gospodaryov",slug:"dmytro-v.-gospodaryov",fullName:"Dmytro V. Gospodaryov",profilePictureURL:"https://mts.intechopen.com/storage/users/115540/images/5400_n.jpg",biography:"Dr. Dmytro V. Gospodaryov graduated from the Chernivtsi National University named after Yuriy Fedkovych (Ukraine) in 2001. In 2005, he defended Ph.D. thesis “Protein And Lipid Oxidation In The Yeast Saccharomyces Cerevisiae And The Role Of Catalases In Its Prevention” supervised by Prof. V. Lushchak. Since 2004, Dmytro Gospodaryov has been working as an Assistant Professor at Department of Biochemistry and Biotechnology of Stefanyk Precarpathian National \nUniversity in Ivano-Frankivsk. Dr. Gospodaryov’s scientific interests of are related to metabolic conditions which can induce and aggravate oxidative stress (e.g., deficiencies in antioxidant or related enzymes). He is also interested in oxidative stress induced by abnormalities in transition metal metabolism or by influence of high concentrations of transition metals.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Vasyl Stefanyk Precarpathian National University",institutionURL:null,country:{name:"Ukraine"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"412",title:"Cardiology",slug:"cardiology"}],chapters:[{id:"35940",title:"Introductory Chapter",doi:"10.5772/39293",slug:"introduction-chapter",totalDownloads:2311,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Volodymyr I. Lushchak and Dmytro V. 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Martins",slug:"luiz-g.-a.-martins"},{id:"23470",title:"MSc.",name:"Leonardo S.",middleName:null,surname:"Alt",fullName:"Leonardo S. Alt",slug:"leonardo-s.-alt"}]},{id:"15016",title:"Cryptography in Quantum Cellular Automata",slug:"cryptography-in-quantum-cellular-automata",signatures:"Mohammad Amin Amiri, Sattar Mirzakuchaki and Mojdeh Mahdavi",authors:[{id:"22708",title:"MSc.",name:"Mohammad Amin",middleName:null,surname:"Amiri",fullName:"Mohammad Amin Amiri",slug:"mohammad-amin-amiri"},{id:"60978",title:"Dr.",name:"Sattar",middleName:null,surname:"Mirzakuchaki",fullName:"Sattar Mirzakuchaki",slug:"sattar-mirzakuchaki"},{id:"60979",title:"MSc.",name:"Mojdeh",middleName:null,surname:"Mahdavi",fullName:"Mojdeh Mahdavi",slug:"mojdeh-mahdavi"}]},{id:"15017",title:"Research on Multi-Dimensional Cellular Automation Pseudorandom Generator of LFSR Architecture",slug:"research-on-multi-dimensional-cellular-automation-pseudorandom-generator-of-lfsr-architecture",signatures:"Yong Wang, Dawu Gu, Junrong Liu, Xiuxia Tian and Jing Li",authors:[{id:"22575",title:"Dr.",name:"Yong",middleName:null,surname:"Wang",fullName:"Yong Wang",slug:"yong-wang"},{id:"24085",title:"Prof.",name:"Dawu",middleName:null,surname:"Gu",fullName:"Dawu Gu",slug:"dawu-gu"},{id:"24086",title:"Dr.",name:"Junrong",middleName:null,surname:"Liu",fullName:"Junrong Liu",slug:"junrong-liu"},{id:"24087",title:"Dr.",name:"Xiuxia",middleName:null,surname:"Tian",fullName:"Xiuxia Tian",slug:"xiuxia-tian"},{id:"24088",title:"Dr.",name:"Jing",middleName:null,surname:"Li",fullName:"Jing Li",slug:"jing-li"}]},{id:"15018",title:"An Improved PRNG Based on the Hybrid between One- and Two- Dimensional Cellular Automata",slug:"an-improved-prng-based-on-the-hybrid-between-one-and-two-dimensional-cellular-automata",signatures:"Sang-Ho Shin and Kee-Young Yoo",authors:[{id:"20812",title:"Dr.",name:"Sang-Ho",middleName:null,surname:"Shin",fullName:"Sang-Ho Shin",slug:"sang-ho-shin"},{id:"137022",title:"Dr.",name:"Kee-Young",middleName:null,surname:"Yoo",fullName:"Kee-Young Yoo",slug:"kee-young-yoo"}]},{id:"15019",title:"A Framework of Variant Logic Construction for Cellular Automata",slug:"a-framework-of-variant-logic-construction-for-cellular-automata",signatures:"Jeffrey Z.J. Zheng, Christian H.H. Zheng and Tosiyasu L. Kunii",authors:[{id:"20706",title:"Dr.",name:"Jeffrey",middleName:"Zhi Jie",surname:"Zheng",fullName:"Jeffrey Zheng",slug:"jeffrey-zheng"},{id:"20714",title:"Mr.",name:"Christian",middleName:null,surname:"Zheng",fullName:"Christian Zheng",slug:"christian-zheng"},{id:"24213",title:"Prof.",name:"Tosiyasu",middleName:null,surname:"Kunii",fullName:"Tosiyasu Kunii",slug:"tosiyasu-kunii"}]},{id:"15020",title:"Using Probabilistic Cellular Automaton for Adaptive Modules Selection in the Human State Problem",slug:"using-probabilistic-cellular-automaton-for-adaptive-modules-selection-in-the-human-state-problem",signatures:"Martin Lukac, Michitaka Kameyama and Marek Perkowski",authors:[{id:"3279",title:"Mr.",name:"Martin",middleName:null,surname:"Lukac",fullName:"Martin Lukac",slug:"martin-lukac"},{id:"23507",title:"Prof.",name:"Michitaka",middleName:null,surname:"Kameyama",fullName:"Michitaka Kameyama",slug:"michitaka-kameyama"},{id:"23508",title:"Prof.",name:"Marek",middleName:null,surname:"Perkowski",fullName:"Marek Perkowski",slug:"marek-perkowski"}]},{id:"15021",title:"Design of Self-Assembling, Self-Repairing 3D Irregular Cellular Automata",slug:"design-of-self-assembling-self-repairing-3d-irregular-cellular-automata",signatures:"David Huw Jones, Richard McWilliam and Alan Purvis",authors:[{id:"23559",title:"Dr.",name:"David Huw",middleName:null,surname:"Jones",fullName:"David Huw Jones",slug:"david-huw-jones"},{id:"23560",title:"Dr.",name:"Richard",middleName:null,surname:"McWilliam",fullName:"Richard McWilliam",slug:"richard-mcwilliam"},{id:"23561",title:"Prof.",name:"Alan",middleName:null,surname:"Purvis",fullName:"Alan Purvis",slug:"alan-purvis"}]},{id:"15022",title:"Cellular Automata for Medical Image Processing",slug:"cellular-automata-for-medical-image-processing",signatures:"Sartra Wongthanavasu",authors:[{id:"22205",title:"Dr.",name:"Sartra",middleName:null,surname:"Wongthanavasu",fullName:"Sartra Wongthanavasu",slug:"sartra-wongthanavasu"}]},{id:"15023",title:"Accelerating 3D Cellular Automata Computation with GP GPU in the Context of Integrative Biology",slug:"accelerating-3d-cellular-automata-computation-with-gp-gpu-in-the-context-of-integrative-biology",signatures:"Jonathan Caux, Pridi Siregar and David Hill",authors:[{id:"21948",title:"Prof.",name:"David R.C.",middleName:null,surname:"Hill",fullName:"David R.C. 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All surgical procedures, including dental surgery, present risk of complications, which may include pain, nerve injury, swelling, infections, and hemorrhage. Dental surgery is defined as any dental intervention including an incision in the oral mucosa or gingiva, including anything from a simple dental extraction to alveoloplasties [1]. Bleeding control is an important step during dental surgery procedures [2] because excessive bleeding complicates surgery and increases the risk of morbidity. To avoid such complications when long-lasting bleeding occurs, despite the proper use of traditional techniques for hemorrhage control, a broad range of hemostatic agents are available, as adjunctive measures to enhance hemostasis in the course of dental surgeries [3]. Despite the expressive rise in the amount and types of topical hemostats in the past decade, high-level evidence regarding the management of these agents during bleeding in dental surgery is still lacking.
\nThe periprocedual management of patients receiving therapeutic anticoagulation represents a challenge for dental practitioners, as the risk of bleeding must be counterbalanced against the risk of systemic or local thromboembolic phenomena. Recommendations for dental interventions in individuals receiving anticoagulation therapy remain quite unclear, in spite of practice guidelines from both dental [4] and medical [5] fields.
\nThis chapter aims to discuss the effective ways of managing bleeding complications in dental surgery, mainly in high-risk patients. The role of biosurgical materials to prevent or solve these complications, during and after dental surgery procedures, will also be addressed, as well as their modes of action, practical applications, adverse effects, and effectiveness.
\nThe physiological mechanism that prevents and hinders bleeding at the area of an injury while preserving regular blood flow everywhere else in the circulation is called hemostasis [6]. The hemostasis process has two major components. Primary hemostasis initiates promptly after vascular injury, and it can be divided into four consecutive and superposed stages: (A) vasoconstriction, (B) platelet adhesion, (C) platelet activation, and (D) platelet aggregation [7, 8, 9, 10]. Primary hemostasis results in the formation of a platelet plug [10]. Secondary hemostasis comprises a sequence of serine protease zymogens and their cofactors, which interact successively on phospholipid surfaces (damaged endothelial cells or platelets), leading to the development of covalently cross-linked fibrin [10, 11, 12]. This cross-linked fibrin mesh is then incorporated into and around the platelet plug. It strengthens and stabilizes the blood clot. These two processes are intertwined and occur at the same time [6]. These systems are regulated by multiple anticoagulant mechanisms, which are responsible for maintaining blood fluidity in the absence of injury, generating a clot that is consistent with the trauma. Hemostasis and the avoidance of bleeding or thrombosis are directly related to the adequate balance between procoagulant and anticoagulant systems [6].
\nHemorrhage in dental surgery can be categorized as:
Primary hemorrhage: bleeding occurs during surgery
Reactionary hemorrhage: bleeding occurs 2–3 hours after surgery
Secondary hemorrhage: bleeding occurs until 14 days after surgery, probably due to an infection
Hemorrhage can also be categorized according to the area injured: vascular, bone, and soft tissue [13, 14]. Bleeding diathesis is an unusual susceptibility to bleeding and may be genetic, autoimmune, or acquired (Table 1) [15, 17]. Selected bleeding disorders will be covered in this chapter.
\n\nThe most prevalent hereditary bleeding disorders are von Willebrand disease and hemophilia, affecting 1% of the population and 20,000 people in the USA, respectively [18, 19, 20, 21, 22]. Dental patients presenting inherited bleeding present a significantly higher risk of perioperative bleeding. The frequency and severity of bleeding are related to disease-related factors, such as the severity of the hemophilia. Factors related to the patient include the level of periodontal disease, vasculopathy or platelet dysfunction, and procedure-related factors (teeth extracted—type and the number—or the size of the wound area) [23].
\nOne example of autoimmune bleeding diathesis is the immune thrombocytopenic purpura (ITP), an idiopathic thrombocytopenic purpura condition, characterized by isolated thrombocytopenia without a clinically apparent cause [24].
\nThe most common acquired bleeding diathesis is the one related to hemostasis-altering medications. Anticoagulant agents are among the most prescribed medications in the USA [25]. For decades, anticoagulants have been prescribed to prevent arterial and venous thromboembolism [1]. Prolonged bleeding and bruising are some of the adverse events related with these medications [4]. The most frequently used drugs are therapeutic platelet inhibitors, vitamin K antagonists, or direct oral anticoagulants. Patients susceptible to hemorrhage may present severe bleeding resulting from dental surgery procedures. The use of biosurgical hemostatic agents to decrease or control bleeding may be beneficial for patients at risk for bleeding diathesis.
\nBleeding complications can occur either in healthy or systemically compromised patients. Some patients tend to bleed excessively during or after dental surgery, due to different factors, such as anticoagulant therapy, inherited bleeding disorders, uncontrolled hypertension, extreme trauma to soft tissues, and non-compliance to postoperative recommendations. In these cases, the use of an effective hemostatic agent enhances hemostasis, providing a wide spectrum of benefits, such as superior management of the anticoagulated patient, shorter operation time, as well as smaller wound exposure and shorter recovery time.
\nThe ideal topical hemostatic agent should be biocompatible, affordable, and effective [14, 26, 27]. In recent years, the number of different topical hemostatic agents has increased significantly (Table 2). Knowledge and familiarity with the wide range of topical hemostatic agents available are essential for dental practitioners, including their effectiveness, mode of action, and adverse effects. A well-informed professional will be able to opt for the most effective and practical agent for each situation. In relation to the use of local hemostatic in dental procedures, available scientific data is not homogenous. Most publications use one or more local hemostatic agents to compensate for the anticoagulant effect and prevent postoperative bleeding [29]. The most common local biosurgical hemostatic agents used in dentistry and approved by the Food and Drug Administration (FDA) are listed in Table 2.
\nTypes and trade name of some biosurgical agents–adapted from Pereira et al. [28].
Local biosurgical hemostatic agents can be classified into (A) passive or mechanical, (B) active, and (C) flowables [30].
\nConsidered as the most effective agents for small amounts of bleeding, passive or mechanical agents provide platelet activation and aggregation. This results in a matrix formation in the bleeding area that works as a barrier to stop bleeding, by activating the extrinsic clotting pathway and providing a surface that will allow coagulation to occur faster [30]. As these agents are biologically inactive, they rely on the individual’s own fibrin production to attain hemostasis. Passive hemostats are only indicated for individuals with an unscathed coagulation cascade [27]. They are generally applied as frontline agents, since they are readily available, do not require special storage or handling, and are relatively affordable [14, 27, 31].
\nGelatin is a hydrocolloid derived from acid partial hydrolysis of purified animal collagen. It is presented as a gelatin sponge, powder (mixed to form a paste), or film. Gelatin can be placed dry or after moistening it with saline [14, 28, 32, 33]. Gelatin-based products adapt effortlessly to wounds making it appropriate for application into irregular surfaces [27]. Although their mode of action is not completely understood, gelatin-based products likely act more physically than chemically in the coagulation cascade [28, 34]. Affordability, ease of use and good hemostatic activity make topical hemostats with gelatin matrix a popular tool for reducing the morbidity caused by hemorrhage [27, 28] after dental extractions and periodontal surgeries.
\nThe most popular absorbable gelatin sponge in dentistry is Gelfoam®. It is a hemostatic compressed sponge obtained from purified porcine skin gelatin. Gelfoam® is capable of absorbing many times its weight of whole blood [35]. Generally, when applied in soft tissues, its complete absorption occurs within 4–6 weeks.
\nCollagen absorbable products are nontoxic and non-pyrogenic. They are sourced from either bovine dermal collagen or bovine tendon. Collagen hemostats provide a matrix for clot formation and consolidation. These products also improve clotting factor release and platelet aggregation and degranulation, thereby breaking up clot formation. Their presentation in sheets and flours allows for easy adaptation and adhesion to irregular surfaces. Although they are commercialized at a higher price than gelatin-based hemostats, hemostasis can usually be accomplished relatively quicker (1–5 min). Collagen absorbable products are easily removed, reducing the risks of rebleeding and the need for various applications. They are absorbed in 8–10 weeks if remained in place. Adverse effects linked to bovine collagen products might include swelling and allergic reaction [30].
\nHelistat® is a collagen-based product originated from purified and freeze-dried bovine flexor tendon and is available as a spongelike structure [14, 27]. Helistat® can hold many times its own weight of fluid, as it is highly absorbent. Collagen induces platelet agglomeration when in contact with blood. In order to achieve hemostasis, Helistat® must be kept at the site (approximately 2–5 minutes). Subsequently, it can be removed, replaced, or left in place. It is easily manipulated, and it must be handled dry, and any excess must be removed. Complete reabsorption occurs within 14–56 days [14, 27, 36]. Helistat® may foster bacterial growth, acting as a nidus for abscess formation [14, 27, 37]; therefore, it should not be placed in wounds with any kind of contamination or infection. Possible adverse reactions of Helistat® or similar products are allergic reaction, foreign body reaction, and adhesion formation [27, 38].
\nSimple oxidized cellulose was first introduced in the early 1940s in the USA. In the 1960s, a new topical hemostatic-oxidized regenerated cellulose (ORC) was launched as a meshwork made from treated and sterilized cellulose—Surgicel®. ORC products are originated from vegetal-based alpha cellulose, available in absorbable knitted fabrics (low or high density), and prepared as sterile fabric meshworks. They are ready-to-use products that may be kept at room temperature and absorb 7–10 times its own weight [27, 30]. ORC cause contact activation and platelet activation, and, when absorbed, a gelatinous mass is created, assisting in the establishment of the clot formation [30]. Thrombin is ineffective with these agents due to low-pH factors. ORC are utilized in the management of capillary, venous, and small arterial bleeding, and they require dry application, without addition of saline or thrombin [27, 39] and are absorbed within 4–8 weeks, depending on the volume applied, the tissue bed, and the magnitude of blood saturation [27, 40, 41, 42]. To prevent delayed healing, excessive volumes should be removed [27]. ORC should not be used in osseous defects as it may intervene with bone regeneration [14, 27, 31]. Adverse effects also include reactions related to the acidic nature of ORC. This characteristic may induce necrosis and inflammation of the surrounding tissue and makes thrombin inefficient with these agents. When left in the wound, they may lead to fluid encapsulation and foreign body reaction [14, 27].
\nThe most common commercial products in this category are Surgicel®, Oxycel®, and Surgicel Nu-Knit®. Surgicel® and Surgicel Nu-Knit® come in knit, solid fiber form, whereas Oxycel® comes in knit, hollow fiber form; however, they function basically in a similar manner [30].
\nOxidized cellulose (OC) agents are produced from sterilized and treated cellulose, presented as a meshwork. In the presence of blood, they present a three- to fourfold increase in volume and are converted into gel. OC dissolve completely in 1–2 weeks into biodegradable end products glucose and water, and they do not interfere with wound healing [14, 27].
\nActCel® binds to calcium ions, resulting in more calcium available for the coagulation cascade [14, 27, 37]. Biochemically, it intensifies the coagulation process by increasing platelet aggregation and physically by 3D clot stabilization. ActCel® is especially indicated in third molar extractions, to avoid the occurrence of dry sockets, and in orthognathic and periodontal surgeries [27]. ActCel® is hypoallergenic, as it does not contain collagen, thrombin, or chemical additives. It also has important bacteriostatic properties [27, 43], which are particularity relevant in infected wounds [27].
\nGelita-Cel® is a relatively quick acting, oxidized resorbable cellulose hemostatic gauze of natural origin. It presents a decreased risk for encapsulation, as it resorbs as fast as 96 hours [14, 27, 37].
\nPolysaccharide hemospheres are a fairly new class of topical biosurgical hemostatic agents, produced from vegetable starch, and they contain no animal or human elements. They are commercially presented in powder form. Polysaccharide hemospheres increase barrier formation by creating a hydrophilic effect, dehydrating the blood, and concentrating its solid components [14, 27]. Due to their 3D scaffold, they are devised to enhance clot formation and organization, even in the absence of intrinsic coagulation activity [14, 44, 45]. Polysaccharide hemospheres should be used with caution in diabetic patients, as they consist of sugars [27].
\nArista™AH is the only FDA-approved product in the polysaccharide hemosphere category. It is used in dental surgery as an adjunctive hemostatic agent, when conventional mechanical procedures, such as pressure and ligature, are not effective or practical.
\nHemostatic adhesives are often used as adjuncts to standard hemostatic procedures to control bleeding from surgical areas [30]. One of the most well-known products in this category is BioGlue®. It consists of a solution of 10% glutaraldehyde and 45% bovine albumin solution purified by precipitation, heat, and chromatography radiation [28, 46]. BioGlue® has been extensively used for its sealants and hemostatic characteristics. The risk of leaking through the suture tracks is the main disadvantage of BiolGue® [27]. In the search for newly created adhesives with the chemical features and the safe reabsorptive profile required to benefit dental surgery patients, several clinical trials are currently in process.
\nActive hemostatic agents are biologically active, as they play a direct role in the coagulation cascade, inducing the formation of a fibrin clot [26, 27].
\nThrombin is key to hemostasis, as well as to the inflammatory and cell signaling processes. It is the base of the fibrin clot, fostering the transformation of fibrinogen to fibrin [28]. Topical thrombin hemostats are originated from either bovine or human plasma, and they can also be produced through recombinant DNA techniques [14, 27]. In the past, the only thrombin hemostat available was composed of bovine plasma (Thrombin-JMI). Although it has proven to be efficient in terminating bleeding, bovine thrombin induces an important immune response [28, 47]. Individuals on hemodialysis, with increased levels of antibodies against topical bovine thrombin, had higher incidence of vascular access thrombosis, severe coagulopathy, and bleeding after exposure to bovine thrombin [28, 48]. As an attempt to avoid these hazardous effects, thrombin derived from human plasma (Evithrom®) and recombinant human thrombin (Recothrom®) were developed. In 2010, Browman et al. [49] demonstrated, in a comparative study between recombinant human thrombin and bovine thrombin, that human recombinant thrombin showed the same efficacy in surgical hemostasis, a comparable safety profile, and a remarkably lower immune response than bovine thrombin. Thrombin may be applied topically, as a solution combined with gelatin sponges mixed with a gelatin matrix, as a dry powder, or as a spray [14, 27]. It is commonly used in conjunction with Gelfoam® to stop moderate to severe bleeding.
\nFibrin sealant or fibrin glue originates from bovine and/or human blood components and simulates the last phases of the coagulation cascade, generating a fibrin clot [30]. These agents control local, as well as diffuse, bleeding from the surgical area. Nevertheless, they are ineffective in controlling intense bleeding. Its use in dentistry includes tooth extraction sites, bone grafting, and periodontal surgery [14].
\nTisseel® was the first fibrin sealant approved by the FDA. It has in its composition human thrombin and fibrinogen, intermixed with aprotinin and CaCl2. Because aprotinin is a bovine protein, it is a potential allergen. Multiple exposures may cause allergic reactions, as well as anaphylactic reaction approaching lethality [30, 50]. As for its ideal application, a dry operating field is required; Tisseel® is particularly effective when applied prior to bleeding. In this situation, fibrinogen may polymerize before blood pressure increases local microcirculation flow. When used after the onset of bleeding, one should apply local pressure over the wound to allow polymerization [28, 51]. Tisseel® is available in a pre-filled syringe, allowing for effective application using the EasySpray and DuploSpray MIS systems.
\nAnother option for fibrin sealants, Evicel®, originates from pooled human plasma. It is available as two separate vials of fibrinogen and human thrombin. Prior to use, the two deep frozen solutions must be thawed and mixed after defrosting and heating up (20–30°C) [30].
\nCrosseal™ is a virally inactivated, second-generation surgical sealant. It is produced from concentrated human clottable proteins, namely, biological active component (BAC), which contains the active component fibrinogen, and human α-thrombin (1000 IU/ml) [52]. This fibrin sealant is applied using an application device which drips/sprays Crosseal™ onto the bleeding site.
\nThere are two main categories of flowable biosurgicals: products containing porcine gelatin, which can be combined with thrombins (bovine, human-pooled plasma thrombin, or rhThrombin), and bovine collagen-based agents, packed with human-pooled plasma thrombin. The flowable agents are deemed the most effective of all the local hemostatic agents [30, 53].
\nSurgiflo® is an absorbable, sterile, hemostatic porcine gelatin matrix, combined with Thrombin-JMI, a topical bovine-derived thrombin. It should be placed directly to the bleeding areas to activate the hemostatic process [30]. A compression period is required for polymerization of the sealant components [28].
\nFloseal® consists of a bovine gelatin matrix, plasma-extracted human thrombin, and CaCl2. Its gelatin granules expand (10–20%), as it comes in contact with blood, producing a seal when the product is applied to a bleeding area [27, 30]. The thrombin fraction of the product triggers the regular pathway of the coagulation cascade, converting fibrinogen to a fibrin polymer and creating a clot around the firm matrix [27], which is reabsorbed within the expected period of standard wound healing (6–8 weeks) [14, 27, 33, 42, 54]. A distinctive feature of Floseal® is the need for the presence of blood for activation [30, 55]. Neither compression, nor a dry surgical field is required for its application [28].
\nBecause of this biosurgical flowability, they can easily adapt to irregular wounds. Flowables have been utilized as frontline topical hemostats in major dental surgeries, in patients where conventional procedures are ineffective. They can be utilized as an adjunct to hemostasis in practically all dental surgical interventions. Flowables are effective on both hard and soft tissues [27, 30]. They have a risk of transmitting infectious agents and are contraindicated in patients who are allergic to materials of bovine origin [27].
\nAlthough traditional methods, such as ligature and manual pressure, can promote hemostasis, they are not an effective approach of bleeding control in less accessible sites and complex injuries. Furthermore, bleeding control is especially challenging in patients presenting acquired or congenital coagulation disorders.
\nTopical biosurgical hemostatic agents comprise a wide range of products aiming at minimizing the risk of bleeding. In recent years, several clinical trials have analyzed the effectiveness, advantages, and limitations of biosurgicals, as well as performed comparisons among the different types of biosurgicals and other non-biologic agents. Despite the beneficial effect of these local hemostatic agents in preventing bleeding in dental surgery, available data comparing their effectiveness and efficiency is still scarce and inconclusive. Methodological heterogeneities, such as the lack of a standard therapy and comparable treatment regimens, are noticeable among studies, as well as the reduced number of randomized controlled trials [2, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70].
\nIn summary, local hemostatic agents are very distinct products with diverse indications. Presently, there is no definite evidence-based approach to guide the dental practitioner when selecting a local hemostatic agent. They must be aware of the characteristics of each single hemostatic agent, to elect the most suitable product for every particular clinical situation. In addition, current available data shows that no topical agent can be regarded as superior or more effective than the others [2]. Further experimental research and controlled clinical trials are warranted to define the most cost-effective biosurgical hemostatic agents in dentistry.
\nThe dental practitioner should assess the bleeding risk of the patient, as well as the bleeding risk of the surgical intervention, preoperatively. After assessing both bleeding risks, the professional can then conceive an intraoperative and postoperative plan. The international normalized ratio (INR) must be evaluated in patients reporting an elevated risk of bleeding. While a standard parameter of coagulation has an INR of 1 [71], the therapeutic range runs from 2.0 to 3.5. In this case, it is recommended to use local hemostatic measures independently or in combination with conventional methods. These agents can be used before, during, and after dental surgeries.
\n\n
Comprehensive medical history, including all medications in the patient’s regimen, to identify potential bleeding issues prior to the surgery [26].
In order to decrease surgical bleeding, patients receiving anticoagulant therapy may need to break up exodontia into multiple appointments [26, 72].
Laboratory values such as platelet count, INR, and prothrombin time are of critical value in medically compromised patients [26].
Demographic risk factors (female sex and older age) [73].
Supplemental patient-related risk determinants: diabetes mellitus, hypertension, obesity, hemostatic disorders, renal impairment, and other major organ system failures [73, 74, 75].
Timing of the appointment: early morning visits allowing patients to return to the dental office in case of postsurgical hemorrhage [26].
Patients at a higher bleeding risk are those reporting family history of bleeding and previous bleeding problems after dental surgery or trauma and individuals using medications, such as aspirin, anticoagulants, and/or long-term antibiotics. Any illnesses associated with bleeding problems, such as leukemia, congenital heart disease, liver disease, or hemophilia, present a higher risk of bleeding. The dental professional needs to be aware and prepared for any intercurrence, during or after a surgical procedure. Individuals presenting advanced periodontal disease are also considered as having a higher risk of perioperative bleeding. In such cases, the surgical plan should include a preoperative phase, consisting of scaling and root planning and a proper chlorhexidine gluconate mouth rinse regimen, 2 weeks before an elective procedure [26].
\nThe risk of bleeding of a dental intervention may be ranked as high, moderate, and low [25, 76, 77, 78]. In most patients, antithrombotic therapy is not interrupted before dental interventions with low bleeding risk, due to the disastrous complications of thrombosis (Table 3) [25, 76, 77, 78]. Moderate and high bleeding potential interventions might need the temporary discontinuation of the antithrombotic therapy [25, 76, 77, 78].
\nDental interventions that do not require anticoagulation therapy interruption*–adapted from Kaplovitch and Dounaevskaia [25].
Dental surgical interventions are considered by most recommendations, as minor procedures presenting self-limited blood loss and low bleeding risk. Bleeding, in most cases, can be managed with local hemostatic agents [79, 80].
\nThe dental care of individuals receiving therapeutic anticoagulation becomes critical when invasive procedures are needed. At this time, the clinician must decide either to maintain the anticoagulation therapy and risk bleeding complications or withdraw the anticoagulation medication and risk developing systemic thrombosis [1]. After decades of controversial data, there is currently a nearly unanimous consensus that anticoagulation therapy, for most dental surgeries, should not be discontinued. The higher risk of bleeding complications is compensated by the elevated risk of developing thromboembolic complications [1, 81, 82, 83, 84].
\nNational dental and medical group statements and multiple evidence-based clinical guidelines have considered the issue independently and support the maintenance, for most dental patients, of anticoagulation therapy (American Dental Association; American Academy of Dental Sleep Medicine; American Heart Association; American College of Cardiology; American Academy of Neurology; American Society of Anesthesiologists; Society for Neuroscience in Anesthesiology and Critical Care; American College of Chest Physicians (ACCP)) [1]. In a 2012 statement [76], the ACCP recommended continuing anticoagulation therapy with warfarin, with the additional utilization of a local hemostatic. The ACCP advised a 2–3-day anticoagulation therapy suspension, in order to lower the INR levels to a range of 1.6 and 1.9 [76, 85].
\nLately, the dental care of patients receiving anticoagulant treatment has been the focus of expressive scientific interest, in both dental and medical fields. A recent literature review showed that only 31 (0.6%) of more than 5400 patients receiving over 11,300 dental surgical interventions while continuing to take vitamin K antagonist anticoagulants (warfarin in most cases) demanded more than local maneuvers for hemostasis. No cases of fatal hemorrhage were reported. In over 2600 individuals whose anticoagulation was discontinued for dental interventions, 22 thromboembolic complications (0.8% of medication withheld), including 6 fatal events (0.2% of medication withheld), were observed [83]. Similar results have been shown in a literature review of dental surgery and antiplatelet medications. Of more than 1200 patients receiving over 2300 dental surgical procedures while continuing their antiplatelet medications (aspirin in most cases), only 2 (0.2%) needed more than local measures for hemostasis. Conversely, in over 320 individuals undergoing 370 antiplatelet interruptions for dental procedures, 17 (5.3%) suffered thromboembolic complications [86].
\nAvailable data shows that the majority of dental interventions can be safely conducted in patients receiving anticoagulation treatment, when considering older medications [4]. However, there are fewer studies reporting the provision of dental care in individuals using newer direct oral anticoagulants. The clinical implications of these newer anticoagulant and antiplatelet therapies have only been recently investigated [80, 87]. The protocol followed by the dental practitioner when managing these patients varies significantly and shows inconsistencies reflecting the lack of large-scale studies and evidence-based clinical guidelines [80, 88, 89]. The risk of postoperative bleeding after invasive periodontal treatment in individuals using different anticoagulation therapies was assessed, retrospectively, in 456 individuals receiving an antiplatelet and/or anticoagulant therapy [90]. Data was collected after 484 invasive periodontal interventions, with 99.6% of patients continuing their medications during the procedures. Postoperative bleeding was reported only following three interventions (0.35%), and it was controlled with local hemostatic maneuvers. Although the authors did not specify which type of local hemostatic procedure was used, this retrospective study showed a very low risk of bleeding in patients receiving an invasive periodontal intervention while using an anticoagulant or antiplatelet medication [90]. These results support the recommendation that such medications do not need to be discontinued in anticipation to invasive periodontal interventions.
\nExtended inter- or postoperative bleeding following dental surgery is infrequent, seldom demanding anything more than the use of local hemostatic biosurgicals. The judgment of whether or not to interrupt anticoagulation treatment can be both intricate and dynamic, and it should be based on the indication for pharmacological therapy, as well as previous thromboembolic history. The discontinuation of anticoagulant therapy may be required in dental interventions with moderate and high bleeding risk [25, 76, 77, 78]. Currently, most clinicians dealing with anticoagulant management tend to personalize the periprocedural management of the bleeding potential, according to the individual risk of each procedure—low, moderate, or high—following the current clinical practice recommendations based on best evidence and maintaining the anticoagulant therapy. Thereby, the patient anticoagulant regimen should be continued in specific low-risk dental procedures, without consultation or fear of disproportionate bleeding demanding additional intervention (Table 3) [25].
\nUndoubtedly, anticoagulant agents are effective in preventing thromboembolism. Nevertheless, their potential for critical adverse effects cannot be ignored. The use of antithrombotic medications is the most frequent cause of an adverse drug event requiring individuals to seek out emergency care [25, 91]. The majority of drug interactions with anticoagulants lead to elevated risk of bleeding. The nature of the interactions cannot be predicted, as they are expressed through both pharmacodynamic mechanisms and pharmacokinetic properties [25].
\nRegarding patient safety, potential risk for interaction, as well as knowledge of appropriate prescribing and monitoring, is crucial. Equally decisive is selecting the appropriate anticoagulant agent and monitoring the potential for drug–drug interaction [10, 11, 12, 13, 14, 15, 17, 25]. Common anticoagulants and their interaction with the most common medications prescribed for dental patients are described in Table 4 [25, 92, 93, 94, 95, 96, 97, 98].
\nCommon anticoagulants and potential interactions with dental medications–adapted from Kaplovitch and Dounaevskaia [25].
Most studies evaluating the occurrence of peri- and postoperative bleeding show anticoagulation therapy can be maintained when adequate local hemostatic maneuvers are used.
\nAs an example, a controlled clinical trial compared the occurrence of bleeding following dental extractions in individuals receiving oral anticoagulants (experimental group) versus patients that had never received oral anticoagulant therapy (control group). Tooth extractions were performed, and a piece of oxidized cellulose was placed only into the sockets in the experimental group. The wound borders were sutured, and a gauze saturated with tranexamic for 30–60 minutes was applied with pressure in the wound. Both groups presented similar bleeding complications [99]. In a similar clinical trial [100], 161 tooth extractions were performed in patients undertaking warfarin. After tooth extraction, an oxidized cellulose gauze was placed in the socket, and the wound was sutured. Patients were assigned to four groups, according to their INR range (INR was 1.5–1.99 in group 1; 2.0–2.49 in group 2; 2.5–2.99 in group 3; and 3.0–3.7 in group 4). No significant differences were found in the postoperative bleeding among groups.
\nBased on the latest evidence and clinical practice recommendations on the perioperative management of dental patients receiving direct oral anticoagulants, on single or dual antiplatelet therapy or vitamin K antagonists, as well as on the current scientific knowledge on biosurgical hemostatic agents, the following conclusions can be made:
The majority of dental procedures can be securely executed without the withholding of anticoagulants, using only local hemostatic therapy. In fact, current recommendations and consensus support the continuation of antiplatelet or anticoagulant therapy. Discontinuing these drugs can increase the risk of thromboembolism, at the cost of minor bleeding, which can be restrained without difficulty. The appropriate use of local hemostatic measures, such as topical biosurgical hemostatic agents, should always be considered whenever indicated.
In order to safely treat a patient receiving anticoagulant therapy, familiarity with anticoagulants and with the potential for drug–drug interactions is required, in addition to knowledge about the topical hemostatic options available.
Topical biosurgical hemostatic agents are diverse agents with distinct indications. The dental practitioner must be aware of the properties of each single agent, in order to properly select the product needed in each different clinical condition.
Based on current available data, no topical hemostatic agent can be regarded as superior or more effective than the others. Further experimental research and controlled clinical trials are warranted to define the most cost-effective biosurgical hemostatic agents in dentistry.
A definite protocol for excessive bleeding is still required for dental surgery in patients with hemorrhagic diathesis. The most effective local hemostatic agent with lesser complications should be determined in future research, considering their availability and cost-effectiveness.
The authors are grateful to Kisa Iqbal BSc Hons, DDS Candidate c/o 2020, New York University College of Dentistry, for editing this article.
\nThe authors declare no conflict of interest.
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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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When a robot works in a structured environment, its automation is easier than in a non-structured environment in which case its modeling is quite difficult and presents a high computational effort. To overcome this difficulty, series elastic actuator (SEA) has been applied in compliant robotic grasping. Unlike rigid actuators, a SEA contains an elastic element in series with the mechanical energy source. Such an elastic element gives SEAs tolerance to impact loads, low mechanical output impedance, passive mechanical energy storage, and increased peak power output. The spring has to be able to support the loads, but it cannot be too stiff; otherwise, system impedance will be high. This chapter describes a comparison between two types of SEA, an electric series elastic actuator (ESEA) and a hydraulic series elastic actuator (HSEA), for four-legged dynamic robot application. The parameters employed in the comparison are bandwidth, output impedance, time response, power density, and dynamic range. The results indicate that HSEA is a better actuator than ESEA for a weight carrying four-legged dynamic robot because of its higher power density and dynamic ratio with desirable output impedance, time response, and bandwidth.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Arnaldo Gomes Leal Junior, Rafhael Milanezi de Andrade and\nAntônio Bento Filho",authors:[{id:"182082",title:"Dr.",name:"Rafhael",middleName:"Milanezi De",surname:"Andrade",slug:"rafhael-andrade",fullName:"Rafhael Andrade"},{id:"185372",title:"Dr.",name:"Antônio",middleName:null,surname:"Bento Filho",slug:"antonio-bento-filho",fullName:"Antônio Bento Filho"},{id:"185373",title:"MSc.",name:"Arnaldo",middleName:null,surname:"Gomes Leal Junior",slug:"arnaldo-gomes-leal-junior",fullName:"Arnaldo Gomes Leal Junior"}]},{id:"51618",doi:"10.5772/63575",title:"Validation and Experimental Testing of Observers for Robust GNSS-Aided Inertial Navigation",slug:"validation-and-experimental-testing-of-observers-for-robust-gnss-aided-inertial-navigation",totalDownloads:1697,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"This chapter is the study of state estimators for robust navigation. Navigation of vehicles is a vast field with multiple decades of research. The main aim is to estimate position, linear velocity, and attitude (PVA) under all dynamics, motions, and conditions via data fusion. The state estimation problem will be considered from two different perspectives using the same kinematic model. First, the extended Kalman filter (EKF) will be reviewed, as an example of a stochastic approach; second, a recent nonlinear observer will be considered as a deterministic case. A comparative study of strapdown inertial navigation methods for estimating PVA of aerial vehicles fusing inertial sensors with global navigation satellite system (GNSS)-based positioning will be presented. The focus will be on the loosely coupled integration methods and performance analysis to compare these methods in terms of their stability, robustness to vibrations, and disturbances in measurements.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Jakob M. Hansen, Jan Roháč, Martin Šipoš, Tor A. Johansen and\nThor I. 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This compliance is generated with an articular muscle emulator system, which is designed using two neural networks (NNs). One NN models a muscle and a second learns to tune the proportional integral derivative (PID) of the articulation DC motor, allowing it to behave analogously to the muscle model. Muscle emulators are implemented in the knees of a three‐dimensional (3D) simulated biped robot. The simulation results show that the muscle emulator creates compliance in articulations and that the dynamic walk, even in walk‐halt‐stop transitions, improves. If an external thrust unbalances the biped during the walk, the muscle emulator improves the control and prevents the robot from falling. The total power consumption is significantly reduced, and the articular trajectories approach human trajectories.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Hayssan Serhan and Patrick Henaff",authors:[{id:"184415",title:"Dr.",name:"Patrick",middleName:null,surname:"Henaff",slug:"patrick-henaff",fullName:"Patrick Henaff"},{id:"185026",title:"Dr.",name:"Hayssam",middleName:null,surname:"Serhan",slug:"hayssam-serhan",fullName:"Hayssam Serhan"}]},{id:"51486",doi:"10.5772/64305",title:"Design, Implementation and Modeling of Flooding Disaster-Oriented USV",slug:"design-implementation-and-modeling-of-flooding-disaster-oriented-usv",totalDownloads:1905,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Although there exist some unmanned surface platforms, and parts of them have been applied in flooding disaster relief, the autonomy of these platforms is still so weak that most of them can only work under the control of operators. The primary reason is the difficulty of obtaining a dynamical model that is sufficient rich for model-based control and sufficient simple for model parameters identification. This makes them difficult to be used to achieve some high-performance autonomous control, such as robust control with respect to disturbances and unknown dynamics and trajectory tracking control in complicated and dynamical surroundings. In this chapter, a flooding disaster-oriented unmanned surface vehicle (USV) designed and implemented by Shenyang Institute of Automation, Chinese Academy of Sciences (SIA, CAS) is introduced first, including the hardware and software structures. Then, we propose a quasi-linear parameter varying (qLPV) model to approach the dynamics of the USV system. We first apply this to solve a structured modeling problem and then introduce model error to solve an unstructured modeling problem. Subsequently, the qLPV model identification results are analyzed and the superiority compared to two linear models is demonstrated. At last, extensive application experiments, including rescuing rope throwing using an automatic pneumatic and water sampling in a 2.5 m radius circle, are described in detail to show the performance of course keeping control and GPS point tracking control based on the proposed model.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Junfeng Xiong, Feng Gu, Decai Li, Yuqing He and Jianda Han",authors:[{id:"9884",title:"Dr.",name:"Yuqing",middleName:null,surname:"He",slug:"yuqing-he",fullName:"Yuqing He"},{id:"9921",title:"Prof.",name:"Jianda",middleName:null,surname:"Han",slug:"jianda-han",fullName:"Jianda Han"},{id:"185358",title:"Dr.",name:"Junfeng",middleName:null,surname:"Xiong",slug:"junfeng-xiong",fullName:"Junfeng Xiong"},{id:"185359",title:"Dr.",name:"Feng",middleName:null,surname:"Gu",slug:"feng-gu",fullName:"Feng Gu"},{id:"185360",title:"Dr.",name:"Decai",middleName:null,surname:"Li",slug:"decai-li",fullName:"Decai Li"}]},{id:"50812",doi:"10.5772/63506",title:"Fish-Like Robot Encapsulated by a Plastic Film",slug:"fish-like-robot-encapsulated-by-a-plastic-film",totalDownloads:1585,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Underwater robots are currently utilized to evaluate water quality and the undersea landscape. Small-sized underwater robots are especially useful in improving the spatial resolution of the measurements, yielding high-quality data. This chapter describes a small-sized fish-like robot, with its surface composed of a flexible thin plastic film. Its internal components, including an actuator, could be encapsulated in the plastic film using a vacuum packaging machine. To simplify the waterproofing and pressure resistance properties of the fish-like robot, its internal components can be filled with insulating fluid. The plastic film on the surface has electromagnetic-wave-transmitting properties, allowing sensors to be arranged within the device, enabling assessment of its autonomous locomotion using infrared sensors. Robot attitude can be altered, based on geography of its internal components, floating blocks, and insulating fluid. This attitude could be especially determined by the differences in densities between the floating block and insulating fluid. Evaluation of attitude control showed that an insulating fluid heavier than water allows a large variation.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Mizuho Shibata",authors:[{id:"180106",title:"Dr.",name:"Mizuho",middleName:null,surname:"Shibata",slug:"mizuho-shibata",fullName:"Mizuho Shibata"}]}],mostDownloadedChaptersLast30Days:[{id:"51224",title:"Series Elastic Actuator: Design, Analysis and Comparison",slug:"series-elastic-actuator-design-analysis-and-comparison",totalDownloads:3481,totalCrossrefCites:4,totalDimensionsCites:12,abstract:"In general, actuators are built to be as stiff as possible to increase the bandwidth. When a robot works in a structured environment, its automation is easier than in a non-structured environment in which case its modeling is quite difficult and presents a high computational effort. To overcome this difficulty, series elastic actuator (SEA) has been applied in compliant robotic grasping. Unlike rigid actuators, a SEA contains an elastic element in series with the mechanical energy source. Such an elastic element gives SEAs tolerance to impact loads, low mechanical output impedance, passive mechanical energy storage, and increased peak power output. The spring has to be able to support the loads, but it cannot be too stiff; otherwise, system impedance will be high. This chapter describes a comparison between two types of SEA, an electric series elastic actuator (ESEA) and a hydraulic series elastic actuator (HSEA), for four-legged dynamic robot application. The parameters employed in the comparison are bandwidth, output impedance, time response, power density, and dynamic range. The results indicate that HSEA is a better actuator than ESEA for a weight carrying four-legged dynamic robot because of its higher power density and dynamic ratio with desirable output impedance, time response, and bandwidth.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Arnaldo Gomes Leal Junior, Rafhael Milanezi de Andrade and\nAntônio Bento Filho",authors:[{id:"182082",title:"Dr.",name:"Rafhael",middleName:"Milanezi De",surname:"Andrade",slug:"rafhael-andrade",fullName:"Rafhael Andrade"},{id:"185372",title:"Dr.",name:"Antônio",middleName:null,surname:"Bento Filho",slug:"antonio-bento-filho",fullName:"Antônio Bento Filho"},{id:"185373",title:"MSc.",name:"Arnaldo",middleName:null,surname:"Gomes Leal Junior",slug:"arnaldo-gomes-leal-junior",fullName:"Arnaldo Gomes Leal Junior"}]},{id:"50884",title:"Autonomous Quadrocopter for Search, Count and Localization of Objects",slug:"autonomous-quadrocopter-for-search-count-and-localization-of-objects",totalDownloads:1758,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"This chapter describes and evaluates the design and implementation of a new fully autonomous quadrocopter, which is capable of self‐reliant search, count and localization of a predefined object on the ground inside a room.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Nils Gageik, Christian Reul and Sergio Montenegro",authors:[{id:"168230",title:"Ph.D. Student",name:"Nils",middleName:null,surname:"Gageik",slug:"nils-gageik",fullName:"Nils Gageik"},{id:"168231",title:"Prof.",name:"Sergio",middleName:null,surname:"Montenegro",slug:"sergio-montenegro",fullName:"Sergio Montenegro"},{id:"181110",title:"MSc.",name:"Christian",middleName:null,surname:"Reul",slug:"christian-reul",fullName:"Christian Reul"}]},{id:"51432",title:"CODA Algorithm: An Immune Algorithm for Reinforcement Learning Tasks",slug:"coda-algorithm-an-immune-algorithm-for-reinforcement-learning-tasks",totalDownloads:1556,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This document presents the design of an algorithm that takes on its basis: reinforcement learning, learning from demonstration and most importantly Artificial Immune Systems. The main advantage of this algorithm named CODA (Cognition from Data). Is; it can learn from limited data samples- that is given a single example and the algorithm will create its own knowledge. The algorithm imitates from the Natural Immune System the clonal procedure for obtaining a repertoire of antibodies from a single antigen. It also uses the self-organised memory in order to reduce searching time in the whole action-state space by searching in specific clusters. CODA algorithm is presented and explained in detail in order to understand how these three principles are used. The algorithm is explained with pseudocode, flowcharts and block diagrams. The clonal/mutation results are presented with a simple example. It can be seen graphically how new data that has a completely new probability distribution. Finally, the first application where CODA is used, a humanoid hand is presented. In this application the algorithm created affordable grasping postures from limited examples, creates its own knowledge and stores data in memory data in memory in order to recognise whether it has been on a similar situation.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Daniel R. Ramirez Rebollo, Pedro Ponce Cruz and Arturo Molina",authors:[{id:"181021",title:"Ph.D. Student",name:"Daniel",middleName:"Rodrigo",surname:"Ramirez Rebollo",slug:"daniel-ramirez-rebollo",fullName:"Daniel Ramirez Rebollo"},{id:"181149",title:"Dr.",name:"Pedro",middleName:null,surname:"Ponce",slug:"pedro-ponce",fullName:"Pedro Ponce"},{id:"181151",title:"Dr.",name:"Arturo",middleName:null,surname:"Molina",slug:"arturo-molina",fullName:"Arturo Molina"}]},{id:"51357",title:"Muscle‐Like Compliance in Knee Articulations Improves Biped Robot Walkings",slug:"muscle-like-compliance-in-knee-articulations-improves-biped-robot-walkings",totalDownloads:1678,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"This chapter focuses on the compliance effect of dynamic humanoid robot walking. This compliance is generated with an articular muscle emulator system, which is designed using two neural networks (NNs). One NN models a muscle and a second learns to tune the proportional integral derivative (PID) of the articulation DC motor, allowing it to behave analogously to the muscle model. Muscle emulators are implemented in the knees of a three‐dimensional (3D) simulated biped robot. The simulation results show that the muscle emulator creates compliance in articulations and that the dynamic walk, even in walk‐halt‐stop transitions, improves. If an external thrust unbalances the biped during the walk, the muscle emulator improves the control and prevents the robot from falling. The total power consumption is significantly reduced, and the articular trajectories approach human trajectories.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Hayssan Serhan and Patrick Henaff",authors:[{id:"184415",title:"Dr.",name:"Patrick",middleName:null,surname:"Henaff",slug:"patrick-henaff",fullName:"Patrick Henaff"},{id:"185026",title:"Dr.",name:"Hayssam",middleName:null,surname:"Serhan",slug:"hayssam-serhan",fullName:"Hayssam Serhan"}]},{id:"51053",title:"Recent Developments in Monocular SLAM within the HRI Framework",slug:"recent-developments-in-monocular-slam-within-the-hri-framework",totalDownloads:1890,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter describes an approach to improve the feature initialization process in the delayed inverse-depth feature initialization monocular Simultaneous Localisation and Mapping (SLAM), using data provided by a robot’s camera plus an additional monocular sensor deployed in the headwear of the human component in a human-robot collaborative exploratory team. The robot and the human deploy a set of sensors that once combined provides the data required to localize the secondary camera worn by the human. The approach and its implementation are described along with experimental results demonstrating its performance. A discussion on the usual sensors within the robotics field, especially in SLAM, provides background to the advantages and capabilities of the system implemented in this research.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Edmundo Guerra, Yolanda Bolea, Rodrigo Munguia and Antoni\nGrau",authors:[{id:"13038",title:"Prof.",name:"Antoni",middleName:null,surname:"Grau",slug:"antoni-grau",fullName:"Antoni Grau"},{id:"18024",title:"Dr.",name:"Yolanda",middleName:null,surname:"Bolea",slug:"yolanda-bolea",fullName:"Yolanda Bolea"},{id:"163432",title:"Dr.",name:"Rodrigo",middleName:null,surname:"Munguia",slug:"rodrigo-munguia",fullName:"Rodrigo Munguia"},{id:"165970",title:"Ph.D. Student",name:"Edmundo",middleName:null,surname:"Guerra",slug:"edmundo-guerra",fullName:"Edmundo Guerra"}]}],onlineFirstChaptersFilter:{topicId:"1291",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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