Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery
Article first published online: 7 DEC 2009
© 2010 International Endodontic Journal
International Endodontic Journal
Volume 43, Issue 1, pages 57–63, January 2010
How to Cite
Jensen, S. S., Yazdi, P. M., Hjørting-Hansen, E., Bosshardt, D. D. and Von Arx, T. (2010), Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery. International Endodontic Journal, 43: 57–63. doi: 10.1111/j.1365-2591.2009.01637.x
- Issue published online: 7 DEC 2009
- Article first published online: 7 DEC 2009
- Received 15 July 2009; accepted 25 August 2009
- animal study;
- apical surgery;
- haemorrhage control;
- haemostatic agent
Aim To compare the haemostatic effect and tissue reactions of different agents and methods used for haemorrhage control in apical surgery.
Methodology Six standardized bone defects were prepared in the calvaria of six Burgundy rabbits. Five haemostatic modalities were tested for their haemostatic effect and tissue reactions, and were compared with untreated control defects: ExpasylTM + Stasis®, ExpasylTM + Stasis® + freshening of the bone defect with a bur, Spongostan®, Spongostan® + epinephrine, and electro cauterization. The haemostatic effect was analysed visually and compared using Wilcoxon’s signed rank test. Two groups of three animals were evaluated histologically for hard and soft tissue reactions related to the different haemostatic measures, after 3 and 12 weeks of healing respectively.
Results ExpasylTM + Stasis® and electro cauterization proved most effective in reducing bleeding (P < 0.05), but were accompanied by unfavourable tissue reactions, as indicated by the presence of necrotic bone, inflammatory cells and the absence of bone repair. These adverse tissue reactions did not recover substantially over time. However, adverse reactions were not observed when the superficial layer of bone had been removed with a rotary instrument. In contrast, Spongostan® + epinephrine showed only a moderate haemostatic effect, but elicited also only mild adverse tissue reactions.
Conclusions Haemostasis in experimental bone defects is most effectively accomplished by using ExpasylTM + Stasis® or electro cauterization. However, the bone defects should be freshened with a rotary instrument before suturing so as not to compromise healing.