Haemostatic agents in apical surgery. A systematic review.

Area of Science:

• Endodontics
• Oral Surgery
• Biomaterials

Background:

• Bleeding in apical surgery obscures the surgical field.
• Blood contamination affects filling materials and their sealing capacity.
• Effective hemostasis is crucial for successful apical surgery outcomes.

Purpose of the Study:

• To identify the most effective and safest hemostatic agents for apical surgery.
• To review current evidence on hemostatic agents in endodontic surgery.

Main Methods:

• Systematic review of human clinical studies.
• Searched Medline and Cochrane Library databases.
• Included studies published within the last 10 years.

Main Results:

• Calcium sulphate (100%) and collagen plus epinephrine (92.9%) demonstrated superior bleeding control.
• Ferric sulphate (60%), gauze packing (30%), and collagen (16.7%) were less effective.
• Aluminium chloride showed high lesion improvement but potentially increased swelling; epinephrine with collagen had minimal impact on vital signs.

Conclusions:

• Limited evidence exists on the effectiveness and safety of hemostatic materials in apical surgery.
• Calcium sulphate and epinephrine plus collagen are the most effective agents identified.
• Further randomized clinical trials are necessary to validate hemostatic effectiveness and safety profiles.