Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery.
OBJECTIVE
To compare the haemostatic effect and tissue reactions of different agents and methods used for haemorrhage control in apical surgery.


METHODS
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: Expasyl + Stasis, Expasyl + Stasi + 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
Expasyl + 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 Expasyl + Stasis or electro cauterization. However, the bone defects should be freshened with a rotary instrument before suturing so as not to compromise healing.
Jensen
S S
SS
Department of Oral Surgery and Stomatology, University of Bern, Switzerland. simon.storgaard@jensen.mail.dk
Yazdi
P M
PM
Hjørting-Hansen
E
E
Bosshardt
D D
DD
von Arx
T
T
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001861:Bone Regeneration; D001842:Bone and Bones / Q000601:surgery*; D004564:Electrocoagulation; D005339:Fibrin Foam / Q000627:therapeutic use; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006472:Oral Hemorrhage / Q000517:prevention & control; D010020:Osteonecrosis / Q000139:chemically induced / Q000517:prevention & control; D010486:Periapical Tissue / Q000601:surgery; D011817:Rabbits; D011897:Random Allocation; D012886:Skull / Q000601:surgery; D019227:Tooth Apex / Q000601:surgery
D005339:Fibrin Foam; D006490:Hemostatics