Hemostatic agents used in apical surgery: a review

Objective: A review was made of the current literature on hemostatic agents used in apical surgery in order to determine their effectiveness and adverse effects. Material and methods: The main search terms used were: endodontic surgery, apicoectomy, apical surgery, periradicular surgery, hemostasis, hemostatic agents, and bleeding control. The authors searched the Medline database for articles published up to 1 September 2010. Experimental and clinical studies comparing the effectiveness and/ or adverse effects of two or more hemostatic agents and published between 2000 and 2010 were included in the review. Results: Four studies were analyzed: two clinical studies and two experimental studies. According to the clinical studies, epinephrine produces no changes in blood pressure or heart rate when used to control bleeding in periapical surgery. Aluminum chloride alone or in combination with ferric sulfate was found to be the most effective agent in the experimental studies, and the tissue damage it causes was not observed when the superficial bone layer was eliminated with rotary instruments. Conclusion: Additional controlled clinical trials are needed to not only assess the efficacy of the different hemostatic agents but also to investigate their influence upon healing and the outcome of periapical surgery.