Restor Dent Endod.  2014 May;39(2):79-88.

Biologic response of local hemostatic agents used in endodontic microsurgery

Affiliations
  • 1Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea. andyendo@yuhs.ac

Abstract

Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.

Keyword

Calcium sulfate; Endodontic microsurgery; Epinephrine; Ferric sulfate; Hemostatic agent; Hemostatics

MeSH Terms

Animals
Calcium Sulfate
Collagen
Epinephrine
Foreign-Body Reaction
Hemostatics
Ischemia
Microsurgery*
Population Characteristics
Prognosis
Calcium Sulfate
Collagen
Epinephrine
Hemostatics

Reference

1. Kim S, Rethnam S. Hemostasis in endodontic microsurgery. Dent Clin North Am. 1997; 41:499–511.
2. Witherspoon DE, Gutmann JL. Haemostasis in periradicular surgery. Int Endod J. 1996; 29:135–149.
Article
3. Cho YW, Kim E. Is stopping of anticoagulant therapy really required in a minor dental surgery? - How about in an endodontic microsurgery? Restor Dent Endod. 2013; 38:113–118.
Article
4. Finn MD, Schow SR, Schneiderman ED. Osseous regeneration in the presence of four common hemostatic agents. J Oral Maxillofac Surg. 1992; 50:608–612.
Article
5. Ibarrola JL, Bjorenson JE, Austin BP, Gerstein H. Osseous reactions to three hemostatic agents. J Endod. 1985; 11:75–83.
Article
6. Johnson P, Fromm D. Effects of bone wax on bacterial clearance. Surgery. 1981; 89:206–209.
7. Papay FA, Morales L Jr, Ahmed OF, Neth D, Reger S, Zins J. Comparison of ossification of demineralized bone, hydroxyapatite, Gelfoam, and bone wax in cranial defect repair. J Craniofac Surg. 1996; 7:347–351.
Article
8. Thaller SR, Kim JC, Kawamoto HK. Calvarial bone graft donor site: a histological study in a rabbit model. Ann Plast Surg. 1989; 23:390–395.
Article
9. Nappi JF, Lehman JA Jr. The effects of Surgicel on bone formation. Cleft Palate J. 1980; 17:291–296.
10. Alkan A, Inal S, Yildirim M, Baş B, Ağar E. The effects of hemostatic agents on peripheral nerve function: an experimental study. J Oral Maxillofac Surg. 2007; 65:630–634.
Article
11. Boyes-Varley JG, Cleaton-Jones PE, Lownie JF. Effect of a topical drug combination on the early healing of extraction sockets in the vervet monkey. Int J Oral Maxillofac Surg. 1988; 17:138–141.
Article
12. Hjortdal O. The fate of resorbable hemostatic implants in rats. Acta Odontol Scand. 1970; 28:323–336.
Article
13. De Leonardis D, Pecora GE. Augmentation of the maxillary sinus with calcium sulfate: one-year clinical report from a prospective longitudinal study. Int J Oral Maxillofac Implants. 1999; 14:869–878.
14. Pecora G, De Leonardis D, Ibrahim N, Bovi M, Cornelini R. The use of calcium sulphate in the surgical treatment of a 'through and through' periradicular lesion. Int Endod J. 2001; 34:189–197.
Article
15. Vickers FJ, Baumgartner JC, Marshall G. Hemostatic efficacy and cardiovascular effects of agents used during endodontic surgery. J Endod. 2002; 28:322–323.
Article
16. Vy CH, Baumgartner JC, Marshall JG. Cardiovascular effects and efficacy of a hemostatic agent in periradicular surgery. J Endod. 2004; 30:379–383.
Article
17. Csillag M, Nyiri G, Vag J, Fazekas A. Dose-related effects of epinephrine on human gingival blood flow and crevicular fluid production used as a soaking solution for chemo-mechanical tissue retraction. J Prosthet Dent. 2007; 97:6–11.
Article
18. Scarano A, Carinci F, Cimorelli E, Quaranta M, Piattelli A. Application of calcium sulfate in surgical-orthodontic treatment of impacted teeth: a new procedure to control hemostasis. J Oral Maxillofac Surg. 2010; 68:964–968.
Article
19. Scarano A, Artese L, Piattelli A, Carinci F, Mancino C, Iezzi G. Hemostasis control in endodontic surgery: a comparative study of calcium sulfate versus gauzes and versus ferric sulfate. J Endod. 2012; 38:20–23.
Article
20. Lemon RR, Steele PJ, Jeansonne BG. Ferric sulfate hemostasis: effect on osseous wound healing. Left in situ for maximum exposure. J Endod. 1993; 19:170–173.
Article
21. Jeansonne BG, Boggs WS, Lemon RR. Ferric sulfate hemostasis: effect on osseous wound healing. II. With curettage and irrigation. J Endod. 1993; 19:174–176.
Article
22. Pecora G, Andreana S, Margarone JE 3rd, Covani U, Sottosanti JS. Bone regeneration with a calcium sulfate barrier. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:424–429.
Article
23. Clokie CM, Moghadam H, Jackson MT, Sandor GK. Closure of critical sized defects with allogenic and alloplastic bone substitutes. J Craniofac Surg. 2002; 13:111–121.
Article
24. Miller Q, Meekin G, Murdock C. The effect of topical epinephrine on peripheral nerve conduction. Laryngoscope. 2002; 112:1888–1891.
Article
25. Murashima Y, Yoshikawa G, Wadachi R, Sawada N, Suda H. Calcium sulphate as a bone substitute for various osseous defects in conjunction with apicectomy. Int Endod J. 2002; 35:768–774.
Article
26. Strocchi R, Orsini G, Iezzi G, Scarano A, Rubini C, Pecora G, Piattelli A. Bone regeneration with calcium sulfate: evidence for increased angiogenesis in rabbits. J Oral Implantol. 2002; 28:273–278.
Article
27. Walsh WR, Morberg P, Yu Y, Yang JL, Haggard W, Sheath PC, Svehla M, Bruce WJ. Response of a calcium sulfate bone graft substitute in a confined cancellous defect. Clin Orthop Relat Res. 2003; 406:228–236.
Article
28. Apaydin ES, Torabinejad M. The effect of calcium sulfate on hard-tissue healing after periradicular surgery. J Endod. 2004; 30:17–20.
Article
29. Orsini G, Ricci J, Scarano A, Pecora G, Petrone G, Iezzi G, Piattelli A. Bone-defect healing with calcium-sulfate particles and cement: an experimental study in rabbit. J Biomed Mater Res B Appl Biomater. 2004; 68:199–208.
Article
30. von Arx T, Jensen SS, Hänni S, Schenk RK. Haemostatic agents used in periradicular surgery: an experimental study of their efficacy and tissue reactions. Int Endod J. 2006; 39:800–808.
Article
31. Jensen SS, Yazdi PM, Hjørting-Hansen E, Bosshardt DD, von Arx T. Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery. Int Endod J. 2010; 43:57–63.
Article
32. Azargoon H, Williams BJ, Solomon ES, Kessler HP, He J, Spears R. Assessment of hemostatic efficacy and osseous wound healing using HemCon dental dressing. J Endod. 2011; 37:807–811.
Article
33. Katzung BG, Masters S, Trevor A. Basic and clinical pharmacology. 12th ed. Columbus, OH: McGraw-Hill Education;2011. p. 129–149.
34. Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod. 2006; 32:601–623.
Article
35. Chu WS, Park SH, Ahn DK, Kim SK. Effect of local anesthesia on pulpal blood flow in mechanically stimulated teeth. J Korean Acad Conserv Dent. 2006; 31:257–262.
Article
36. Lee JS, Kim SK. The influence of epinephrine concentration in local anesthetics on pulpal and gingival blood flows. J Korean Acad Conserv Dent. 2003; 28:475–484.
Article
37. Kim E, Song JS, Jung IY, Lee SJ, Kim S. Prospective clinical study evaluating endodontic microsurgery outcomes for cases with lesions of endodontic origin compared with cases with lesions of combined periodontal-endodontic origin. J Endod. 2008; 34:546–551.
Article
38. Song M, Jung IY, Lee SJ, Lee CY, Kim E. Prognostic factors for clinical outcomes in endodontic microsurgery: a retrospective study. J Endod. 2011; 37:927–933.
Article
39. Chowdhry S, Seidenstricker L, Cooney DS, Hazani R, Wilhelmi BJ. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010; 126:2031–2034.
Article
40. Häfner HM, Röcken M, Breuninger H. Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges. 2005; 3:195–199.
41. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am. 2005; 30:1061–1067.
Article
42. Sylaidis P, Logan A. Digital blocks with adrenaline. An old dogma refuted. J Hand Surg Br. 1998; 23:17–19.
43. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001; 108:114–124.
Article
44. Jang Y, Kim E. Cardiovascular effect of epinephrine in endodontic microsurgery: a review. Restor Dent Endod. 2013; 38:187–193.
Article
45. Troullos ES, Goldstein DS, Hargreaves KM, Dionne RA. Plasma epinephrine levels and cardiovascular response to high administered doses of epinephrine contained in local anesthesia. Anesth Prog. 1987; 34:10–13.
46. Gogerty JH, Strand HA, Ogilvie AL, Dille JM. Vasopressor effects of topical epinephrine in certain dental procedures. Oral Surg Oral Med Oral Pathol. 1957; 10:614–622.
Article
47. Wood M, Reader A, Nusstein J, Beck M, Padgett D, Weaver J. Comparison of intraosseous and infiltration injections for venous lidocaine blood concentrations and heart rate changes after injection of 2% lidocaine with 1:100,000 epinephrine. J Endod. 2005; 31:435–438.
Article
48. Besner E. Systemic effects of racemic epinephrine when applied to the bone cavity during periapical surgery. Va Dent J. 1972; 49:9–12.
49. Ferry DR, Henry RL, Kern MJ. Epinephrine-induced myocardial infarction in a patient with angiographically normal coronary arteries. Am Heart J. 1986; 111:1193–1195.
Article
50. Foster CA, Aston SJ. Propranolol-epinephrine interaction: a potential disaster. Plast Reconstr Surg. 1983; 72:74–78.
51. Lee JY, Hong SJ, Chon JY, Kwon SY. Cardiac arrest induced by submucosal injection of epinephrine in a patient with variant angina. Rhinology. 2010; 48:251–253.
Article
52. Umino M, Ohwatari T, Shimoyama K, Nagao M. Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient. Anesth Prog. 1994; 41:77–80.
53. Monsel L. Proprieté hémostatique du sulfate de peroxyde de Fer. Rec Mem Med Milit. 1856; 17:424.
54. Fischer DE. Tissue management: a new solution to an old problem. Gen Dent. 1987; 35:178–182.
55. Smith NL, Seale NS, Nunn ME. Ferric sulfate pulpotomy in primary molars: a retrospective study. Pediatr Dent. 2000; 22:192–199.
56. von Arx T, Jensen SS, Hänni S. Clinical and radiographic assessment of various predictors for healing outcome 1 year after periapical surgery. J Endod. 2007; 33:123–128.
Article
57. von Arx T, Jensen SS, Hänni S, Friedman S. Five-year longitudinal assessment of the prognosis of apical microsurgery. J Endod. 2012; 38:570–579.
Article
58. Evans BE. Local hemostatic agents. N Y J Dent. 1977; 47:109–114.
59. Davis JR, Steinbronn KK, Graham AR, Dawson BV. Effects of Monsel's solution in uterine cervix. Am J Clin Pathol. 1984; 82:332–335.
Article
60. Sawchuk WS, Friedman KJ, Manning T, Pinnell SR. Delayed healing in full-thickness wounds treated with aluminum chloride solution. A histologic study with evaporimetry correlation. J Am Acad Dermatol. 1986; 15:982–989.
Article
61. Armstrong RB, Nichols J, Pachance J. Punch biopsy wounds treated with Monsel's solution or a collagen matrix. A comparison of healing. Arch Dermatol. 1986; 122:546–549.
Article
62. Amazon K, Robinson MJ, Rywlin AM. Ferrugination caused by Monsel's solution. Clinical observations and experimentations. Am J Dermatopathol. 1980; 2:197–205.
Article
63. Duray PH, Livolsi VA. Recurrent dysplastic nevus following shave excision. J Dermatol Surg Oncol. 1984; 10:811–815.
Article
64. Horbett TA. Principles underlying the role of adsorbed plasma proteins in blood interactions with foreign materials. Cardiovasc Pathol. 1993; 2:Supplement. 137–148.
Article
65. Ziats NP, Pankowsky DA, Tierney BP, Ratnoff OD, Anderson JM. Adsorption of Hageman factor (factor XII) and other human plasma proteins to biomedical polymers. J Lab Clin Med. 1990; 116:687–696.
66. Thomas MV, Puleo DA. Calcium sulfate: properties and clinical applications. J Biomed Mater Res B Appl Biomater. 2009; 88:597–610.
Article
67. Payne JM, Cobb CM, Rapley JW, Killoy WJ, Spencer P. Migration of human gingival fibroblasts over guided tissue regeneration barrier materials. J Periodontol. 1996; 67:236–244.
Article
68. Guarnieri R, Pecora G, Fini M, Aldini NN, Giardino R, Orsini G, Piattelli A. Medical grade calcium sulfate hemihydrate in healing of human extraction sockets: clinical and histological observations at 3 months. J Periodontol. 2004; 75:902–908.
Article
69. Larson PO. Topical hemostatic agents for dermatologic surgery. J Dermatol Surg Oncol. 1988; 14:623–632.
70. Palm MD, Altman JS. Topical hemostatic agents: a review. Dermatol Surg. 2008; 34:431–445.
Article
71. Scarano A, Degidi M, Iezzi G, Pecora G, Piattelli M, Orsini G, Caputi S, Perrotti V, Mangano C, Piattelli A. Maxillary sinus augmentation with different biomaterials: a comparative histologic and histomorphometric study in man. Implant Dent. 2006; 15:197–207.
Article
72. Orsini M, Orsini G, Benlloch D, Aranda JJ, Lazaro P, Sanz M, De Luca M, Piattelli A. Comparison of calcium sulfate and autogenous bone graft to bioabsorbable membranes plus autogenous bone graft in the treatment of intrabony periodontal defects: a split-mouth study. J Periodontol. 2001; 72:296–302.
Article
73. Aichelmann-Reidy ME, Heath CD, Reynolds MA. Clinical evaluation of calcium sulfate in combination with demineralized freeze-dried bone allograft for the treatment of human intraosseous defects. J Periodontol. 2004; 75:340–347.
Article
74. Kim CK, Chai JK, Cho KS, Moon IS, Choi SH, Sottosanti JS, Wikesjo UM. Periodontal repair in intrabony defects treated with a calcium sulfate implant and calcium sulfate barrier. J Periodontol. 1998; 69:1317–1324.
Article
75. Shaffer CD, App GR. The use of plaster of paris in treating infrabony periodontal defects in humans. J Periodontol. 1971; 42:685–690.
Article
76. Kalbermatten DF, Kalbermatten NT, Hertel R. Cotton-induced pseudotumor of the femur. Skeletal Radiol. 2001; 30:415–417.
Article
77. Sexton CC, Lawson JP, Yesner R. Case report 174: 'Cottonballoma' of femur (due to retained surgical sponge with foreign body giant cell reaction). Skeletal Radiol. 1981; 7:211–213.
78. Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod. 2010; 36:536–541.
Article
79. Ferris DM, Baumgartner JC. Perforation repair comparing two types of mineral trioxide aggregate. J Endod. 2004; 30:422–424.
Article
80. Stein MD, Salkin LM, Freedman AL, Glushko V. Collagen sponge as a topical hemostatic agent in mucogingival surgery. J Periodontol. 1985; 56:35–38.
Article
81. Chvapil M. Collagen sponge: theory and practice of medical applications. J Biomed Mater Res. 1977; 11:721–741.
Article
82. Mannai C, Leake D, Pizzoferrato A, Ciapetti G, Spangiogi C. Histological evaluation of purified bovine tendon collagen sponge in tooth extraction sites in dogs. Oral Surg Oral Med Oral Pathol. 1986; 61:315–323.
Article
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