Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery S. S. Jensen 1,2 , P. M. Yazdi 3 , E. Hjørting-Hansen 1,4 , D. D. Bosshardt 1 & T. von Arx 1 1 Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; 2 Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Glostrup, Denmark; 3 Department of Oral & Maxillofacial Surgery, School of Dental Medicine, University of A ˚ rhus, A ˚ rhus, Denmark; and 4 Department of Oral & Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark Summary 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. International Endodontic Journal, 43, 57–63, 2010. 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 haemo- static effect and tissue reactions, and were compared with untreated control defects: Expasyl TM + Stasis Ò , Expasyl TM + Stasis Ò + freshening of the bone defect with a bur, Spongostan Ò , Spongostan Ò + 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 reac- tions related to the different haemostatic measures, after 3 and 12 weeks of healing respectively. Results Expasyl TM + Stasis Ò and electro cauteriza- tion 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 Ò + 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 TM + Stasis Ò or electro cauterization. However, the bone defects should be freshened with a rotary instrument before suturing so as not to compromise healing. Keywords: animal study, apical surgery, haemor- rhage control, haemostatic agent. Received 15 July 2009; accepted 25 August 2009 Introduction Haemorrhage control is important in apical surgery to facilitate inspection of the root-end surface and to allow placement and setting of the root-end filling. Usually, one or more local agents are needed to achieve sufficient haemostasis. These agents should be either removed completely or should be fully biocompatible and degrade without interfering with periapical healing. The haemostatic effect and tissue reactions of bone wax, ferric sulphate (Stasis Ò , Belport Co, Camarillo, CA, USA), and an aluminium chloride-containing paste (Expasyl TM , Pierre Rolland, Merignac, France) intended for application into the sulcus prior to impression-taking has been reported (von Arx et al. 2006). The combina- tion of Stasis Ò and Expasyl TM or Expasyl TM alone proved most efficient in controlling haemorrhage. However, their use was accompanied by an inflammatory and a Correspondence: Dr Simon Storga ˚rd Jensen, Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital Glostrup, Ndr. Ringvej, DK-2600 Glostrup, Denmark (Tel.: +45 43 23 32 08; fax: +45 43 23 39 63; e-mail: simon.storgaard@jensen.mail.dk). doi:10.1111/j.1365-2591.2009.01637.x ª 2010 International Endodontic Journal International Endodontic Journal, 43, 57–63, 2010 57