Haemostatic agents in apical surgery. A systematic review

Clé-Ovejero et al., 2016 | Med Oral Patol Oral Cir Bucal | Systematic Review

Citation

Clé-Ovejero A, Valmaseda-Castellón E. Haemostatic agents in apical surgery. A systematic review. Med Oral Patol Oral Cir Bucal. 2016-Sep-01;21(5):e652-7

Abstract

BACKGROUND: Blood presence in apical surgery can prevent the correct vision of the surgical field, change the physical properties of filling materials and reduce their sealing ability. OBJECTIVES: To describe which are the most effective and safest haemostatic agents to control bleeding in patients undergoing apical surgery. MATERIAL AND METHODS: We carried out a systematic review, using Medline and Cochrane Library databases, of human clinical studies published in the last 10 years. RESULTS: The agents that proved more effective in bleeding control were calcium sulphate (100%) and collagen plus epinephrine (92.9%) followed by ferric sulphate (60%), gauze packing (30%) and collagen (16.7%). When using aluminium chloride (Expasyl®), over 90% of the apical lesions improved, but this agent seemed to increase swelling. Epinephrine with collagen did not significantly raise either blood pressure or heart rate. CONCLUSIONS: Despite the use of several haemostatic materials in apical surgery, there is little evidence on their effectiveness and safety. The most effective haemostatic agents were calcium sulphate and epinephrine plus collagen. Epinephrine plus collagen did not seem to significantly raise blood pressure or heart rate during surgery. Aluminium chloride did not increase postoperative pain but could slightly increase postoperative swelling. Randomized clinical trials are needed to assess the haemostatic effectiveness and adverse effects of haemostatic materials in apical surgery.

Key Findings

The agents that proved more effective in bleeding control were calcium sulphate (100%) and collagen plus epinephrine (92.9%) followed by ferric sulphate (60%), gauze packing (30%) and collagen (16.7%). When using aluminium chloride (Expasyl®), over 90% of the apical lesions improved, but this agent seemed to increase swelling. Epinephrine with collagen did not significantly raise either blood pressure or heart rate.

Outcomes Measured

• blood pressure

Population

MeSH Terms

• Bandages
• Hemostatics
• Humans
• Oral Hemorrhage
• Tooth Apex

Evidence Classification

• Level: Systematic Review
• Publication Types: Journal Article, Systematic Review
• Vertical: collagen

Provenance

• PMID: 27475689
• DOI: (not available)
• PMCID: PMC5005106
• Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09