Haemostatic agents used in periradicular surgery: an experimental study of their efficacy and tissue reactions

AIM: To evaluate the haemostatic efficacy and the histologic tissue responses after the application of different haemostatic agents used in periradicular surgery. METHODOLOGY: The study was conducted in the calvarium of six rabbits. Standardized bone defects (diameter 4 mm) were trephined, and different haemostatic agents were applied and compared with control defects: bone wax (left for 10 min), Stasis (ferric sulphate, left for 5 s), Expasyl (aluminium chloride, left for 2 min and left permanently in situ), and a combination of Expasyl (2 min) and Stasis (5 s). The sites were photographed before the application and after the removal of the haemostatic agents. Three independent examiners judged the initial and final bleeding (on the photographs) using a bleeding score for each site and treatment. The results were compared using Wilcoxon's signed rank test. For the histologic analysis, three animals were killed after 3 weeks and three animals after 12 weeks. Transverse, nondecalcified sections were stained with combined basic fuchsin and toluidine blue for descriptive histology. RESULTS: The most efficient haemorrhage control was provided by Expasyl in combination with Stasis and by Expasyl alone, whereas bone wax had the weakest bleeding reduction effect. The histologic analysis after 3 weeks demonstrated an inflammatory and foreign body tissue response towards all haemostatic agents. At 12 weeks, this tissue response was less pronounced but still present in sites treated with bone wax or Expasyl. In general, the inflammatory tissue reactions were limited to the bone defects, and never extended into the surrounding tissues. CONCLUSIONS: Expasyl alone or in combination with Stasis appeared to be the most efficient of tested agents to control the bleeding within the bony defects created in a rabbit calvarium model.