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Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery

2016-05-12 / Categories:Hemostatic, Sponges,
Basedonthesefindings,theclinicaluseofExpasylTM has been modified to include freshening the bony surface of the periapical crypt with a bur after placement and initial setting of the root-end filling material.

Resorbable gelatin-based sponges, such as Spongostan!, Spongostan!, Dental, Johnson & Johnson medical Ltd., Ascot, UK, are frequently used for haemostasis in several surgical specialties (Petersen et al. 1984, finn et al. 1992, Schonauer et al. 2004). Spongostan! can be used alone, but is often combined with a vasoconstrictor to enhance the haemostatic effect (Rud et al. 2001). Tissue reactions to Spongostan! are generally considered to be mild (Alpaslan et al. 1997). However, when Spongostan! is left inside osseous defects, delayed healing has been reported (Liening et al. 1997, Schonauer et al. 2004). It is not known how the tissue reacts if the gelatin sponge is removed after haemorrhage control has been achieved.

Electro cauterization is an effective method for producing haemostasis by coagulation and vesicular clumping. Most often, electro cauterization is used to stop localized bleeding in the soft tissues, but it has also been reported to be efficient when used on oozing bone surfaces (Jensen et al. 2002). With this approach, no foreign substance is introduced into the bony crypt.

To compare the haemostatic effects of ExpasylTM + Stasis!, Spongostan!, Spongostan! + epinephrine and electro cauterization in standardized bone defects.

To evaluate the tissue reactions after using ExpasylTM + Stasis! with and without freshening of the bone defect with a bur, after electro cauterization, and after using Spongostan! alone or in combination with epinephrine.

Material and methods

Approval to perform the study was granted by the authorities of the Canton of Bern, Department of Agriculture, Section Veterinary Service, Experimental Animal Studies (study number 100/06). The experimental study was conducted in six adult Burgundy rabbits, each at least 5 months old and weighing between 3 and 4.5 kg.

The surgical procedures were performed under intravenous general anaesthesia using the medication and surgical protocol presented by von Arx et al. (2006). In each rabbit, six standardized monocortical bone defects were created in the calvarium. The defects were prepared using a trephine with an outer diameter of 4 mm. The depth of the defects depended on the thickness of the outer cortical bone layer. Each defect then received one of the following treatments in a randomized sequence.

Histological analysis

The non-decalcified specimens were embedded in methyl-methacrylate and stained with combined basic fuchsin and toluidine blue. Transversal sections with a thickness of approximately 80 lm were obtained for descriptive histology (Schenk et al. 1984). The histologic examination for the description of qualitative tissue reactions included absence or presence of (i) remnants of anticoagulation agents; (ii) new bone; (iii) necrotic bone; (iv) an inflammatory cell infiltrate; and (v) multinucleated giant cells.