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Radiograph before periapical surgery.
Source publication
O b j e c t i v e The aim of the current investigation was to review techniques and materials available to achieve bleeding control during periapical surgery. An adequate bleeding control is crucial, since it improves vision in the surgical site, minimizes surgical time, enhances the root-end resection and filling, and reduces surgical blood loss,...
Contexts in source publication
Context 1
... amine-type sympathomimetic vasocon- strictors have been used as topical agents for the control of hemorrhage in periapical surgery 2 (Figs. 1-8). Epinephrine produces vasoconstric- tion by stimulation of -adrenergic receptors. Besner suggested that its use in periapical sur- gery can produce a systemic cardiovascular response. 7 Vickers et al. evaluated the hemo- static efficacy and cardiovascular effects of ferric sulfate and pellets impregnated with racemic epinephrine, and ...
Context 2
... and electrocauterization. 13 The most effective methods in the reduction of bleeding were Expasyl and Stasis combined (P < 0.05) and electrocauterization. Menéndez- Nieto et al. compared the hemostatic efficacy of epinephrine and aluminum chloride in 99 patients and concluded that aluminum chloride produced better results (P < 0.05; 14 Figs. ...
Citations
... As far as the effect of incision design on clinical attachment loss is concerned, out of two studies, only one (Von Arx et al.) was in favor of FSF. [2] No difference in clinical attachment loss was reported by Sargolzaie et al. [28] The result of metanalysis Omar [13] 2018 Single arm Irrelevant objective Peñarrocha Diago and Cervera Ballester [14] 2017 A review Irrelevant objective von Arx et al. [15] 2012 Observational cohort Irrelevant objective Grandi and Pacifici [16] 2009 A review Irrelevant objective Kreisler et al. [17] 2009 Clinical observational study Irrelevant objective von Arx et al. [18] 2008 Cohort Irrelevant objective Velvart and Peters [4] 2005 Review Irrelevant objective Lieblich [19] 2015 Review Study design Verardi [20] 2012 Letter to editor/review Study design von Arx [3] 2011 Review Study design von Arx et al. [21] 2009 Cohort Study design Taschieri et al. [22] 2008 Case report Study design Von Arx and Salvi [23] 2008 Review Study design Velvart et al. [24] 2004 Single arm Study design Velvart [25] 2002 Single arm Study design Velvart et al. [26] 2003 RCT Duplicate data Taschieri et al. [27] 2014 RCT Duplicate data RCT -Randomized control trial were significantly in favour of PSF as significantly less clinical attachment loss was observed in PSF group as opposed to FSP group (P = 0.0004). ...
Background:
Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss.
Objective:
The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries.
Materials and methods:
It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made.
Results:
Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession (P = 0.79), papilla height (P = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004) were observed for the two flap designs in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004).
Conclusions:
The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.
... Different hemostatic agents and materials have been proposed for bleeding control in endodontic surgery (bone wax, collagen membranes, ferric sulfate, epinephrine, and aluminum chloride). However, consensus is lacking regarding the best hemostatic option 3 . To date, only 4 clinical trials have evaluated the efficacy of different hemostatic agents, specifically comparing epinephrine pellets versus 20% ferric sulfate, collagen sponges 1 2.25% racemic epinephrine versus collagen sponges 1 saline, calcium sulfate versus gauze tamponade versus 20% ferric sulfate, and epinephrine versus aluminum chloride [4][5][6][7] . ...
Introduction
Bleeding control is an important aspect in endodontic surgery. Two hemostatic techniques were compared with regard to their efficacy to bleeding control in endodontic surgery.
Methods
A randomized, 2-arm, parallel pilot study involving 30 patients with periradicular lesions was performed including the following hemostatic agents: polytetrafluoroethylene strips as an adjunct to epinephrine-impregnated gauze (test group, n = 15) and aluminum chloride (control, n = 15). Bleeding control was independently assessed by the surgeon and 2 blinded observers before and after application of the hemostatic agent. Bleeding control was classified either as adequate (complete bleeding control) or inadequate (incomplete bleeding control).
Results
Hemostasis in both groups proved similar. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosa band (≥2 mm) suggested a risk reduction for an inadequate bleeding control up to 79% (odds ratio = 0.21, P > .05).
Conclusions
No differences in the efficacy of bleeding control were observed between polytetrafluoroethylene strips as an adjunct to epinephrine-impregnated gauze and aluminum chloride.
Manifestation of developmental disturbances of the teeth can be in the form of variations in number, position, size, shape, eruption or structure. Such disturbances may be independent or associated with more generalised disorders. The form and structure of the teeth may be affected by local and general factors. This paper is a report of a 12-year-old girl with missing both permanent mandibular central incisors along with permanent maxillary right central incisor. Past history revealed trauma 5 years back due to fall from height. Radiographic examination revealed congenitally missing permanent mandibular left and right central incisors and dilacerated permanent maxillary right central incisor. A multidisciplinary approach has been presented for management of such cases.
Objective:
Adequate hemostasis is a critical step in endodontic surgery. It facilitates the procedure and affects the success and prognosis of the operation. This systematic review and network meta-analysis (NMA) aimed to systematically assess the efficacy of hemostatic agents in endodontic surgery and to identify the most effective ones.
Methods:
PubMed, Scopus, Embase, Cochrane Library, Web of Science, ProQuest, and EBSCO host databases were searched up to December 2020. We included randomized controlled trials (RCTs) evaluating the efficacy of different hemostatic measures in endodontic surgery, and their risk of bias was assessed using Cochrane’s randomized trial tool (RoB 2.0). Frequentist network meta-analysis was conducted, with Odds Ratios and 95% confidence intervals (OR, 95% CI) as effect estimates using the "netmeta" package in R. The quality of evidence was assessed using the CINeMA approach.
Results:
Six RCTs involving 353 patients (mean age 48.12 y) were included. NMA revealed that aluminum chloride achieved higher hemostatic efficacy than epinephrine (OR = 2.55, 95% CI [1.41, 4.64]), while there was non-significant difference when compared with PTFE strips + epinephrine (OR = 1.00, 95% CI [0.35, 2.90]), electrocauterization
(OR = 2.67, 95% CI [0.84, 8.46]), or ferric sulfate (OR = 8.65, 95% CI [0.31, 240.92]). Of all hemostatic agents, aluminum chloride ranked
first in control bleeding during endodontic surgery (P-score = 0.84), followed by PTFE strips + epinephrine (P-score = 0.80), electrocauterization (P-score = 0.34), epinephrine (P-score = 0.34), ferric sulfate (P-score = 0.18). The quality of evidence was very low.
Conclusions:
Based on the limited data, aluminum chloride provides better hemostasis than epinephrine, while there was no significant difference between the remaining hemostatic agents used in endodontic surgery, which could help clinicians choose the hemostatic agent that achieves adequate hemostasis. Given insufficient evidence, future RCTs addressing this evidence
gap are required.
This study aimed to analyze characteristics of an innovative α-calcium sulfate hemihydrate (α-CSH) bioceramic and bone healing and regeneration characteristics following its implantation on artificially created defects of rat models and human jaw defects. The α-CSH bioceramic was characterized using field emission scanning electron microscope (FE-SEM), energy-dispersive spectroscopy (EDS), and thermal-imaging instruments. The material was implanted on artificially created defects in a rat’s right hind leg bone and observed histologically after three days and seven weeks. The material was also implanted in patients with bone defects in the posterior maxillary, then observed immediately and six months post-treatment by panoramic and computed tomography image. The FE-SEM confirm this material is a uniform-shaped short column crystal, while the EDS measurement reveals calcium as the most component in this material. Thermal observation shows temperature change during the setting time is less than 2◦C, and the maximum temperature reached is 31◦C. In the histological analysis, α-CSH bioceramic shows new trabecular bone formation and absorbed material at seven weeks post-treatment. Moreover, panoramic and computed tomography image shows intact bone six months post-treatment. Therefore, this study suggests that the innovative α-CSH bioceramic can be useful in bone defect treatment.
