Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.

Citations

Citations to this article as recorded by  

• Expert consensus on apical microsurgery
  Hanguo Wang, Xin Xu, Zhuan Bian, Jingping Liang, Zhi Chen, Benxiang Hou, Lihong Qiu, Wenxia Chen, Xi Wei, Kaijin Hu, Qintao Wang, Zuhua Wang, Jiyao Li, Dingming Huang, Xiaoyan Wang, Zhengwei Huang, Liuyan Meng, Chen Zhang, Fangfang Xie, Di Yang, Jinhua Yu
  International Journal of Oral Science.2025;[Epub]     CrossRef
• Assessing the efficacy of apicoectomy without retrograde filling in treating periapical inflammatory cysts
  Jeong-Kui Ku, Woo-Young Jeon, Seung-O Ko, Ji-Young Yoon
  Journal of the Korean Association of Oral and Maxillofacial Surgeons.2024; 50(3): 140.     CrossRef
• Functional and structural neurodegenerative activities of Ankaferd BloodStopper in a mouse sciatic nerve model
  Ramazan Üstün, Elif Oğuz, Ayşe Şeker, Filiz Taspinar
  Experimental and Therapeutic Medicine.2024;[Epub]     CrossRef
• Local and Systemic Hemostatic Agents: A Comprehensive Review
  Bardia Jamali, Saeed Nouri, Salimeh Amidi
  Cureus.2024;[Epub]     CrossRef
• PLGA Nanoparticle Rapamycin- or Necrostatin-1-Coated Sutures Inhibit Inflammatory Reactions after Arterial Closure in Rats
  Liwei Zhang, Wang Wang, Boao Xie, Peng Sun, Shunbo Wei, Haoliang Wu, Cong Zhang, Jingan Li, Zhuo Li, Hualong Bai
  ACS Applied Bio Materials.2022; 5(4): 1501.     CrossRef
• COMPARING THE CLINICAL AND RADIOGRAPHIC OUTCOMES OF PULPOTOMIES IN PRIMARY MOLARS USING BIOACTIVE ENDODONTIC MATERIALS AND FERRIC SULFATE – A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS
  VELLORE KANNAN GOPINATH, SHAJU JACOB PULIKKOTIL, SAJESH K VEETTIL, LALLI DHARMARAJAN, PONNUDURAI SAMUEL GNANA PRAKASH, VINEET DHAR, JAYAKUMAR JAYARAMAN
  Journal of Evidence-Based Dental Practice.2022; 22(4): 101770.     CrossRef
• Perioperative Antiplatelet and Anticoagulant Management with Endodontic Microsurgical Techniques
  Anita Aminoshariae, Mark Donaldson, Michael Horan, James C. Kulild, Dale Baur
  Journal of Endodontics.2021; 47(10): 1557.     CrossRef
• Effect of blood contamination and various hemostatic procedures on the push-out bond strength of Biodentine when used for furcation perforation repair
  Shanthana Reddy, Ramya Shenoy, LohithReddy Mandadi, Ishani Saluja, ManuelS Thomas
  Journal of Conservative Dentistry.2021; 24(3): 260.     CrossRef
• Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix
  Talal Al-Nahlawi, Maisour Ala Rachi, Amjad Abu Hasna, Zohaib Khurshid
  International Journal of Dentistry.2021; 2021: 1.     CrossRef
• Hemostatic agents in periapical surgery: The systematic review
  Z. S. Khabadze, D. A. Nazarova, E. S. Shilyaeva, A. P. Kotelnikova, Yu. A. Bakayev, S. M. Abdulkerimova, Kh. O. Omarova
  Endodontics Today.2021; 19(3): 184.     CrossRef
• An Innovative Bioceramic Bone Graft Substitute for Bone Defect Treatment: In Vivo Evaluation of Bone Healing
  Syamsiah Syam, Yung-Chieh Cho, Chung-Ming Liu, Mao-Suan Huang, Wen-Chien Lan, Bai-Hung Huang, Takaaki Ueno, Chi-Hsun Tsai, Takashi Saito, May-Show Chen, Keng-Liang Ou
  Applied Sciences.2020; 10(22): 8303.     CrossRef
• Trial finds better haemostasis with aluminium chloride during periapical surgery
  Niall Mc Goldrick, Carly Ross, James Nelson
  Evidence-Based Dentistry.2017; 18(2): 50.     CrossRef
• Comparison of the Hemostatic Activity of Quercus persica Jaub. & Spach. (Oak) With Ferric Sulfate in Bony Crypts
  Mohammad Reza Nabavizadeh, Arman Zargaran, Fariborz Moazami, Fatemeh Askari, Safoora Sahebi, Alireza Farhadpoor, Pouya Faridi
  Journal of Evidence-Based Complementary & Alternative Medicine.2016; 21(1): 34.     CrossRef
• Effect of the plant-based hemostatic agent Ankaferd Blood Stopper® on the biocompatibility of mineral trioxide aggregate
  Muzaffer Emir Dinçol, Hakan Ozbas, Bulent Yılmaz, Handan Ersev, Selcuk Gokyay, Vakur Olgac
  BMC Oral Health.2016;[Epub]     CrossRef