Hemostasis

Hemostasis is an indispensable factor for microsurgery because a dried surgical field provides better visualization of the microanatomy, dramatically improves the surgical efficiency and minimizes root-end filling contamination.

Anesthesia provides effective hemostasis. Both buccal and lingual-palatal injections are required to get effective hemostasis. Use of anesthetics during surgery to get hemostasis is ineffective.

The microscope is used at medium magnification (10x).

Armamentarium

2% Lidocaine with 1:50,000 epinephrine anesthetic solution
Epinephrine pellets (Racellets, Pascal Co., Bellevue, WA, USA)
Ferric sulfate with different concentrations: Stasis (21 %), Cutrol (50%), Monsel Sol (70%)
Calcium sulfate (Class Implant, Rome, Italy)
Surgical wax (Ethicon, Johnson & Johnson Medical, Somerville NJ, USA)
Trombine
Celfoam (Pharmacia, Peapack, NJ, USA)
Surgicel (Ethicon, Johnson & Johnson Medical)
Collagen (CollaCote, Sulzer medical, Plainsboro, NJ, USA).

History

A thorough review of the patient’s medical history is necessary to identify any undiagnosed condition that might affect hemostasis during endodontic microsurgery. Many patient medications can affect the clotting mechanism. Vital signs like blood pressure, heart and respiratoy rates should be assesed.

Inducing Hemostasis

Haemostasis can be divided into three phases: presurgical, surgical and postsurgical.

Presurgical (prior to incision)

Hemostasis is provided by the local anaesthetics (lidocaine) with 1:50,000 epinephrine that produces vasocontriction of the smooth muscle of the arterioles of the oral mucosa, submucosa and periodontal ligament.

Surgical

Several topical hemostatics are available. No local anaesthetics are given at this time because no vasoconstriction effect will be obtained.

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