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Khater AGA, Al-Hamed FS, Safwat EM, Hamouda MMA, Shehata MSA, Scarano A. EFFICACY OF HEMOSTATIC AGENTS IN ENDODONTIC SURGERY: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Evid Based Dent Pract 2021; 21:101540. [PMID: 34479672 DOI: 10.1016/j.jebdp.2021.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
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 EBSCOhost 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. achieve adequate hemostasis. Given insufficient evidence, future RCTs addressing this evidence gap are required.
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Affiliation(s)
- Ahmad G A Khater
- Faculty of Oral and Dental Medicine, Ahram Canadian University, Egypt..
| | - Faez Saleh Al-Hamed
- Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
| | - Engie M Safwat
- Restorative and Dental Materials Department, National Research Centre, Egypt
| | | | | | - Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), University of Chieti-Pescara, Chieti, Italy; Research staff at Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD, USA
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Coakley A, Wu MJ, Kumar J, Dadrass F, Tao J, Moy L, Webb K, Lee K. A Comparison of Ferric Subsulfate Solution, Silver Nitrate, and Aluminum Chloride for Pain Assessment, Time to Hemostasis, and Cosmesis in Acrochordon Snip Excision. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:32-37. [PMID: 33488917 PMCID: PMC7819594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND: Acrochordon (skin tag) removal by snip excision is a routine dermatologic procedure. Bleeding is a common sequelae of snip excision that requires hemostatic control. Chemical cautery is a common means of achieving hemostasis in this procedure. OBJECTIVE: The aim of this study was to evaluate three different chemical cautery solutions for their time to hemostasis, pain upon application, and associated pigmentary changes. METHODS: Twelve patients with six or more skin tags on the bilateral neck and/or axilla were enrolled. Two skin tags were cauterized with ferric subsulfate solution, two with silver nitrate, and two with aluminum chloride hexahydrate solution. Time to hemostasis and pain with application of each cautery solution to the skin tag was recorded. At a two-week follow-up appointment, patient satisfaction was assessed with a survey, and pigmentary changes were documented with digital photography. RESULTS: There was no significant variability in the time to hemostasis among the three chemical cautery solutions (p=0.57). Pain response was significantly different among the three solutions (p=0.003). Compared to silver nitrate (median=6.00, interquartile range [IQR]: 4.50-6.50), aluminum chloride hexahydrate (median=1.00, IQR: 0.50 to 6.00; Sidak p=0.02) and ferric subsulfate (median=1.50, IQR: 0.00-3.50; Sidak p=0.01) had a significantly lower pain response. Among participants, three (25%) experienced a pigmentary change with ferric subsulfate, two (17%) with aluminum chloride, and six (50%) with silver nitrate (overall p= 0.14). CONCLUSION: These results indicate that the three standard chemical cautery solutions for skin tag snip excision have significant differences in pain upon application and pigmentary changes. This might be a relevant consideration when selecting a chemical cautery solution.
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Affiliation(s)
- Anne Coakley
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
| | - Matthew J Wu
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
| | - Jayanth Kumar
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
| | - Farinoosh Dadrass
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
| | - Joy Tao
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
| | - Lauren Moy
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
| | - Kirsten Webb
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
| | - Kristin Lee
- Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois
- Drs. Tao, Moy, Webb, are with the Division of Dermatology, Department of Internal Medicine at Loyola University Medical Center in Maywood, Illinois
- Dr. Lee is with the Department of Dermatology at DuPage Medical Group in Lombard, Illinois
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Sarac N, Ugur A, Karaca I. Evaluation of antioxidant and antimutagenic activities of aluminum chloride. Eur Oral Res 2019; 53:51-55. [PMID: 31309193 PMCID: PMC6614690 DOI: 10.26650/eor.20197852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/22/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose: Hemostatic agents are used to control hemorrhage and the gingival crevicular fluid
for dental applications. In this study; the antimutagenic and antioxidant activities of
aluminum chloride (AlCl3), a topical hemostatic agent used especially in the fields
of dermatology and dentistry, were determined. To our knowledge, this is the first
study that investigates these properties. Materials and methods: The antioxidant activity was determined by DPPH free radical scavenging and
β-carotene-linoleic acid bleaching assays. The antimutagenic activity was evaluated
with the Ames Salmonella/ microsome mutagenicity test using Salmonella
typhimurium TA98 and TA100 strains. Results: The total antioxidant activity of AlCl3, determined by β-carotene bleaching assay
was found to be 25.59 ± 2.55% and the DPPH scavenging activity of AlCl3 was
determined as 17.49 ± 3.07%. AlCl3 showed not any mutagenicity at the tested
concentrations by the AMES test used S. typhimurium TA98 and TA100. This drug
demonstrated antimutagenic effects at the test concentrations and the strongest
antimutagenic activity was observed on 1.25 mg·mL-1/plate concentration of AlCl3. Conclusion: AlCl3 showed potent antimutagenic and antioxidant activities and these properties
are significant for dentistry and dermatology.
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Affiliation(s)
- Nurdan Sarac
- Department of Biology, Faculty of Science, Mugla Sitki Kocman University, MuglaTurkey
| | - Aysel Ugur
- Section of Medical Microbiology, Department of Basic Sciences, Faculty of Dentistry, Gazi University, AnkaraTurkey
| | - Inci Karaca
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, AnkaraTurkey
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Maischberger C, Liebermann A, Stawarczyk B. The Effect of Hemostatic Agents on the Retention Strength of Zirconia Crowns Luted to Dentin Abutments. MATERIALS (BASEL, SWITZERLAND) 2019; 12:ma12060979. [PMID: 30934551 PMCID: PMC6471257 DOI: 10.3390/ma12060979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to investigate whether hemostatic agents (HA) show an effect on the retention strength (RS) of zirconia crowns luted to dentin abutments after cleaning with an air/water spray. Human molars (N = 60/n = 12) were prepared and zirconia crowns were milled. Prior to luting (Scotchbond Universal/RelyX Ultimate), molars were pretreated using HA: i. 25% AlCl₃ (VSC), ii. 20% Fe₂(SO₄)₃ (VS), iii. 15.5% Fe₂(SO₄)₃ (AS), iv. 12.7% iron ion solution (ASX) and v. no pretreatment (control). Mastication simulation and pull-out tests were performed. Failure types were defined: cohesive 1-tooth root; cohesive 2-tooth crown; adhesive 1-cement on tooth; adhesive 2-cement on tooth and crown; mixed-adhesive/cohesive. Data were analyzed using 1-way ANOVA, post-hoc Scheffé, Pearson's chi-square-test and Ciba⁻Geigy table (p = 0.05). No RS differences between the tested groups were observed (p = 0.200). ASX fractured more cohesive 2 than the control group. VSC showed more cohesive 2 than adhesive 1 fractures. VS showed more adhesive 2 than mixed fractures. AS showed more cohesive 2 than adhesive 1 and more adhesive 2 than mixed fractures. ASX showed predominantly cohesive 2 fractures. RS was not affected when HA were cleaned off by 30 s of air/water spray prior to luting. HA still seem to weaken the dentin abutment, making it prone to cohesive fractures.
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Affiliation(s)
- Christian Maischberger
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany.
| | - Anja Liebermann
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany.
| | - Bogna Stawarczyk
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany.
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Nouri S, Sharif MR, Afzali H, Sharif A, Satkin M. The Advantages and Disadvantages of Methods Used to Control Liver Bleeding: A Review. Trauma Mon 2015; 20:e28088. [PMID: 26839866 PMCID: PMC4727474 DOI: 10.5812/traumamon.28088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/15/2015] [Accepted: 08/17/2015] [Indexed: 01/22/2023] Open
Abstract
Context: Despite advancements in the science of surgery, minimizing bleeding from parenchymal tissue of the liver continues to be one of the challenges surgeons are facing to protect patients’ lives. However, the number of surgeries needing incisions in the liver tissue, e.g. metastatectomy, is constantly increasing. Evidence Acquisition: A MEDLINE and conventional search of the past 50 years of the medical literature was performed to identify relevant articles on hemostasis in the liver parenchymal tissue. Results: The studies that have been published on hemostasis in the liver parenchymal tissue can be classified into 3 categories: 1. surgical procedures; 2. methods affecting body hemodynamic; 3. pharmacological methods. The purpose of these studies are to identify the best therapeutic approaches that not only minimize the bleeding, but also save the maximum amount of the liver tissue and minimize the use of partial liver resections. Conclusions: The excessive blood loss and the long time needed to control the bleeding during liver surgery impose several side effects and complications on patients. Topical hemostatic agents such as ferric chloride, potassium aluminum sulfate (alum) and aluminum chloride are safely applicable in patients. These agents might be used along with other current methods to minimize the blood loss and the need for blood products during liver surgeries.
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Affiliation(s)
- Saeed Nouri
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Sharif
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Reza Sharif, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9123788713, Fax: +98-3615558900, E-mail:
| | - Hasan Afzali
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Alireza Sharif
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mojtaba Satkin
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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