Efficacy of hemostatic agents in endodontic surgery: A systematic review and network meta-analysis

Faculty of Oral and Dental Medicine, Ahram Canadian University, Egypt.. Electronic address: ahmed.g.a.khater@gmail.com. Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada. Restorative and Dental Materials Department, National Research Centre, Egypt. Faculty of Dentistry, Misr University of Science and Technology, Egypt. Faculty of Medicine, Zagazig University, Zagazig, Egypt. 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.

The journal of evidence-based dental practice. 2021;21(3):101540
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.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine