Dental Tribune United Kingdom Edition

Haemostasis has proved fundamental for the prevention of excessive blood loss and for wound healing after injury, or wound setting. It is a basic prerequisite for flawless work in restorative dentistry. There are numerous tissue management systems for haemostasis and retraction on the dental market, including mechanical techniques and locally acting chemical agents, which can be applied alone or in combination with retraction sutures. In a survey in which German dentists tested the practicality of various haemo- static agents and compared them, the thixotropic HEMOSTASYL (Pierre Rolland, Acteon Group) achieved the best results. Among other things, the gel was found superiorintermsofastringentandhaemo- static effects, as well as handling proper- ties. The best means of avoiding possible bleeding complications is a conservative procedure that causes little trauma to the tissues and vessels. In many cases, a suffi- cient local therapy can also help prevent bleeding complications during and after surgical procedures or reconstruction. In addition to the body’s own haemostatic mechanisms, there are a number of meas- ures and substances in dentistry that sup- port haemostasis. They can be mechanical, chemical, thermal or surgical, or any com- bination of these. The choice of product or technique depends on the clinical situa- tion (localisation, and the extent or risk of bleeding), as well as on the clinician’s pref- erences. Adopting a different approach to the products available on the market, Pierre Rolland introduced a new type of gel in Germany in 2007. HEMOSTASYL is a thixotropic product for light to moder- ately heavy bleeding and contains aluminiumchloride.Itsangledsyringeap- plicator facilitates direct and precise ap- plication. The gel achieves its haemostatic effect through a combination of aluminium chloride and kaolin. This is mechanically augmented by the thixo- tropic properties of the material. Haemostasis should begin to take effect in less than 2 minutes, after which the treated area should be free of bleeding. The gel is applied with the application cannula, withnopressureexertedonthegingiva.Af- ter haemostasis has been achieved, the turquoise-blue substance is removed with a light air and water spray and simultane- ous suction (Figs. 1–4). In order to determine whether this prod- uct offers advantages over other products used for haemostasis, some 1,000 sample packs were distributed to dentists, ortho- dontists and oral surgeons throughout Ger- many, along with instructions for use and a questionnaire. Over 500 participants agreed to take part in the test. The question- naire was developed in collaboration with the Department of Medical Biometry and Epidemiology at the University Medical Center Hamburg-Eppendorf. It consisted of twosections:thefirstpartdealtwithgeneral information about other products used for haemostasis and their indications, and the second part asked participants to evaluate HEMOSTASYLandcompareitwiththeother products with respect to haemostatic prop- erties, handling and time to haemostasis. Over the course of the study, HEMOSTA- SYL was tested 2,542 times. The majority (69.4 %) of the participants applied it four to ten times. The properties of the product were compared with those of more than 13 other haemostatic products, including ViscoStat, Ultradent; Astringedent, Ultra- dent; and Racestyptine, Septodont, which were used by over 50 per cent of the partici- pants. Just under half of the participants said impression taking was the most fre- quent indication, followed by composite fillings. Only one in ten reported using it in tooth preparation. Other indications in- cluded cementation, temporary crowns, bracket bonding, retainer bonding, and amalgam and CEREC restorations. Using the Mann–Whitney test, it was de- termined that the participants rated haemostasis with HEMOSTASYL statisti- cally significantly better than with the otherproductsforthelistedindications.Al- most 87 % (443) of the participants gave haemostasis with the thixotropic gel a score of 1 or 2. Only 69.4 % (354) of the participants gaveanyofthereferenceprod- ucts such a high rating. A result of no bleeding after application of HEMOSTASYL was reported by 32.2 % (164)oftheparticipants.Withthereference products, only 20 % achieved this effect. Moderate bleeding with HEMOSTASYL was reported by only 10.4 % (53) of the partici- pants.Bycontrast,moderatebleedingafter application of one of the reference prod- ucts was relatively frequent (26.3 %). The gel from Pierre Rolland also achieved a statistically significantly better result withregardtohandling:over90%ratedthe handling of HEMOSTASYL as very good or good. This rating was given to the other haemostatic products in only half of the cases. These received a score of 1 from only 13.9 % (71) and a score of 2 from 40.6 % (207) of the participants. Using the chi-squared test, it was deter- mined that the rating for HEMOSTASYL re- garding time to haemostasis was also sta- tistically significantly better than for the reference products. More than three-quar- ters (386) of the participants reported that haemostasis using the gel was achieved rapidly.Only34.7 %(177)oftheparticipants rated the other products just as highly. Considering all properties together (haemostasis, handling/application and time to haemostasis), HEMOSTASYL was rated better overall than any other refer- ence product. The aluminium chloride in the gel appears to offer additional enhancement ofhaemostasis.Asitcanbeapplieddirectly and precisely in the mouth with the angled syringe applicator, it also fared better with the testers with regard to its handling and application. Other advantages are that it canberemovedeasilywithanairandwater spray and it is easy to detect owing to its high-contrast turquoise colour. In addi- tion, HEMOSTASYL was given a higher rat- ingbymostoftheparticipantswithrespect to the time factor, as treatment (for exam- ple, taking an impression or bonding in- lays) can be continued immediately after haemostasis with the haemostatic wound dressing under optimal conditions. Participants also reported other benefits of the product, including painless treat- ment, particularly when the wound dress- ing is applied to a healthy periodontium, and high tolerability without undesirable systemic side-effects, as can be the case with haemostatic agents containing epine- phrine for example. Overall, HEMOSTASYL distinguishes itself with its thixotropic properties and consequent ease of application and very good adhesion to the tissue without exert- ing pressure, as well as the associated mechanical effect. The results proved that HEMOSTASYL is indicated for efficient haemostasis in cases of light to moderate bleeding. With clear indications for use and easyapplicationwithreducedrisktothepa- tient, it can be considered another step for- ward in quality assurance in the dental practice. Editorialnote:Alistofreferencesisavailable from the publisher. 11Dental Tribune United Kingdom Edition | 9/2014 TRENDS & APPLICATIONS Advantages of HEMOSTASYL for thixotropic wound dressing conﬁrmed Results from an empirical comparative study Dr Sven Schomaker,Germany 1 2 3 4 DR SVEN SCHOMAKER maintains a private prac- tice in Hamburg in Ger- many.His contact details can be found at www.zah- narzt-hamburg.biz. 12 34

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