Osseous Reactions to Three Hemostatic Agents

By Ibarrola JL, Bjorenson JE, Austin BP, Gerstein H.

Date: 06/1985
Journal: JOE

Purpose: to evaluate and compare the effects of Gelfoam, Surgicel, and bone wax on the healing of osseous defects in rat tibias.

N= Fifty male (400- to 450-g) Sprague-Dawley rats .

Materials/Methods: •Sample divided into 3 groups where n=15 and one group n=5 •An incision was made and defects created in both tibias of animals in groups 1, 2, 3 then filled with hemostatic agents •Hemostatic agents in the right tibia were left in place for the experimental period.  In the left tibias it was removed after 10 minutes and are curettage performed to mimic apical surgery conditions. •Group 1 = Bone wax. Group 2 = Surgicel. Group 3 = GelfoamGroup 4 = control. Same surgical procedure performed but no hemostatic agent placed. Incisions were closed with 4-0 gut sutures placed 3 mm apart. •3 animals of each group 1-3 and one from group 4 were killed at different time intervals. (3, 7, 14, 40, 120 days) •All sections were examined with a Zeiss universal microscope.

Most highlighted Results: 

1.Microscopic examination was done at a specific intervals. 40 days showed completion of bone regeneration.

1.Gelfoam: more rapid healing in left tibias.

2.Surgicel: delayed healing in right tibias, remnants in left tibia after 40 days 3.Bone wax: greatly impaired osseous regeneration. In righ t tibias, complete inhibition of bone regeneration.

2.Histological examination demonstrated that distinct osseous reactions occurred depending upon the hemostatic agent utilized and whether the material was removed 10 min after implantation (left tibias) or left in situ (right tibias) for the duration of the experiment


1. Bone wax + Surgicel if left in situ = greatly inhibited osteogenesis and caused a foreign body reaction.

2.        Gelfoam if left in situ = complete resorption of the material  (2/3) 120-day specimens.

3.Curettage did not prevent residues of the hemostatic agents from causing similar but less severe reactions.

Clinical Significance:

1.Gel-foam is the most acceptable hemostatic agent.

2.It is recommended that clinicians using these hemostatic agents during periapical surgery be particularly attentive to the meticulous removal of the material.