Laura Maestre-Ferrín

University of Valencia, Valenza, Valencia, Spain

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Publications (20)24.14 Total impact

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    ABSTRACT: Purpose: To report 20 cases with implant periapical pathology diagnosed during the osseointegration phase, evaluating retrospectively the efficacy of the treatment with implant periapical surgery. Materials and Methods: A retrospective chart review was conducted of all patients in whom implant periapical surgery was performed between 1996 and 2010. The criteria for diagnosing implant periapical pathology and, accordingly, performing implant periapical surgery were: (1) acute pain during the osseointegration period (8 weeks after implant placement) located in the area of the affected implant or presence of mucous fistula in relation with the implant apex; (2) absence of implant mobility; (3) non-dull percussion of nonsubmerged implants; and (4) presence or absence of implant periapical radiolucency. Results: Twenty-two implants were diagnosed with periapical pathology in 20 patients (13 women and 7 men) with a mean age of 54.3 years (range, 32 to 70 years) and were consecutively treated by a surgical approach. In 19 implants, the diagnosis was acute apical peri-implantitis (nonsuppurated in 7 cases and suppurated in 12), as based on the symptoms and radiographic sign, and in 3 cases it was subacute apical peri-implantitis, as based on the presence of a fistula. After a minimum follow-up of 1 year, 20 implants remained functional, with no clinical or radiologic alterations; the survival rate of the treated implants was 91%. Conclusion: The early diagnosis of inflammatory implant periapical lesions during the osseintegration phase, and their prompt surgical treatment, led to a survival rate of the treated implants of 91%.
    The International journal of oral & maxillofacial implants 01/2013; 28(1):158-62. · 1.91 Impact Factor
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    ABSTRACT: Objective: To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery. Design: A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow-up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl™). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery. Results: A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the success rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p>0.05). Conclusion: The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant.
    Medicina oral, patologia oral y cirugia bucal 12/2012; · 1.02 Impact Factor
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    ABSTRACT: The implant periapical lesion is the infectious-inflammatory process of the tissues surrounding the implant apex. It may be caused by different factors: contamination of the implant surface, overheating of bone during drilling, preparation of a longer implant bed than the implant itself, and pre-existing bone disease. Diagnosis is achieved by studying the presence of symptoms and signs such us pain, swelling, suppuration or fistula; in the radiograph an implant periapical radiolucency may appear. A diagnostic classification is proposed to establish the stage of the lesion, and determine the best treatment option accordingly. The following stages are distinguished: acute apical periimplantitis (non-suppurated and suppurated) and subcacute (or suppurated-fistulized) apical periimplantitis. The most adequate treatment of this pathology in the acute stage and in the subacute stage if there is no loss of implant stability is apical surgery. In the subacute stage, if there is implant mobility, the extraction of the implant is necessary.
    Medicina oral, patologia oral y cirugia bucal 08/2012; · 1.02 Impact Factor
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    ABSTRACT: A literature review is made to analyze the survival of implants placed with the osteotome technique. A PubMed search was made based on the key words "osteotome AND dental implants", corresponding to publications between 1998-2008. The inclusion criteria were: a) a minimum of 10 patients; b) a minimum follow-up of 6 months; c) implants placed using the osteotome technique with or without indirect sinus lift; and d) specification of the implant number and survival rate. Sixty-four articles were identified, of which 20 met the inclusion criteria. A total of 2006 implants were placed in 1312 patients using the osteotome technique. The duration of follow-up after prosthetic loading ranged from 6-144 months. Indirect sinus lift was carried out in all but one of the studies. The residual crest height ranged from 2.8-12 mm, with a mean gain in bone after sinus lift of 2.5-5.1 mm. The time from implant placement to prosthetic loading varied from 1.5-9 months. The percentage implant survival rate was 85.1-100%. The survival rate of implants placed with the osteotome technique is high and does not differ with respect to implant placement with the conventional technique.
    Medicina oral, patologia oral y cirugia bucal 05/2012; 17(5):e765-8. · 1.02 Impact Factor
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    ABSTRACT: The purpose of this study was to compare marginal bone loss and success rates 1 year after implants had been placed in maxillary molar sites, either immediately postextraction or after the extraction sites had healed (delayed). A retrospective case study was made of subjects treated with immediate or delayed dental implants in the maxillary molar region between January 2006 and December 2008. A protocol was prepared in which patient age, sex, implant length and diameter, type of prosthesis, buccal plate width, and use of bone grafting were recorded. After 12 months, data relating to the clinical and radiologic conditions of the implants and the success rate according to the criteria of Buser et al were recorded. The variables were analyzed statistically (Student t test, Pearson correlation, Games-Howell test). The study included 123 implants placed in 70 patients; 35 implants were immediate and 88 were delayed. Two immediate and six delayed implants failed, resulting in success rates of 94.3% and 93.2%, respectively. Average marginal bone loss was 0.56 mm for immediate implants and 0.67 mm for delayed implants. The placement of immediate implants in maxillary molar sites achieved similar results to implants placed in healed sites in the same region after 12 months. No statistically significant differences were found between implant survival rates or average marginal bone loss.
    The International journal of oral & maxillofacial implants 05/2012; 27(3):604-10. · 1.91 Impact Factor
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    ABSTRACT: The aim of this study was to compare the survival of implants placed in mature bone with the survival of implants placed in fresh extraction sockets in the same patients. A retrospective study of patients treated simultaneously with at least one immediate and one nonimmediate implant was carried out for the period 2005 to 2008. Data were recorded for patient age and sex; implant length, diameter, and position; and, for postextraction implants, distance between the implant and the alveolar bone. One thousand twenty-two implants were placed in 150 patients; 480 were placed immediately and 542 were placed in mature bone. The mean implant survival rate was 93.4%; survival rates were 93.8% for immediate implants and 93.2% for nonimmediate implants. The failure rate in the maxilla was 5.2% and in the mandible it was 2.8%. The failure rate for immediate implants in the posterior maxilla was 8.5%, which was statistically significantly higher than for implants placed elsewhere. Of the failed implants, 72% were early failures. The survival rate of implants placed in fresh extraction sockets was similar to that of implants placed in mature bone. A statistically significantly higher failure rate was seen with immediate implants placed in the posterior maxilla.
    The International journal of oral & maxillofacial implants 03/2012; 27(2):421-7. · 1.91 Impact Factor
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    ABSTRACT: To assess pain and swelling in the first 7 days after periapical surgery and their relationship with the agent used for bleeding control. A prospective study was conducted between October 2006 and March 2009. Patients subjected to root surgery, who completed the questionnaire and who consented to the postoperative instructions were included in the study. The subjects were divided into two groups according to the hemostatic agent used: A) gauze impregnated with anesthetic solution with vasoconstrictor; or B) aluminum chloride. The patients were administered a questionnaire, and were asked to record the severity of their pain and swelling on a plain horizontal visual analog scale (VAS). Data were recorded by the patients on the first 7 postoperative days. In addition, the patients were asked to record analgesic consumption. A total of 76 questionnaires (34 in group A and 42 in group B) were taken to be correctly completed. Pain was reported to be most intense two hours after surgery. At this point 52.6% of the patients had no pain. Seventy-five percent of the patients consumed analgesics in the first 24 hours. There were no significant differences between the two groups in terms of the intensity of pain or in the consumption of analgesics. Swelling reached its maximum peak on the second day; at this point, 60.6% of the patients suffered mild or moderate swelling. The Expasyl group showed significantly greater swelling than the gauzes group. The type of hemostatic agent used did not influence either the degree of pain or the need for analgesia among the patients in this study. However, the patients belonging to the Expasyl group suffered greater swelling than the patients treated with gauzes impregnated with anesthetic solution with vasoconstrictor.
    Medicina oral, patologia oral y cirugia bucal 02/2012; 17(4):e594-600. · 1.02 Impact Factor
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    ABSTRACT: The future of dental practice is closely linked to the utilization of computer-based technology, specifically virtual reality, which allows the dental surgeon to simulate true life situations in patients. The virtual articulator has been designed for the exhaustive analysis of static and dynamic occlusion, with the purpose of substituting mechanical articulators and avoiding their errors. These tools will help both odontologists and dental prosthetists to provide the best individualized treatment for each patient. The present review analyzes the studies published in the literature on the design, functioning and applications of virtual articulators. A Medline-PubMed search was made of dental journals, with the identification of 137 articles, of which 16 were finally selected. The virtual articulator can simulate the specific masticatory movement of the patient. During mandibular animation, the program calculates the sites where the opposing teeth come into contact. The studies made to assess the reliability of the virtual articulator show good correspondence in visualization of the number and position of the dynamic contacts. The virtual articulator is a precise tool for the full analysis of occlusion in a real patient.
    Medicina oral, patologia oral y cirugia bucal 12/2011; 17(1):e160-3. · 1.02 Impact Factor
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    ABSTRACT: To evaluate the clinical efficacy of polycarboxylate cement as retrograde filling material. A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material. Measurements were made of the area and diameter of the lesions pre- and postoperatively, and 6 and 12 months after the operation. The apical resection and retrograde filling areas were also measured, and the prognosis following surgery was recorded. A total of 23 patients with 31 apicoectomized teeth were studied (2 patients being lost to follow-up). The mean area of the periapical lesions before surgery was 52.25 mm2, with a mean major diameter of 6.1 mm and a mean lesser diameter of 4.8 mm. The success rate after 12 months was 54.7%, according to the criteria of Von Arx and Kurt. The prognosis was poorer in females, in larger lesions, and in cases with larger retrograde filling areas. Polycarboxylate cement offers good results, with important bone regeneration after periapical surgery.
    Medicina oral, patologia oral y cirugia bucal 12/2011; 17(2):e276-80. · 1.02 Impact Factor
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    ABSTRACT: To determine the prevalence, location, and size of maxillary sinus septa, and to compare the results of panoramic radiographs and computed tomography (CT) scans. This study included 30 patients, 17 women and 13 men, with a mean age of 50.9 years (range, 28-73 years), undergoing treatment planning for implant-supported restorations in the maxilla. Three observers analyzed the panoramic radiographs, the conventional CT scans in acetate, and the Implametric 3-dimensional CT (3Dent, Valencia, Spain). The maxillary sinus septa of each patient and the type of septa, as well as its location and size, were recorded. In 60 maxillary sinuses, panoramic radiographs showed 32 septa (53.3%); CT in acetate showed 42 septa (70%); and Implametric 3-dimensional CT showed 40 septa (66.7%). Most septa (60%) were located in the middle region of the maxillary sinus, 22.5% in the posterior region, and 17.5% in the anterior region. The mean height of the septa was 4.78 ± 1.76 mm. Panoramic radiographs led to an erroneous diagnosis in 46.5% of the cases. Maxillary sinus septa are a frequent anatomic variation. They can be found in any of the maxillary sinus regions independently of patient edentulism. The panoramic radiograph can lead to false-positive and false-negative findings in the visualization of septa in almost half of cases. Therefore, whenever a maxillary sinus lift is planned, a thorough study of the affected sinus should be made using CT.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 02/2011; 69(2):507-11. · 1.58 Impact Factor
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    ABSTRACT: To assess the prevalence of radiographic signs of maxillary sinus pathology in patients undergoing dental implant treatment and to compare the efficacy of panoramic radiography, computed tomography (CT), and three-dimensional (3D) CT with Implametric software in the diagnosis of sinus pathology. Thirty patients were selected at random from those being treatment-planned to receive implant-supported restorations in the maxilla and who had a panoramic radiograph, a conventional CT scan in acetate, and a 3D CT scan in digital format. The radiographic maxillary sinus findings were categorized as: (1) no sign of pathology, (2) mucosal thickening, (3) mucous cyst, or (4) occupation of the entire sinus. Seventeen women and 13 men were included, with a mean age of 50.9 years. There was a 38.3% prevalence of radiographic abnormalities (23.3% mucosal thickenings, 10% mucous cysts, and 5% occupation of the entire sinus). Of the 23 sinuses that displayed radiographic signs of pathology, only 1 (4.3%) was correctly diagnosed by the panoramic radiograph. The most common radiographic maxillary sinus finding was mucosal thickening, followed by mucous cysts and occupation of the whole sinus. Conventional CT can be considered a reliable method for the diagnosis of maxillary sinus pathology.
    The International journal of oral & maxillofacial implants 01/2011; 26(2):341-6. · 1.91 Impact Factor
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    ABSTRACT: Abstract The aim is to describe bilateral vertical ridge augmentation with intraoral block grafts and guided bone regeneration in the posterior mandible in preparation for implant placement.A 61-year-old woman, edentulous in the posterior mandible, presented for implant rehabilitation. The radiographic study showed 3 to 6 mm of bone height from the ridge to the mandibular canal. Autogenous bone block grafts from the chin and the mandibular ramus, harvested with ultrasonics, were used to augment the alveolar ridge. In order to reduce resorption, the grafts were covered with particulate alloplastic material and a collagen membrane. Delayed implants were placed 6 months after vertical augmentation, and 3 months later implants were loaded with a fixed prosthesis. A temporary sensory complication occurred, and 12 months after implant loading, there were no failures. In this case report block bone grafting was a feasible option to vertically augment the alveolar ridge in posterior mandible.
    Journal of Oral Implantology 01/2011; · 1.15 Impact Factor
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    ABSTRACT: A review is made of the publications on the marginal bone loss of implants with a polished neck, rough neck with microthreading, and rough neck without microthreading. A PubMed search was carried out with the following key words: machined neck implant, polished neck implant, marginal bone loss, covering the period between January 1998 and March 2009. Inclusion was limited to those human clinical studies involving a minimum follow-up of 12 months, and registering the level of bone loss from the time of placement of the implant or prosthetic restoration to the end of follow-up. For most of the authors there were no significant differences in marginal bone loss between polished neck and rough neck implants. On the other hand, implants with a rough neck and microthreading showed significantly less bone loss than those with a polished neck or with a rough neck without microthreading. The survival rate of the implants with a polished neck ranged from 87% to 97.7%, versus 94.5% to 100% for those with a rough neck, and 100% for the rough neck implants with microthreading. No peri-implant disease was registered in the different studies.
    Medicina oral, patologia oral y cirugia bucal 01/2011; 16(3):e365-8. · 1.02 Impact Factor
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    ABSTRACT: A review is made of the publications on bone regeneration using particulate grafts, with an evaluation of the success of implants placed in such regenerated areas. A Medline search using different key words was made of the articles published between 1999-2009 involving at least two patients subjected to grafting with autologous, homologous or xenogenic bone, non-bony substitutes, or a combination of these grafts for the placement of dental implants. Studies involving block grafting were excluded. A total of 11 studies were evaluated. These grafts are indicated in cases of small or peri-implant bone defects such as dehiscences and fenestrations, with the possibility of combining a barrier membrane. However, some authors have used particulate block grafts to secure vertical or horizontal increments of the alveolar process. In most of these cases, graft healing until implant placement lasted 6-9 months. The most frequent complications in the receptor zone were wound dehiscences with exposure of the membrane. In almost all cases, prosthetic loading of the implants took place more than three months after their placement. The implant survival rate varied from 90.9% to 100%, with an implantation success rate of 85.7% to 100%. Although our sample is small, due to the difficulty of finding homogeneous studies, it can be concluded that particulate grafts are effective in correcting localized defects of the alveolar process. The complications of particulate grafting are few, and the success rate of implants placed in the reconstructed areas varies from 85.7% to 100%.
    Medicina oral, patologia oral y cirugia bucal 01/2011; 16(2):e210-4. · 1.02 Impact Factor
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    ABSTRACT: The aim of the study was to examine articles published on risk factors associated with early failure of dental implants. We conducted a search on PubMed for articles published between January 2000 and December 2009 using the keywords 'dental implants' and 'early failure'. Seven studies that specified the number of early failed implants and studied the associated risk factors were included. Early failures are caused by the inability of tissue to establish osseointegration prior to prosthetic restoration; however the causal factors and mechanisms are unclear. In the reviewed literature there was a higher percentage of early than late failures; nevertheless, few articles were found that analyzed risk factors associated with early implant failure. In the majority of studies, statistically significant factors associated with early implant failure were smoking, quantity and quality of bone, and posterior implant location. The low number of studies in the literature does not allow definitive conclusions to be drawn.
    Medicina oral, patologia oral y cirugia bucal 01/2011; 16(4):e514-7. · 1.02 Impact Factor
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    ABSTRACT: To compare the success rates, after 1 year of loading, for implants placed immediately after tooth extraction and in healed sites in patients undergoing extraction of all residual teeth for rehabilitation with a fixed, full-arch, implant-supported prosthesis. A retrospective case series study was conducted of 38 patients treated from June 2004 to June 2008 by extraction of all remaining teeth and implant placement in both mature bone and at the extraction site in the same procedure. After osteointegration, the implants were restored with fixed full-arch prostheses. The marginal bone loss around the implants was measured after 1 year. The success rate according to Buser criteria was calculated for the immediate and nonimmediate implants. A total of 41 arches were restored in 30 patients, 23 in the maxilla and 18 in the mandible. A total of 292 implants were placed, 173 immediately and 119 in mature bone. Of the 292 implants, 8 failed, 4 in the immediate group and 4 in the nonimmediate group. The mean bone loss was 0.6 mm at 1 year of loading (0.63 ± 0.18 mm at the immediate implant sites and 0.58 ± 0.26 in mature bone). The mean success rate was 96.9% overall, 97.7% for the immediate group, and 96.3% for the nonimmediate group. Enhanced bone healing and remodeling can take place in fresh extraction socket defects associated with immediately placed implants. The results of the present study have demonstrated that immediate implant osseointegration can be as, or more, successful than nonimmediate implantation during the same healing period.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 11/2010; 69(1):154-9. · 1.58 Impact Factor
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    ABSTRACT: This review analyzes articles published on the presence of septa in maxillary sinuses. An automated search was conducted on PubMed using different key words. This search resulted in 11 papers in which the presence of antral septa was assessed. These septa are barriers of cortical bone that arise from the floor or from the walls of the sinus and may even divide the sinus into two or more cavities. They may originate during maxillary development and tooth growth, in which case they are known as primary septa; or they may be acquired structures resulting from the pneumatization of maxillary sinus after tooth loss, in which case they are called secondary septa. Several methods have been used in their study, direct observation on dried skulls or during sinus lift procedures; and radiographic observation using panoramic radiographs or computed tomographs. Between 13 and 35.3% of maxillary sinuses have septa. They can be located in any region of the maxillary sinus and their size can vary between 2.5 and 12.7 mm in mean length. Some authors have reported a higher prevalence of septa in atrophic edentulous areas than in non-atrophic ones. If a sinus lift is conducted in the presence of maxillary sinus septa, it may be necessary to modify the design of the lateral window in order to avoid fracturing the septa.
    Medicina oral, patologia oral y cirugia bucal 09/2009; 15(2):e383-6. · 1.02 Impact Factor
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    ABSTRACT: The purpose of this review was to analyze publications related to augmentation procedures using autologous onlay grafts and to evaluate the survival/success rates of implants placed in the augmented areas. An automated search was made in Medline, of clinical publications from 2002 to 2007, including at least 5 patients and with a minimum follow-up of 6 months. Ten papers were included. These suggested that grafts are indicated when the height of the alveolar crest is less than 5mm, or the width less than 4mm. The surface resorption of grafts protected by guided bone regeneration membranes was less than for unprotected grafts. Calvarial grafts suffered less resorption than did iliac grafts. The healing period of the graft until implant placement was, in most cases, 4-6 months. The most frequent complications in the recipient site were wound dehiscences. Prosthetic loading time was, in almost all patients, 3 months after implant placement. Implant survival rate ranged from 97.1% to 100%. Although , due to the difficulty in finding homogenous studies, the sample is small, we can conclude that autologous onlay block bone grafts are an effective procedure for alveolar crest augmentation; graft surface resorption is reduced when the grafts are protected by regeneration membranes; few complications arise from the procedure; and the success rate for implants placed in the reconstructed area is between 89.5 and 95.7%.
    Medicina oral, patologia oral y cirugia bucal 06/2009; 14(8):e402-7. · 1.02 Impact Factor
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    ABSTRACT: Oromandibular dystonia consists of prolonged spasms of contraction of the muscles of the mouth and jaw. Primary idiopathic forms and secondary forms exist. Secondary dystonia develops due to environmental factors; some cases of cranial dystonia after dental procedure have been reported, but the causal relationship between these procedures and dystonia remains unclear. Traumatic situations in the mouth, such as poor aligned dentures or multiple teeth extractions may cause an impairment of proprioception of the oral cavity, leading to subsequent development of dystonia. The clinical characteristics of oromandibular dystonia are classified according to the affected muscles. The muscles involved may be the muscles of mastication, muscles of facial expression, or the muscles of the tongue. At present, there is no known cure for OMD. The mainstay of treatment for most focal dystonia is botulinum toxin injections. It is important for the dentist to be familiar with oromandibular dystonia, as it can develop after dental treatment and is often misdiagnosed as a dental problem.
    Medicina oral, patologia oral y cirugia bucal 01/2009; 15(1):e25-e27. · 1.02 Impact Factor
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    Laura Maestre-Ferrín, María Peñarrocha-Diago
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    ABSTRACT: Objective: A review was made of the current literature on hemostatic agents used in apical surgery in order to de-termine their effectiveness and adverse effects. Material and methods: The main search terms used were: endodontic surgery, apicoectomy, apical surgery, perira-dicular surgery, hemostasis, hemostatic agents, and bleeding control. The authors searched the Medline database for articles published up to 1 September 2010. Experimental and clinical studies comparing the effectiveness and/ or adverse effects of two or more hemostatic agents and published between 2000 and 2010 were included in the review. Results: Four studies were analyzed: two clinical studies and two experimental studies. According to the clinical studies, epinephrine produces no changes in blood pressure or heart rate when used to control bleeding in periapical surgery. Aluminum chloride alone or in combination with ferric sulfate was found to be the most effective agent in the experimental studies, and the tissue damage it causes was not observed when the superficial bone layer was eliminated with rotary instruments. Conclusion: Additional controlled clinical trials are needed to not only assess the efficacy of the different hemosta-tic agents but also to investigate their influence upon healing and the outcome of periapical surgery.