The effect of different hemostatic agents on hemorrhage control, pain and quality of life after endodontic microsurgery

This randomized clinical trial evaluated the effect of two different hemostatic materials for endodontic microsurgery on bleeding control, postoperative pain and patients’ quality of life. Thirty-four subjects with apical periodontitis requiring endodontic microsurgery were randomized (computer-generated allocation list, allocation concealment by sequentially numbered opaque sealed envelopes) to receive N-hexyl cyanoacrylate surgical glue ( n = 15) or ferric sulfate 15.5% ( n = 19) for intraoperative haemostasis. The primary outcome was the hemorrhage control score after application of the hemostatic agent. Secondary outcomes were intraoperative bleeding control before agent application, surgical field visibility, bleeding recovery after agent removal, daily postoperative pain on the Numerical Rating Scale (NRS), daily analgesic intake, postoperative swelling and the Oral Health Impact Profile-14 (OHIP-14) quality-of-life score, all collected over seven days. Categorical variables were analysed using the chi-square or Fisher’s exact test; continuous variables were analysed using independent-samples t-tests or Mann–Whitney U tests as appropriate, with significance set at P < 0.05. The mean lesion volume and diameter were higher in the surgical glue group ( P = 0.022 and P = 0.031 respectively). There was no significant difference regarding the bleeding control before ( P = 0.15) and after ( P = 0.27) hemostatic agent use in both groups; at T1, complete hemorrhage control was observed in 60.0% and 52.6% of patients, respectively (absolute difference 7.4% points; 95% CI -24.1 to 36.4). The visibility of the surgical field appeared similar in the two groups ( P = 0.092). After the removal of the surgical glue, there was a significant increase in bleeding recovery compared to ferric sulfate ( P = 0.045). In unadjusted between-group comparisons, postoperative swelling was more frequently reported in the surgical glue group ( P = 0.026), and analgesic consumption was also higher in this group ( P = 0.040). However, these postoperative differences should be interpreted in light of the significant baseline imbalance in lesion size between groups. The postoperative pain curves showed parallel trends ( P = 0.31) and the overall QoL showed no significant differences between groups ( P = 0.54). Both ferric sulfate and N-hexyl cyanoacrylate surgical glue provided comparable intraoperative haemostasis during endodontic microsurgery under the conditions of the present study. Moreover, these statistical differences were not accompanied by significant between-group differences in postoperative pain or overall quality of life and should therefore not be interpreted as establishing a clinically meaningful overall disadvantage of either material. Because follow-up was limited to seven days, the present study provides information only on intraoperative performance and early postoperative morbidity and does not allow conclusions regarding periapical healing, late complications, radiographic healing, or long-term surgical success. ClinicalTrials.gov NCT07311291 (registered 20 November 2025; registration was retrospective with respect to the start of recruitment in November 2023). The study was approved by the local Ethics Committee and Institutional Review Board (Protocol ID: 0272/2023).