Posted by Dr. Richard Mounce, DDS on Mar 7th 2019
Tissue management during impressions and bleeding caused by the removal of subgingival caries can be a clinical challenge. Adaptation of a matrix band, digital or traditional impressions making, working in a clean and dry field, among other indications, often require local hemostatic agents. As an endodontist, I frequently see patients with deep subgingival caries in the posterior region where fitting a matrix band is problematic. Hemorrhage control is essential and the Quick-Stat™ product line is indispensable in my hands.
Clinical hemostatic alternatives include variations comprised of ferric sulfate (FS), aluminum chloride (AC) or aluminum sulfate (AS), all of which act in a clinically similar fashion to rapidly and efficiently stop nuisance tissue bleeding. While use of enhanced magnification and lighting (loupes or a microscope), and/or possibly electrocautery in severe cases, are helpful, hemostatics are an essential component of the restorative armamentarium.
Ferric sulfate (FS) has been used for decades in dentistry as a local hemostatic agent. Dental solutions are approximately 15.5%-20%. The local hemostatic effects of FS in this concentration are rapid and reversible with direct application, often with pressure, on bleeding tissue. FS, AC and AS all provide their local hemostatic effects by mechanically plugging blood vessels with the products of blood protein agglutination.
Vista markets three local hemostatic agents, Quick-Stat™ FS (ferric sulfate), Quick-Stat™ Free (aluminum chloride), and Quick-Stat™ Free Liquid (aluminum sulfate liquid). These agents are indicated for tissue management in restorative dentistry and impression taking.
Aside from their use as local tissue hemostatic agents, other materials in this product class have been used and suggested for use in vital pulp therapy (FS), as antibacterial agents, and as mentioned above, in apical surgery for hemorrhage control (albeit at a different concentration of ferric sulfate), among other uses.
Local hemostatic solutions remove the smear layer from dentinal surfaces and etch dentin. Their use results in contamination of the dentinal tubules and, as a result, evidence exists that smear layer removal by FS solutions and the resulting contamination can diminish the bond strength using some materials and adhesive protocols. As a result, it is generally recommended that FS solutions be optimally used in combination with full etch adhesive systems followed by a thorough rinsing.
One potential downside of using ferric sulfate as a local hemostatic is the potential for discoloration if not adequately rinsed and removed. As a result, AC alternatives like Quick-Stat™ Free gel have been developed in order to eliminate staining, an especially important consideration in the anterior.
Quick-Stat™ FS (gel) (ferric sulfate based), Quick-Stat™ Free (gel) (aluminum chloride based), and Quick-Stat™ Free Liquid (aluminum sulfate based), all provide immediate and profound local hemostatic control. The gel products will not flow onto surrounding tissue. The liquid product is designed for retraction cord soaking prior to impression taking for improved marginal clarity.
All of the kit configurations of Quick-Stat™ include Stat-Flo™ applicator tips. The Stat-Flo™ tips are used with pressure against the bleeding tissue while simultaneously extruding the Quick-Stat™ product.
These systems are configured in a variety of ways: as individual kits, complete kits, and with and without retraction cords and/or cord packing devices.
To order any Quick-Stat™ product, or for more information, please visit vista-dental.com.
Dr. Mounce is a practicing endodontist who writes and lectures nationally and internationally. Literature references available upon request.