Biomaterial-Based and Surgical Approaches to Local Hemostasis in Contemporary Oral Surgery: A Narrative Review.

Abstract

Effective local hemostasis is essential in oral surgery to prevent complications such as delayed healing, infection, and the need for re-intervention. Postoperative bleeding occurs in 4-6% of cases, increasing to 9-12% in patients receiving anticoagulant or antiplatelet therapy. This review evaluates the efficacy, safety, and clinical utility of local hemostatic agents based on 51 studies published between 1990 and 2023. Traditional agents, such as oxidized cellulose and gelatin sponges, control bleeding in over 85% of standard cases but offer limited regenerative benefits. Autologous platelet concentrates (APCs), including platelet-rich plasma (PRP) and leukocyte- and platelet-rich fibrin (L-PRF), reduce bleeding time by 30-50% and enhance soft tissue healing. Studies show the PRP may reduce postoperative bleeding in dental surgery by 30-50%, and in orthopedic and cardiac surgery by 10-30%, particularly in patients on anticoagulants. Tranexamic Acid mouthwash can reduce postoperative bleeding by up to 50-60%. Fibrin sealants achieve a 70-90% reduction in bleeding among high-risk patients, while topical tranexamic acid decreases hemorrhagic events by up to 80% in anticoagulated individuals without increasing thromboembolic risk. However, comparative studies remain limited, particularly in medically compromised populations. Additional gaps persist regarding long-term outcomes, cost-effectiveness, and the standardized use of emerging agents such as nanomaterials. Future research should prioritize high-quality trials across diverse patient groups and develop clinical guidelines that integrate both safety and regenerative outcomes.