Introduction

Controlling bleeding during and after dental procedures is a critical aspect of surgical success and patient safety. The challenge becomes significantly more complex in individuals with systemic comorbidities such as hypertension or diabetes or those on anticoagulant medications like apixaban, warfarin, or rivaroxaban. Common dental procedures like flap surgeries, bone grafting, and tooth extractions can sometimes trigger unexpected bleeding. If not managed promptly, this bleeding can escalate into severe complications, including emergency interventions, delayed wound healing, or even surgical site infections [1, 2].

Traditionally, dentists and oral surgeons have relied on a combination of techniques including mechanical pressure, vasoconstrictor-soaked gauze, or conventional pressure dressings moistened with saline [3,4]. While these methods can be effective, they often fall short in high-risk patients such as the elderly or those on blood thinners where delayed or persistent bleeding poses a greater challenge.

Role of Haemostatic Agent Gel in Modern Dentistry

In recent years, haemostatic agent gel has emerged as a transformative tool in dental and periodontal surgeries. Unlike traditional approaches, these advanced formulations offer targeted, localized control of bleeding, even in difficult-to-access areas or in the presence of active haemorrhage.

Products like Floseal and FLOGEL^® are gelatin-based, flowable haemostats that work by exerting a tamponade effect and promoting rapid clot formation [5]. Their ability to conform to irregular surgical sites, penetrate soft tissue pockets, and stay in place under moist conditions make them especially valuable in oral procedures.

FLOGEL^®: Next-Gen haemostatic agent gel matrix for haemostasis

FLOGEL^® is a flowable gelatin haemostatic matrix made from absorbable gelatin sponge powder, into a flowable form prefilled in a syringe. The flowable nature of FLOGEL^® allows it to conform to any irregular wound geometries and be applied in difficult-to-reach locations.

 Key Features of FLOGEL^®:

Whether applied to control bleeding from lacerated vestibular tissues or deep periodontal pockets, FLOGEL^® offers surgeons a powerful and user-friendly haemostatic solution.

How to Use FLOGEL^® Effectively in Oral Surgery

• Apply FLOGEL^® directly to the source of bleeding—not into blood vessels.

• Use adequate amounts of FLOGEL^® to completely cover the tissue defect.

• Immediately contain FLOGEL^® at the site with a moist gauze and gentle approximation for 2 minutes to benefit of the tamponade effect.

• Always irrigate excess FLOGEL® and suction it out gently once haemostasis is achieved.

Clinical Evidence: Case study in an anticoagulated elderly patient

A compelling case report illustrates the efficacy of Floseal^® in a high-risk patient scenario [4]. An 81-year-old man on Eliquis (apixaban) experienced uncontrolled bleeding on the third day after periodontal surgery. Initial management with standard techniques—pressure application, epinephrine-soaked gauze, and Gelfoam—was ineffective.

Upon arriving at the emergency department with persistent bleeding from multiple sites, Floseal^® was applied directly to the affected gingival and vestibular tissues. Gauze pressure was maintained for several minutes, leading to rapid haemostasis. The patient was observed for four hours and discharged without recurrence of bleeding.

This case underscores the critical role of advanced haemostatic agents in managing patients who cannot discontinue anticoagulation therapy and where traditional haemostasis techniques prove inadequate.

Conclusion

The increasing prevalence of patients with complex medical histories necessitates more reliable and effective methods for managing intraoral bleeding. Haemostatic agent gels like Floseal^® and FLOGEL^® represent a transformative advance in dental surgery, combining ease of use with superior efficacy.

As dental practices evolve and patient profiles become more challenging, incorporating flowable haemostatic agents into routine surgical protocols is not only prudent—it’s essential. Their ability to reduce bleeding-related complications, improve surgical efficiency, and enhance overall patient safety makes them a cornerstone of modern oral surgical care.

References

1. Morimoto Y, Niwa H, Minematsu K. Risk factors affecting postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy. Journal of oral and maxillofacial surgery. 2011 Jun 1;69(6):1550-6.
2. Dinkova A, Petrov P, Shopova D, Daskalov H, Harizanova S. Biomaterial-Based and Surgical Approaches to Local Hemostasis in Contemporary Oral Surgery: A Narrative Review. Journal of Functional Biomaterials. 2025 May 21;16(5):190.
3. Patil K, Goyal JN, Dudhe S, John J, Joseph S, Kadbe S, Gupta S, Joseph Sr S. Comparative evaluation of local hemostatic agents in minor oral surgical procedures: A randomized clinical trial. Cureus. 2025 Jun 11;17(6).
4. Rosenfeld J, Dym H. FloSeal hemostatic matrix for management of postoperative bleeding for patients on eliquis after periodontal surgery. New York State Dental Journal. 2019 Mar 1;85(2):24-6.
5. Kamamoto D, Kanazawa T, Ishihara E, Yanagisawa K, Tomita H, Ueda R, Jinzaki M, Yoshida K, Toda M. Efficacy of a topical gelatin–thrombin hemostatic matrix, Floseal, in intracranial tumor resection.