***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To assess  pain and swelling in the first 7 days after periapical surgery and their relationship with the agent used for bleeding control . Study Design : A prospect i ve study was conducted between October 2006 and March 2009 . Patients subjected to root surgery , who completed the question naire 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 question naire , 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 . Results : A total of 76 question naires ( 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 . Conclusion : 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 . Key words : Hemostasis , periradicular surgery , aluminum chloride , pain , swelling This clinical study prospect ively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery .  The study cohort included 194 teeth in an equal number of patients . Three teeth were lost for the follow-up ( 1.5 % drop-out rate ) .  Clinical and radiographic measures were used to determine the healing outcome . For statistical analysis , results were dichotomized ( healed versus nonhealed ) . The overall success rate was 83.8 % ( healed cases ) . The only individual predictors to prove significant for the outcome were pain at initial examination ( p=0.030 ) and other clinical signs or symptoms at initial examination ( p=0.042 ) , meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms . Logistic regression revealed that pain at initial examination ( odds ratio=2.59 , confidence interval=1.2 - 5.6 , p=0.04 ) was the only predictor reaching significance . Several predictors almost reached statistical significance : lesion size ( p=0.06 ) , retrofilling material ( p=0.06 ) , and postoperative healing course ( p=0.06 ) This prospect i ve clinical study aim ed to evaluate the benefits of the endoscope as an aid to root-end management , and to assess the treatment outcome during 2 years following surgery . Forty-three endodontic surgical procedures in 30 patients were performed with the aid of an endoscope and followed for a period of 2 years . Radiographic criteria and clinical evaluation were used to assess the outcome . All cases were evaluated in terms of healing and functionality . 91.1 % and 90.7 % of the teeth evaluated after 1 and 2 years , respectively , were classified as successful . We found no statistically significant differences for both healing and functionality between the 1- and 2-year evaluations . No difference related to tooth type or tooth location was found at the 2-year follow-up . Fisher 's exact test was used to statistically assess the difference between successful and unsuccessful cases for each of the variables considered . The endoscope can be an aid for endodontic surgical procedures in terms of both periapical healing and functionality up to 2 years follow-up INTRODUCTION Obtaining hemostasis in the surgical crypt during periradicular surgery is essential . It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material . Although current material s may not be moisture sensitive during setting , hemostasis is important for proper placement of root-end filling material s during apical surgery . A new hemostatic agent , HemCon dental dressing ( Patterson Dental , St Paul , MN ) , may improve upon the efficacy of wound healing and hemostasis both in extent and time . The aim of this study was to evaluate the hemostatic effect of HemCon in osseous wound sites and evaluate the wound healing potential and percentage of new bone formation in osseous crypts treated with HemCon . METHODS A split-mouth design was used with r and om allocation of sham and experimental sites in 12 rabbits . In experimental sites , either HemCon or 15.5 % ferric sulfate was applied to osseous crypts created with a round bur . Hemostatic efficacy was evaluated using predetermined scores . Rabbits were sacrificed at 21 days , and tissues were harvested and prepared for histologic evaluation . A blinded pathologist scored sample s relative to inflammation . The percentage of new bone deposition was calculated using NIS Elements software ( Nikon Instruments Inc , Melville , NY ) . RESULTS There was no statistical significant difference in hemostatic efficacy or wound healing between HemCon and ferric sulfate ( P > .05 ) . The HemCon group showed a significantly higher percentage of new bone deposition compared with the controls ( P < .01 ) . CONCLUSIONS HemCon shows promise as an adjunct to the endodontic surgical armamentarium We  did apicectomies  of 30 teeth with periradicular lesions in 23 patients , using a 3 mm endoscope . Two patients failed to attend for postoperative assessment and of the remaining 21 patients who had 28 teeth treated the operation was judged after 1 year to be a success in 26 ( 93 % ) The hemostatic efficacy , as well as the cardiovascular effects , of two hemostatic agents currently used during endodontic surgery was examined . The hemostatic agents used were epinephrine pellets ( Racellet pellets ) or 20 % ferric sulfate ( Viscostat ) .  Patients were assigned to one of two experimental groups .  Blood pressure and pulse rate were recorded pre- and postoperatively and at three additional times during the surgery ( root-end resection , root-end preparation , and filling ) . The adequacy of hemostasis was rated by the surgical operator . Results indicated that there is no significant change in cardiovascular effects when using either of these hemostatic agents . Except in one case where ferric sulfate was the agent , both agents produced surgical hemostasis that allowed for a dry field for root-end filling AIM To evaluate periodontal changes following apical surgery  , and to relate changes to the type of incision and to the type of restoration present at the gingival margin ( GM ) . METHODOLOGY Periodontal parameters [ probing depth ( PD ) , level of GM and clinical attachment , plaque and bleeding indices ] were recorded at baseline and 1 year following apical surgery . The periodontal changes were calculated and assessed with respect to the incision technique ( intrasulcular incision , papilla base incision and submarginal incision ) , as well as to the presence and type of a restoration margin in contact with the gingiva . RESULTS One hundred and eighty-four teeth could be evaluated . No significant differences between the three incision techniques were found regarding changes in PDs and plaque index over time . However , significant differences between the intrasulcular and submarginal incisions were found for changes in levels of GM and clinical attachment . For example , with the intrasulcular incision , there was a mean recession of 0.42 mm at buccal sites , whereas using the submarginal incision there was a gain of 0.05 mm . No statistically significant influence could be demonstrated for the presence and type of restoration margins , or the smoking habit of the patient . CONCLUSION The type of incision was found to affect changes significantly in periodontal parameters within an observation period of 1 year following apical surgery , whereas the restoration margin and smoking habit did not prove to have any significant effect 
    Output:
    
When using aluminium chloride ( Expasyl ® ) , over 90 % of the apical lesions improved , but this agent seemed to increase swelling .
Epinephrine with collagen did not significantly raise either blood pressure or heart rate .
CONCLUSIONS Despite the use of several haemostatic material s in apical surgery , there is little evidence on their effectiveness and safety .
The most effective haemostatic agents were calcium sulphate and epinephrine plus collagen .
Epinephrine plus collagen did not seem to significantly raise blood pressure or heart rate during surgery .
Aluminium chloride did not increase postoperative pain but could slightly increase postoperative swelling .