Other factors, though rarely seen, that can Mandibular teeth are most commonly associ-
delay healing are: prolonged bleeding due ated with dry socket. Sites aected are ranked
to clotting defects, formation of an oro-antral in order from highest to lowest as follows: lower
stulas, proliferation of malignant tumors, molars, upper molars, premolars, canines, inci-
radiation therapy, immunosuppresion due to sors. Studies have demonstrated that the more
corticosteroid use, dietary deciencies includ- dicult the extraction, the higher the chance
ing but not limited to vitamin C, and overall of dry socket. It has also been demonstrated
immune system disorders. that less-experienced dental surgeons had a
higher incidence of dry socket in lower third
Dry Socket Identication molars. The peak age for dry sockets is 30-34
Dry socket delays the healing of the extraction years. Most reported cases occur between the
site and surrounding bone. Dry socket can be ages of 20 and 40.
diagnosed by looking for certain symptoms.
5
Bacteria, especially anaerobic, have been linked Tetracycline
to the formation of dry sockets. Investigators One study shows that placement of tetracy-
have found strains of Streptococci, Fuso-spiro- cline in a suspension with a few drops of saline
chaetal, Treponema denticola, and bacteroides dipped in a square of Gelfoam signicantly
within extraction sites. reduce the incidence of dry socket when used
as a dressing after impacted mandibular third
Studies have shown that smokers are four molar extractions. This study supports ndings
times more likely to develop third-molar dry reported by other authors. Both the tetracycline
sockets than nonsmokers. This may be related studies have strikingly similar ndings showing
to creation of suction when inhaling, contami- an average of a 3.8% incidence of dry socket
nation of the socket with smoke, or increased when using tetracycline prophylactically.
temperatures in the oral cavity. Researchers
have identied that women have a 20% better Another study looked at neomycin, bacitracin,
chance to develop dry socket than males. Oral and tetracycline combined with saline, soaked
contraceptives are also linked to higher inci- in Gelfoam, and placed in the extraction socket
dence of dry socket along with post-extraction of third molars. Results demonstrated that
trismus and pain. tetracycline was far more eective than either
neomycin or bacitracin (combined with Gel-
Patients with uncontrolled diabetes mellitus foam) in decreasing dry socket.
have a greater incidence of dry socket and
should be monitored carefully. Clindamycin
Trieger studied the eects of a 1x1 cm square
Prevention of Dry Socket of Gelfoam soaked with 1 ml of clindamycin
Developing cures and techniques that will phosphate solution (150 milligrams/milliliter)
prevent dry socket has been a topic of interest compared to controls using no clindamycin.
in oral surgery for many years. Well-controlled Results indicated that out of 172 impacted
studies indicate that the incidence of dry socket molar sites, only 7 dry sockets occurred, all of
after mandibular third-molar surgery can be which were control sites that were not exposed
reduced. Proper surgical techniques should in- to clindamycin. Clindamycin is especially pre-
clude thorough debriding and irrigation of the ferred as the drug of choice in the prevention of
extraction site with large quantities of saline. dry socket due to its antianaerobic properties.
This should be rst on your list in controlling
the incidence of dry socket. Chapnick performed a study of 520 mandibular
teeth in 270 patients. Sites were irrigated with
The incidence of dry socket may be decreased Betadine (Purdue Frederick) prior to placement
by preoperative and postoperative rinsing with of clindamycin. One site received Gelfoam
antimicrobial mouth rinses, such as chlorhexi- soaked in clindamycin, the other received
dine gluconate (Peridex, Zila Pharmaceuticals). Gelfoam without clindamycin. Results indi-
A study was performed involving preoperative cated that there was a signicant decrease in
prophylaxis in conjunction with chlorhexidine dry socket in the sites that received Gelfoam
gluconate 0.2 percent rinse. Incidence of dry soaked in clindamycin. These studies demon-
socket was decreased to some degree. Use of strate reduction in dry socket is as low as 3%
other medicaments such as Betadine Mouth- from 36% when antibiotic medicaments were
wash may also be useful in reducing bacterial placed. There is evidence that bacteria, through
loads prior to surgery. Use of topically placed mechanisms not yet understood, play a role in
antibiotics administered within the extrac- the brinolytic phenomenon of dry socket.
tion site immediately after completion of the
extraction has been the most widely studied Treating Dry Socket
modality to reduce dry socket. Antibiotics such If dry socket (alveolar osteitis) should arise,
as clindamycin or tetracycline have been suc- treatment should be focused on relieving
cessfully used to help to decrease the incidence pain. If the patient does not receive treatment
of dry socket in mandibular third molars. for the relief of pain, the healing process will
6
eventually resolve itself with no dierence in Catellani J: Review of factors Contributing to Dry Socket Through Enhanced Fibrinoly-
sis. J Oral Surg. 1979: 37(1):42-6.
time as if treated. Treatment should begin by Chapnick P, Diamond L: A Review of Dry Socket: A Double-Blind Study on the Eec-
tiveness of Clindamycin in Reducing the Incidence of Dry Socket. Journal of the
gently irrigating with saline, and the insertion Canadian Dental Association. 1992: 58: 43-52.
Chiapasco M, De Cicco L, Marrone G: Side Eects and Complications Associated with
of a medicated dressing. Do not curette the Third Molar Surgery. Oral Surg Oral Med Oral Pathol. 1993: 76(4):412-20.
socket because this will increase the amount of Field A, Speechley J, Rotter E: Dry Socket Incidence Compared after a 12-Year Interval.
Br. J Oral Maxillofac Surg 1985: 23:419.
exposed bone and the pain, and remove parts Goldman D, Panzer J, Atkinson W: Prevention of Dry Socket by Local Application of
Lincomycin in Gelfoam. Oral Surg Oral Med Oral Pathol. 1973: 35(4) 472-4.
of the blood clot that have not been lysed. The Hall H, Bildman B, Hand C: Prevention of Dry Socket with Local Application of Teracy-
cline. J Oral Surg 1971: 29:35-7.
socket should then be carefully suctioned of Hanson E:Alveolitis Sicca Dolorosa (dry socket): Frequency of Occurrence and Treat-
all excess saline. Then, a small piece of gelatin ment with Trypsin. J Oral Surg Anesth Hosp Dent Serv. 1960: 18:409-16.
Johnson W, Blanton E: An Evaluation of 9-aminoacridine/Gelfoam to Reduce Dry Socket
sponge or gauze soaked with the medication Formation. Oral Surg Oral Med Oral Pathol. 1988: 66(2):167-70.
Julius L, Hungerford R, Nelson W, McKercher T, Zellhoefer, R: Prevention of Dry
should be placed. This may need to be re- Socket with Local Application of Terra-Cortril in Gelfoam. J Oral Maxillofac Surg.
1982:40(5):285-6.
peated for 3-6 days depending on the severity Khosla v, Gough J: Evaluation of Three Techniques for the Management of Postextrac-
of the pain. At each visit, the socket will need tion Third Molar Sockets. Oral Surg Oral Med Oral Pathol. 1971: 31(2):189-98.
Krogh H: Incidence of Dry Socket. JADA 1937: 24:1, 829.
to be irrigated, and insertion of the medicated Laskin D, Oral and Maxillofacial Surgery. Vol. 2. St. Louis: Mosby; 1985 144-46.
dressing repeated. Medicaments used to treat MacGregor A: Aetiology of Dry Socket: A Clinical Investigation.Br J Oral Surg. 1968:
6(1):49-58.
dry socket may contain a combination of the MacGregor A: Bacteria of the extraction wound. J Oral Surg. 1970: 28(12):885-7.
following ingredients: bone pain relievers (Eu- Moighadam H, Caminiti M: Life-Threatening Hemorrhage after Extraction of Third
Molars: Case Report and Management Protocol. Journal of the Canadian Dental
genol, benzocaine), anti-microbials (iodoform), Association. 2002: 68: 670-674.
Moore J. Surgery of the Mouth and Jaws. . Oxford: Blackwell Scientic Publications;
and carrying vehicles (balsam of Peru, Pengha- 1986. 272
Petersons L, Ellis E, Hupp J, Tucker M. Contemporary Oral and Maxillofacial Surgery. 3rd
war). ed. St. Louis: Mosby; 1998. p. 270-75
Quinley J, Royer R, Goresd R: Dry socket After Mandibular Odontectomy and use of
Soluble Tetracycline Hydrochloride. Oral Surg Oral Med Oral Pathol. 1960: 13:38-42.
Dry socket pastes and liquids (various manu- Schatz J, Fiore-Donno G, Henning G: Fibrinolytic Alveolitis and its Prevention.Int J Oral
Maxillofac Surg. 1987: 16(2):175-83.
facturers) can be used and placed directly in Swanson A: A Double-Blind Study on the Eectiveness of Tetracycline in Reducing the
the socket alone or using absorbable prod- Incidence of Fibronolytic Alveolitis. Journal of Oral Maxillofacial Surgery. 1989: 47:
165-67.
ucts such as Gelfoam. Alvyjel (Septodont) is a Swanson AE: Reducing the Incidence of Dry Socket: A Clinical Appraisal.J Can Dent
Assoc. 1966:32(1):25-33.
brous product that can be placed and left in Sweet J, Macynski A: Eect of Antimicrobial Mouth Rinses on the Incidence of Localized
Alveolitis and Infection Following Mandibular Third Molar Oral Surgery. Oral Surg
the socket. Iodoform Packing Gauze (Johnson Oral Med Oral Pathol. 1985: 59(1):24-6.
Tjernberg A, Inuence of oral hygiene measures on the development of alveolitis sicca
& Johnson) is also available. Once placed in the dolorosa after surgical removal of mandibular third molars.Int J Oral Surg. 1979:
8(6):430-4.
extraction socket, the patient will experience Tozanis J, Schoeld I, Warren B: Is dry socket preventable? J Canada Dent Assoc. 1977:
profound relief from pain within 5 minutes. 43(5):233-6.
Trieger N, Schlagel G: Preventing Dry Socket. A Simple Procedure That Works. Journal of
Generally, anesthesia is not recommended the American Dental Association. 1991: 122: 67-68.
Conclusion
This continuing dental education course was
designed to review the most common com-
plications, etiology, and treatment modalities
found in the literature to manage complica-
tions associated with dry socket. Techniques
and products that were presented were most
commonly used in the literature. Other tech-
niques exist that may be as eective as the ones
discussed here. Further research is needed to
provide answers to questions associated with
post extraction diculties.
References
Alexander A: Bacitracin and Gelfoam. U. S. Armed Forces Medical Journal. 1951: Vol. II
No. 8: 1247-50.
Belinfante L, Marlow C, Meyers W: Incidence of Dry Socket Complication in Third Molar
Removal. J Oral Surg. 1973: 31(2):106-8.
Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T: Dental extractions in patients
maintained on continued oral anticoagulant: comparison of local hemostatic mo-
dalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999: 88(2):137-40.
Butler D, Sweet J: Eect of Lavage on the Incidence of Localized Osteitis in Mandibular
Third Molar Extraction Sites. Oral Surg Oral Med Oral Pathol. 1977: 44(1):14-20.
7
Continuing Dental 9. Woven bone follows trabecular bone, until the normal
pattern of the alveolus is restored. Finally, compact bone
Education Questions forms over the surface of the alveolus, and remodeling
continues as the bone shrinks.
1. Having a thorough medical history prior to surgery a. The rst statement is True. The second statement is True.
will allow the surgeon to better deal with complications b. The rst statement is True. The second statement is False.
that may arise. Be certain to always follow proper surgical c. The rst statement is False. The second statement is True.
techniques, and know your limitations prior to beginning d. The rst statement is False. The second statement is False.
any extraction.
a. The rst statement is True. The second statement is True. 10. Once a tooth is extracted, direct primary wound
b. The rst statement is True. The second statement is False. closure is sometimes impossible, and there usually is an
c. The rst statement is False. The second statement is True. inability to apply and sustain direct pressure to the socket
d. The rst statement is False. The second statement is False. of an extracted tooth.
a. True
2. If and when diculties develop, it is always b. False
recommended to explain the situation to the patient.
a. True 11. What forces exist to complicate clotting?
b. False a. Disruptive forces from tongue motion
b. Passage of food
3. Extraction diculty increases when the following c. Normal speech
conditions exist except d. All of the above
a. strong supporting tissue
b. dicult root morphology 12. Which is not a condition that may prolong bleeding?
c. teeth containing weakened coronal surfaces a. Primarily hepatitis
d. desiccated teeth b. Hypertension
e. none of the above c. Osteoporosis
d. None of the above
4. The clot functions by
a. Preventing debris, food, and other irritants from entering the 13. There are how many groups of drugs known to
extraction site. promote bleeding?
b. Protecting the underlying bone from bacteria. a. 3
c. Acts as a supporting system in which granulation tissue b. 4
develops. c. 2
d. All of the above d. 5
19. Gelatin sponge forms a scaold for the formation of 29. What is the occurrence of dry socket in impacted
a. exudite mandibular third molars.
b. osseous bone a. 9-30%
c. a blood clot b. 10-40%
d. none of the above c. 11-50%
d. 12-60%
20. Topical thrombin (Thrombostat Pzer) is derived from
a. Equine thrombin 30. Which teeth are most commonly associated with dry
b. Bovine thrombin socket?
c. Porcine thrombin a. Upper molars
d. Feline thrombin b. Lower molars
c. Premolars
21. Thrombin bypasses all steps in the coagulation cascade d. Canines, incisors.
and helps to convert brinogen to
a. Cancellus bone 31. Studies have demonstrated extraction diculty is not
b. Collagen related to the chance of dry socket.
c. Fibrin a. True
d. None of the above b. False
22. It is recommended that block techniques are 32. It has also been demonstrated that less-experienced
encouraged instead of local inltrations when treating dental surgeons had a higher incidence of dry socket in
secondary bleeding. lower third molars.
a. True a. True
a. False b. False
23. Ecchymosis can appear _____ after the surgery. 33. What is the peak patient age for dry sockets?
a. Immediately a.15-19 years old
b. 1-2 days after surgery b.20-29 years old
c. 2-5 days after surgery c.30-34 years old
d. 3-6 days after surgery d.35-40 years old
24. Ecchymosis occurs more frequently in what patient 34. Smokers are how many more times likely to develop
population? third molar dry sockets than nonsmokers?
a. Children a. Four
b. Teenagers b. Three
c. Elderly Patients c. Two
d. Young Adults d. None
25. Signs and symptoms associated with infection can 35. Researchers have identied that women have a higher
include chance to develop dry socket than males. How much higher
a. Fever is the incidence in women?
b. Swelling a. 10%
c. Erythema b. 20%
d. All of the above c. 30%
d. 35%
26. Which is not a factor that can delay healing?
a. Clotting defects 36. What are the two most studied antibiotics that have
b. Formation of an oro-antral stula been successfully used to help to decrease the incidence of
c. Proliferation of malignant tumors dry socket in mandibular third molars?
d. Corticosteroid use a. Cefzil & Cipro
e. None of the above b. Penicillan & Biaxin
c. Clindamycin & Zithromax
27. Which is not a symptom of dry socket? d. Clindamycin & Tetracycline
a. Localized pain
b. Bad odor 37. When antibiotic medicaments were placed in dry socket
c. Bad taste studies, there was a reduction from
d. Dramatic relief when treated a. 34- 1%
e. None of the above b. 35- 2%
c. 36- 3%
d. 37-4%
9
Etiology, Prevention, and Management of 10
Post Extraction Complications
Continuing Dental Education Course Answer Sheet
Name:
Title: Specialty:
Address: Email:
City: State: Zip:
Telephone: Home ( ) Oce: ( )
Instructions to obtain 4 Dental Continuing Education credits. 1) Complete all information above. 2) Answer sheets may be
completed with either a pen or pencil. 3) All questions should have only one answer marked. 4) When test is completed,
enclose the completed answer sheet. Successful completion of this course will earn you 4 CEUs.
ADVERSE REACTIONS
DESCRIPTION There have been reports of fever associated with the use of GELFOAM, without
demonstrable infection. GELFOAM Sterile Sponge may serve as a nidus for infection and
GELFOAM Sterile Sponge is a medical device intended for application to bleeding surfaces
abscess formation1, and has been reported to potentiate bacterial growth. Giantcell
as a hemostatic. It is a water-insoluble, off-white, nonelastic, porous, pliable product
granuloma has been reported at the implantation site of absorbable gelatin product in the
prepared from purified pork Skin Gelatin USP Granules and Water for Injection, USP. It may
brain2, as has compression of the brain and spinal cord resulting from the accumulation of
be cut without fraying and is able to absorb and hold within its interstices, many times its
sterile fluid.3
weight of blood and other fluids.
Foreign body reactions, "encapsulation" of fluid and hematoma have also been reported.
Brief Summary Consult the package insert for complete prescribing information.
When GELFOAM was used in laminectomy operations, multiple neurologic events were
DIRECTIONS FOR USE reported, including but not limited to cauda equina syndrome, spinal stenosis, meningitis,
Sterile technique should always be used to remove GELFOAM Sterile Sponge from its arachnoiditis, headaches, paresthesias, pain, bladder and bowel dysfunction, and
packaging. Cut to the desired size, a piece of GELFOAM, either dry or saturated with sterile, impotence.
isotonic sodium chloride solution (sterile saline), can be applied with pressure directly to Excessive fibrosis and prolonged fixation of a tendon have been reported when absorbable
the bleeding site. When applied dry, a single piece of GELFOAM should be manually gelatin products were used in severed tendon repair.
compressed before application to the bleeding site, and then held in place with moderate
pressure until hemostasis results. When used with sterile saline, GELFOAM should be first Toxic shock syndrome has been reported in association with the use of GELFOAM in nasal
immersed in the solution and then withdrawn, squeezed between gloved fingers to expel air surgery.
bubbles, and then replaced in saline until needed. The GELFOAM sponge should promptly Fever, failure of absorption, and hearing loss have been reported in association with the use
return to its original size and shape in the solution. If it does not, it should be removed of GELFOAM during tympanoplasty.
again and kneaded vigorously until all air is expelled and it does expand to its original size
and shape when returned to the sterile saline. ADVERSE REACTIONS REPORTED FROM UNAPPROVED USES
GELFOAM is used wet or blotted to dampness on gauze before application to the bleeding GELFOAM is not recommended for use other than as an adjunct for hemostasis.
site. It should be held in place with moderate pressure, using a pledget of cotton or small While some adverse medical events following the unapproved use of GELFOAM have been
gauze sponge until hemostasis results. Removal of the pledget or gauze is made easier by reported to Pharmacia & Upjohn Company (see ADVERSE REACTIONS), other hazards
wetting it with a few drops of sterile saline, to prevent pulling up the GELFOAM which by associated with such use may not have been reported.
then should enclose a firm clot. Use of suction applied over the pledget of cotton or gauze to
draw blood into the GELFOAM is unnecessary, as the GELFOAM will draw up sufficient blood When GELFOAM has been used during intravascular catheterization for the purpose of
by capillary action. The first application of GELFOAM will usually control bleeding, but if not, producing vessel occlusion, the following adverse events have been reported; fever,
additional applications may be made using fresh pieces, prepared as described above. duodenal and pancreatic infarct, embolization of lower extremity vessels, pulmonary
embolization, splenic abscess, necrosis of specific anatomic areas, asterixis, and death.
Use only the minimum amount of GELFOAM, cut to appropriate size, necessary to produce
hemostasis. The GELFOAM may be left in place at the bleeding site, when necessary. Since These adverse medical events have been associated with the use of GELFOAM for repair of
GELFOAM causes little more cellular reaction than does the blood clot, the wound may be dural defects encountered during laminectomy and craniotomy operations: fever, infection,
closed over it. GELFOAM may be left in place when applied to mucosal surfaces until it leg paresthesias, neck and back pain, bladder and bowel incontinence, cauda equina
liquefies. For use with thrombin, consult the thrombin insert for complete prescribing syndrome, neurogenic bladder, impotence, and paresis.
information and proper sample preparation.
HOW SUPPLIED
CONTRAINDICATIONS GELFOAM Sterile Sponge is supplied in a sterile envelope enclosed in an outer peelable
GELFOAM Sterile Sponge should not be used in closure of skin incisions because it may envelope. Sterility of the product is assured unless the outer envelope has been damaged
interfere with healing of the skin edges. This is due to mechanical interposition of gelatin or opened. It is available in the following sizes:
and is not secondary to intrinsic interference with wound healing. GELFOAM should not be Sponge-Size 127 mm Box of 12 09-0315-03
placed in intravascular compartments, because of the risk of embolization.
Sponge-Size 50 Box of 4 09-0323-01
WARNINGS Sponge-Size 100 Box of 6 09-0342-01
GELFOAM Sterile Sponge is not intended as a substitute for meticulous surgical technique
and the proper application of ligatures, or other conventional procedures for hemostasis. Sponge-Size 200 Box of 6 09-0349-01
GELFOAM is supplied as a sterile product and cannot be resterilized. Unused, opened Pack-Size 6 cm Box of 6 09-0371-01
envelopes of GELFOAM should be discarded.
REFERENCES
Only the minimum amount of GELFOAM necessary to achieve hemostasis should be used. 1. Lindstrom PA: Complications from the use of absorbable hemostatic sponges. AMA Arch
Once hemostasis is attained, excess GELFOAM should be carefully removed. Surg 1956; 73:133-141.
The use of GELFOAM is not recommended in the presence of infection. GELFOAM should 2. Knowlson GTG: Gelfoam granuloma in the brain. J Neuro Neurosurg Psychiatry 1974;
be used with caution in contaminated areas of the body. If signs of infection or abscess 37:971-973.
develop where GELFOAM has been positioned, reoperation may be necessary in order to
remove the infected material and allow drainage. 3. Herndon JH, Grillo HC, Riseborough EJ, et al: Compression of the brain and spinal cord
following use of GELFOAM. Arch Surg 1972; 104:107.
Although the safety and efficacy of the combined use of GELFOAM with other agents such
as topical thrombin has not been evaluated in Pharmacia-controlled clinical trials, if in the 4. Council on Pharmacy and Chemistry: Absorbable Gelatin spongenew and nonofficial
physicians judgment concurrent use of topical thrombin is medically advisable, the product remedies. JAMA 1947; 135:921.
literature for that agent should be consulted for complete prescribing information. 5. Goodman LS, Gilman A: Surface-acting drugs, in The Pharmacologic Basis of
While packing a cavity for hemostasis is sometimes surgically indicated, GELFOAM should Therapeutics, ed 6. New York, MacMillan Publishing Co. 1980, p 955.
not be used in this manner unless excess product not needed to maintain hemostasis is 6. Guralnick W, Berg L: GELFOAM in oral surgery. Oral Surg 1948; 1:629-632.
removed.
7. Jenkins HP, Senz EH, Owen H, et al: Present status of gelatin sponge for control of
Whenever possible, it should be removed after use in laminectomy procedures and from hemorrhage. JAMA 1946; 132:614-619.
foramina in bone, once hemostasis is achieved. This is because GELFOAM may swell to its
original size on absorbing fluids, and produce nerve damage by pressure within confined 8. Jenkins HP, Janda R, Clarke J: Clinical and experimental observations on the use of
bony spaces. gelatin sponge or foam. Surg 1946; 20:124-132.
The packing or wadding of GELFOAM, particularly within bony cavities, should be avoided, 9. Treves N: Prophylaxis of post mammectomy lymphedema by the use of GELFOAM
since swelling to original size may interfere with normal function and/or possibly result in laminated rolls. Cancer 1952; 5:73-83.
compression necrosis of surrounding tissues. 10. Barnes AC: The use of gelatin foam sponges in obstetrics and gynecology. Am J Obstet
PRECAUTIONS Gynecol 1963; 86:105-107.
Use only the minimum amount of GELFOAM Sterile Sponge needed for hemostasis, 11. Rarig HR: Successful use of gelatin foam sponge in surgical restoration of fertility. Am J
holding it at the site until bleeding stops, then removing the excess. Obstet Gynecol 1963; 86:136.
GELFOAM should not be used for controlling postpartum hemorrhage or menorrhagia. 12. MacDonald SA, Mathews WH: Fibrin foam and GELFOAM in experimental kidney
wounds. Annual American Urological Association, July 1946.
It has been demonstrated that fragments of another hemostatic agent, microfibrillar
collagen, pass through the 40 transfusion filters of blood scavenging systems. GELFOAM 13. Jenkins HP, Janda R: Studies on the use of gelatin sponge or foam as a hemostatic
should not be used in conjunction with autologous blood salvage circuits since the safety of agent in experimental liver resections and injuries to large veins. Ann Surg 1946;
this use has not been evaluated in controlled clinical trials. 124:952-961.
Microfibrillar collagen has been reported to reduce the strength of methylmethacrylate 14. Correll JT, Prentice HR, Wise EC: Biologic investigations of a new absorbable sponge.
adhesives used to attach prosthetic devices to bone surfaces. As a precaution, GELFOAM Surg Gynecol Obstet 1945; 181:585-589.
should not be used in conjunction with such adhesives.
GE151604 2004 Pfizer Inc. All rights reserved. February 2004 U.S. Pharmaceuticals