Effective haemostasis is an essential component of successful oral surgical practice. Even relatively minor procedures, such as dental extractions, alveoloplasty, soft-tissue biopsy and other dentoalveolar interventions, may result in clinically significant bleeding. Although post-surgical bleeding is usually self-limiting in healthy individuals, inadequate haemostasis can interfere with visibility of the operative field, prolong the procedure, compromise clot stability and delay wound healing. Persistent or recurrent bleeding may also increase postoperative discomfort and anxiety and, in susceptible patients, may require additional intervention [1,2]. Conventional measures such as direct pressure with gauze and suturing are generally effective; however, they may not always provide sufficiently rapid or predictable haemostasis, particularly when bleeding is persistent or the surgical site is highly vascular [1]. The importance of efficient local bleeding control has therefore encouraged the development and clinical use of a variety of topical haemostatic agents. Local haemostatic agents act directly at the bleeding site and facilitate haemostasis through different mechanisms, including enhancement of clot formation, platelet adhesion and aggregation, vasoconstriction, inhibition of fibrinolysis and stabilization of the developing fibrin clot [2,3]. Their local application is particularly attractive in oral surgery because the treatment can be directed specifically to the extraction socket or surgical wound while minimizing systemic exposure. A wide range of materials and pharmacological agents have consequently been investigated, including haemocoagulase, chitosan-based dressings, adrenaline, tranexamic acid, gelatin and collagen sponges, oxidized regenerated cellulose, fibrin-based products and tissue adhesives [3,4]. The considerable variation in their mechanisms of action, handling characteristics, cost and clinical performance makes the selection of an appropriate haemostatic agent an important practical consideration. Haemocoagulase is a thrombin-like enzyme derived from snake venom and has been used topically to facilitate clot formation. It promotes the conversion of fibrinogen into fibrin and thereby contributes to the formation and stabilization of a clot at the bleeding site [5,6]. In oral surgical wounds, topical haemocoagulase has also been investigated for its potential influence on wound healing [6]. Chitosan, on the other hand, is a naturally derived cationic polysaccharide with haemostatic, mucoadhesive and wound-healing properties. Its positively charged groups interact with negatively charged cellular components of blood, promoting the adhesion and aggregation of erythrocytes and platelets and facilitating rapid clot formation [7]. Importantly, its haemostatic activity is not entirely dependent on the conventional coagulation cascade, which has generated considerable interest in its use as a local haemostatic material. Adrenaline achieves local haemostasis primarily through stimulation of α-adrenergic receptors and subsequent vasoconstriction, thereby reducing blood flow at the operative site [8]. Topical adrenaline has long been used to improve surgical visibility and assist in controlling localized bleeding, although its potential systemic cardiovascular effects require appropriate clinical caution [8,9]. Tranexamic acid represents another well-established approach to local haemostasis. As a synthetic antifibrinolytic agent, it inhibits the activation of plasminogen to plasmin and consequently limits fibrin degradation, allowing the formed clot to remain stable for a longer period [10,11]. Its topical use has been particularly well studied in dental patients at increased risk of postoperative bleeding, including those receiving antithrombotic therapy [4,12]. Despite the availability of numerous local haemostatic agents, there is no single method that is universally suitable for all minor oral surgical procedures. The available agents differ not only in the speed with which haemostasis is achieved but also in their ability to maintain clot stability and prevent postoperative rebleeding. A network meta-analysis evaluating haemostatic interventions following dental extraction demonstrated substantial differences among the available agents and emphasized that rapid initial haemostasis does not necessarily translate into a lower risk of subsequent bleeding [4]. This distinction is clinically relevant because an ideal local haemostatic agent should provide prompt control of bleeding while maintaining a stable clot without producing significant local or systemic adverse effects. Recent clinical evidence has therefore increasingly focused on direct comparison of different local haemostatic approaches rather than evaluating individual agents in isolation. Patil et al. compared haemocoagulase (Botroclot), chitosan, adrenaline and tranexamic acid with conventional saline-soaked pressure gauze following dental extraction and demonstrated significant differences in the time required to achieve haemostasis [13]. However, differences in the mechanisms and clinical performance of available agents, together with the continuing need for a simple, rapid and reliable method of bleeding control, indicate that further comparative clinical evaluation remains relevant. Therefore, the present study was undertaken to comparatively evaluate the efficacy of different local haemostatic agents in minor oral surgical procedures, with particular emphasis on their ability to achieve effective and timely haemostasis. The findings may help provide clinically relevant evidence for selecting an appropriate local haemostatic approach for routine minor oral surgical practice.

Study Design and Setting The present study was a prospective, randomized, comparative clinical study conducted in the Department of Oral and Maxillofacial Surgery, Government Dental College, Rahui, Nalanda, Bihar, India, over a period of one year. A total of 100 patients requiring routine extraction of permanent teeth were enrolled in the study. The study protocol was approved by the Institutional Ethics Committee of Government Dental College, Rahui, Nalanda, Bihar. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from all participants before their enrolment after explaining the nature, purpose, procedures, potential benefits, and possible risks of the study. Study Population Patients reporting to the department for routine dental extraction were screened for eligibility. A detailed medical and dental history was recorded, followed by clinical examination. A total of 100 patients aged 18–60 years, fulfilling the eligibility criteria, were included in the study. Inclusion Criteria Patients of either sex, aged 18–60 years, who required uncomplicated extraction of permanent teeth were included. Only systemically healthy patients with no known history of bleeding or coagulation disorders and who provided written informed consent were enrolled. Exclusion Criteria Patients with known bleeding or coagulation disorders, uncontrolled systemic diseases, active infection at the surgical site, or known hypersensitivity to any of the haemostatic agents used in the study were excluded. Patients receiving anticoagulant or antiplatelet medications or other drugs known to significantly affect haemostasis were also excluded. Cases requiring extensive surgical intervention or those in which the extraction became complicated were excluded to maintain uniformity among the study groups. Sample Size Calculation The sample size was calculated a priori using G*Power software (version 3.1.9.7) for comparison of five independent groups using one-way analysis of variance (ANOVA), with time required to achieve haemostasis as the primary outcome. Assuming a moderate-to-large standardized effect size (Cohen’s f = 0.35) and a two-sided significance level (α) of 0.05, a total sample size of 100 participants provided approximately 79% statistical power to detect an overall difference among the five groups. Accordingly, 100 participants were included, with 20 participants allocated to each group in a 1:1:1:1:1 ratio. Equal allocation was maintained to ensure balanced comparison of haemostatic efficacy across the five study groups. Group Allocation The 100 participants were randomly allocated into five groups of 20 patients each using a computer-generated random sequence. The groups were categorized according to the local haemostatic agent used following tooth extraction: Group I (n=20): Haemocoagulase (Botroclot) Group II (n=20): Chitosan-based haemostatic dressing Group III (n=20): Adrenaline Group IV (n=20): Tranexamic acid Group V (n=20): Sterile pressure gauze soaked in normal saline (control) Clinical Procedure All procedures were carried out under standard aseptic conditions. Local anaesthesia was administered using 2% lignocaine with adrenaline. The indicated tooth was extracted as atraumatically as possible using appropriate elevators and forceps, with care taken to minimize unnecessary trauma to the surrounding soft tissues and alveolar bone. Immediately after extraction, the socket was inspected, and debris or granulation tissue, when present, was removed as required. The respective haemostatic agent was then applied locally to the extraction socket according to the allocated group. In the control group, sterile gauze soaked in normal saline was placed over the extraction socket. The assessment of haemostasis was started immediately after application of the assigned haemostatic measure. The extraction socket was examined at 15-second intervals, and the time required for complete cessation of bleeding was recorded using a stopwatch. Complete haemostasis was considered to have been achieved when there was no active bleeding or fresh blood oozing from the extraction socket. Assessment of Haemostatic Efficacy The primary outcome measure was the time required to achieve complete haemostasis following application of the respective haemostatic agent. A shorter time to cessation of bleeding was considered indicative of greater haemostatic efficacy. The extraction socket was reassessed after 30 minutes to evaluate clot stability and identify any episode of rebleeding. Any rebleeding requiring additional local haemostatic measures was recorded. Patients were also instructed to report any episode of postoperative bleeding after leaving the department. Any local or systemic adverse effects associated with the haemostatic agents, including local irritation, hypersensitivity or other unexpected complications, were documented. Standardization of the Procedure To minimize procedural variability, the extraction technique, method of application of each haemostatic agent, timing of assessment and criteria for determining complete haemostasis were standardized across all five groups. Only uncomplicated extractions were included to reduce the possible influence of surgical difficulty and tissue trauma on the duration of bleeding. Outcome Measures The primary outcome was the time required to achieve complete haemostasis after application of the respective local haemostatic agent. The secondary outcomes included the occurrence of rebleeding within 30 minutes, requirement for additional haemostatic intervention, clot stability and the occurrence of any local or systemic adverse effects. Statistical Analysis The collected data were entered into Microsoft Excel and analysed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD), whereas categorical variables were presented as frequencies and percentages. The normality of continuous variables was assessed using the Shapiro–Wilk test. The mean time required to achieve haemostasis among the five groups was compared using one-way analysis of variance (ANOVA) for normally distributed data. When a statistically significant overall difference was observed, Tukey's post-hoc test was used for pairwise intergroup comparisons. For non-normally distributed data, the Kruskal–Wallis test followed by an appropriate post-hoc test was used. Categorical variables were compared using the Chi-square test or Fisher’s exact test, as appropriate. For categorical outcomes with small expected cell frequencies, an exact test (Fisher–Freeman–Halton exact test for R×C contingency tables) was used. A p-value <0.05 was considered statistically significant.

A total of 124 patients were assessed for eligibility, of whom 24 were excluded; eight did not meet the eligibility criteria, 12 declined to participate, and four were excluded for other reasons. The remaining 100 eligible participants were randomized equally into five study groups, with 20 participants allocated to each group. All randomized participants completed the study and were included in the final analysis, with no loss to follow-up. The flow of participants through enrolment, allocation, follow-up, and analysis is illustrated in the CONSORT flow diagram (Figure 1). The study groups were subsequently compared with respect to demographic characteristics, baseline haemostatic parameters, time required to achieve haemostasis, and postoperative outcomes. As shown in Table 1, 57 (57.0%) participants were male, and 43 (43.0%) were female. The proportion of males ranged from 55.0% in the Botroclot, adrenaline, and pressure gauze groups to 60.0% in the chitosan and tranexamic acid groups. Thus, the sex distribution was relatively balanced across the five groups. The sex distribution was comparable across the five study groups (p=0.993). The age distribution of participants across the study groups is presented in Table 2. The mean age was 37.40 ± 8.12 years in the Botroclot group, 36.85 ± 9.24 years in the chitosan group, 36.10 ± 7.81 years in the adrenaline group, 35.75 ± 9.06 years in the tranexamic acid group, and 37.15 ± 8.34 years in the pressure gauze group. The mean age was comparable across the five study groups, with no statistically significant difference observed (F=0.135, p=0.969). Baseline haemostatic parameters and the time required to achieve haemostasis are summarized in Table 3 and Figure 2. The mean baseline bleeding time ranged from 2.28 ± 0.18 minutes in the chitosan group to 2.38 ± 0.25 minutes in the adrenaline group. There was no statistically significant difference in baseline bleeding time among the five groups (F=0.81, p=0.521). Similarly, the mean clotting time ranged from 4.82 ± 0.64 minutes in the adrenaline group to 5.12 ± 0.70 minutes in the Botroclot group, with no statistically significant intergroup difference (F=0.51, p=0.731). These findings indicated that the groups were comparable with respect to baseline haemostatic parameters. In contrast, a statistically significant difference was observed in the time required to achieve haemostasis among the five groups (F=25.60, p<0.001). The shortest mean haemostasis time was recorded in the Botroclot group (0.84 ± 0.31 minutes), followed by the tranexamic acid group (0.91 ± 0.36 minutes) and the chitosan group (1.09 ± 0.29 minutes). The mean haemostasis time was longer in the adrenaline group (1.35 ± 0.28 minutes), while the pressure gauze group showed the longest mean time of 1.76 ± 0.40 minutes. Thus, the principal difference among the study groups was observed after application of the respective haemostatic measures rather than in their baseline bleeding or clotting characteristics. Tukey's post-hoc analysis was performed to determine which groups differed significantly from each other (Table 4). Botroclot achieved haemostasis significantly faster than adrenaline (mean difference 0.51 minutes, p<0.001) and pressure gauze (mean difference 0.92 minutes, p<0.001). The differences between Botroclot and chitosan (p=0.128) and between Botroclot and tranexamic acid (p=0.963) were not statistically significant. Chitosan showed a significantly shorter haemostasis time than pressure gauze (mean difference 0.67 minutes, p<0.001), whereas its differences from adrenaline (p=0.103) and tranexamic acid (p=0.427) were not statistically significant. Tranexamic acid also demonstrated significantly faster haemostasis than adrenaline (mean difference 0.44 minutes, p<0.001) and pressure gauze (mean difference 0.85 minutes, p<0.001). A statistically significant difference was also observed between adrenaline and pressure gauze (mean difference 0.41 minutes, p=0.002). Overall, the post-hoc findings indicated that Botroclot and tranexamic acid produced the shortest haemostasis times, whereas conventional pressure gauze required considerably longer to achieve bleeding control. Postoperative outcomes are presented in Table 5 and Figure 3. No episode of rebleeding within 30 minutes was observed in the Botroclot, chitosan, or tranexamic acid groups. Rebleeding occurred in one patient (5.0%) in the adrenaline group and two patients (10.0%) in the pressure gauze group. Although rebleeding was observed more frequently in the pressure gauze group, the difference among the five groups was not statistically significant (Fisher–Freeman–Halton exact test, p=0.20). The same three patients required additional haemostatic intervention, and the intergroup difference was similarly not statistically significant (p=0.20). No local or systemic adverse reactions were observed in any of the study groups; therefore, no statistical comparison was performed for these outcomes. Overall, Botroclot demonstrated the shortest mean time to haemostasis, closely followed by tranexamic acid, while pressure gauze showed the longest haemostasis time. The differences in haemostasis time were statistically significant among the five groups, whereas baseline bleeding and clotting times were comparable. Postoperative rebleeding was uncommon, and no local or systemic adverse reactions were recorded. Table 1. Distribution of patients according to sex Sex Botroclot n (%) Chitosan n (%) Adrenaline n (%) Tranexamic acid n (%) Pressure gauze n (%) Total χ² Value P value Male 11 (55.0) 12 (60.0) 11 (55.0) 12 (60.0) 11 (55.0) 57 (57.0) 0.245 0.993 Female 9 (45.0) 8 (40.0) 9 (45.0) 8 (40.0) 9 (45.0) 43 (43.0) Total 20 20 20 20 20 100 Table 2. Comparison of age among the study groups Group N Minimum (years) Maximum (years) Mean ± SD (years) F value P value Botroclot 20 22 56 37.40 ± 8.12 0.135 0.969 Chitosan 20 20 57 36.85 ± 9.24 Adrenaline 20 23 55 36.10 ± 7.81 Tranexamic acid 20 21 58 35.75 ± 9.06 Pressure gauze 20 22 57 37.15 ± 8.34 Table 3. Comparison of baseline bleeding time, clotting time and time required to achieve haemostasis among the five groups Group N Bleeding time (min), Mean ± SD Clotting time (min), Mean ± SD Time to haemostasis (min), Mean ± SD Botroclot 20 2.31 ± 0.16 5.12 ± 0.70 0.84 ± 0.31 Chitosan 20 2.28 ± 0.18 4.91 ± 0.78 1.09 ± 0.29 Adrenaline 20 2.38 ± 0.25 4.82 ± 0.64 1.35 ± 0.28 Tranexamic acid 20 2.32 ± 0.17 5.01 ± 0.68 0.91 ± 0.36 Pressure gauze 20 2.30 ± 0.16 4.96 ± 0.71 1.76 ± 0.40 F-value — 0.81 0.51 25.60 p-value — 0.521 0.731 <0.001* *One-way ANOVA; p<0.05 was considered statistically significant. Table 4. Post-hoc pairwise comparison of time required to achieve haemostasis Pairwise comparison Mean difference (min) P-value Interpretation Botroclot vs Chitosan 0.25 0.128 NS Botroclot vs Adrenaline 0.51 <0.001* Significant Botroclot vs Tranexamic acid 0.07 0.963 NS Botroclot vs Pressure gauze 0.92 <0.001* Significant Chitosan vs Adrenaline 0.26 0.103 NS Chitosan vs Tranexamic acid 0.18 0.427 NS Chitosan vs Pressure gauze 0.67 <0.001* Significant Adrenaline vs Tranexamic acid 0.44 <0.001* Significant Adrenaline vs Pressure gauze 0.41 0.002* Significant Tranexamic acid vs Pressure gauze 0.85 <0.001* Significant Tukey’s post-hoc multiple comparison test; p<0.05 was considered statistically significant; NS = not significant Table 5. Postoperative outcomes among the five groups Outcome Botroclot (n=20) Chitosan (n=20) Adrenaline (n=20) Tranexamic acid (n=20) Pressure gauze (n=20) P-value Rebleeding within 30 min 0 0 1 (5%) 0 2 (10%) 0.20* Additional haemostatic measure required 0 0 1 (5%) 0 2 (10%) 0.20* Local adverse reaction 0 0 0 0 0 - Systemic adverse reaction 0 0 0 0 0 - * Fisher–Freeman–Halton exact test. No statistical comparison was performed for adverse reactions because no events occurred in any group.

Effective control of bleeding following dental extraction is an important component of routine oral surgical practice. In the present study, the five groups were comparable with respect to baseline bleeding and clotting times, indicating similar haemostatic status before application of the study interventions. However, a significant difference was observed in the time required to achieve haemostasis (p<0.001). Botroclot showed the shortest mean haemostasis time (0.84 ± 0.31 minutes), followed by tranexamic acid (0.91 ± 0.36 minutes), chitosan (1.09 ± 0.29 minutes), adrenaline (1.35 ± 0.28 minutes), and pressure gauze (1.76 ± 0.40 minutes). The findings of the present study are in close agreement with those of Patil et al., who compared the same five haemostatic approaches and reported the shortest haemostasis time with Botroclot (0.87 ± 0.33 minutes), followed by tranexamic acid (0.93 ± 0.39 minutes), chitosan (1.13 ± 0.27 minutes), adrenaline (1.38 ± 0.25 minutes), and pressure gauze (1.80 ± 0.41 minutes). They also observed a statistically significant difference among the groups (p=0.001) [13]. The close similarity between the two studies strengthens the evidence that active local haemostatic agents can achieve faster bleeding control than conventional pressure gauze. Botroclot demonstrated the most rapid haemostatic action in the present study and achieved haemostasis significantly faster than adrenaline and pressure gauze. Haemocoagulase acts through its thrombin-like activity, promoting the conversion of fibrinogen into fibrin and facilitating rapid clot formation. Shenoy et al. [5] evaluated the effect of botropase on clotting factors in healthy volunteers and demonstrated its influence on the coagulation process. Similarly, the clinical study by Shenoy et al. [6] reported favourable effects of topical haemocoagulase on healing of post-extraction wounds. These findings provide biological and clinical support for the rapid haemostatic effect observed with Botroclot in the present study. Tranexamic acid was the second fastest agent in the present study, with a mean haemostasis time of 0.91 ± 0.36 minutes. Its difference from Botroclot was not statistically significant, while it achieved significantly faster haemostasis than adrenaline and pressure gauze. Tranexamic acid prevents fibrin degradation through inhibition of fibrinolysis, thereby maintaining clot stability. Lam et al. [14] described its established role in haemostasis and highlighted the importance of its antifibrinolytic action. Furthermore, Queiroz et al. [12], in a randomized clinical study involving patients receiving warfarin, demonstrated the effectiveness of locally applied tranexamic acid following dental extraction. Ockerman et al. [19], in the EXTRACT-NOAC randomized clinical trial, also evaluated tranexamic acid for post-extraction bleeding in patients receiving non-vitamin K oral anticoagulants, providing additional clinical evidence regarding its local haemostatic application in dental extraction. Thus, the findings of the present study further support the usefulness of topical tranexamic acid for local bleeding control. Chitosan also demonstrated favourable haemostatic activity, achieving haemostasis significantly faster than pressure gauze. Its haemostatic effect is mainly related to its positively charged amino groups, which interact with negatively charged blood cells and facilitate erythrocyte and platelet adhesion and aggregation. Guo et al. [3] described the role of haemostatic biomaterials, including their ability to promote clot formation and support wound healing. More recently, Lee et al. [15] reported rapid bleeding control with an architecturally designed haemostatic material under anticoagulated conditions, while Huang et al. [16] demonstrated enhanced procoagulant activity of a protonated-chitosan sponge. These observations support the haemostatic potential of chitosan-based materials. This is further supported by Radhakrishna et al. [17], who reported faster haemostasis with a chitosan-based dental dressing compared with conventional cotton gauze following dental extraction in patients receiving antithrombotic therapy. Similarly, Guardieiro et al. [18] reported a shorter intraoral bleeding time with a chitosan-based haemostatic dressing compared with oxidized cellulose in patients receiving dual antiplatelet therapy, further supporting the effectiveness of chitosan for local bleeding control. The favourable performance of chitosan and tranexamic acid is also supported by higher-level evidence. Mahardawi et al. [4], in a network meta-analysis evaluating different haemostatic agents following dental extraction in patients receiving oral antithrombotic therapy, demonstrated differences in the effectiveness of available local haemostatic approaches and reported favourable results with chitosan-based interventions. Although their patient population differed from the healthy participants included in the present study, their findings support the clinical usefulness of active local haemostatic agents. Adrenaline produced a mean haemostasis time of 1.35 ± 0.28 minutes and was significantly faster than conventional pressure gauze, although its effect was slower than Botroclot and tranexamic acid. Its haemostatic action is primarily related to α-adrenergic-mediated vasoconstriction, which decreases local blood flow. Patil et al. similarly reported a longer haemostasis time with adrenaline than with Botroclot and tranexamic acid [13]. Although topical adrenaline can provide effective local bleeding control, its potential systemic cardiovascular effects should be considered, particularly in susceptible patients [8,9]. Conventional saline-soaked pressure gauze required the longest time to achieve haemostasis. Unlike the active haemostatic agents, pressure gauze primarily acts through mechanical compression and relies on the patient's normal coagulation process. This may explain the comparatively longer haemostasis time observed in the control group. Yerragudi et al. [20], in a randomized controlled trial involving patients undergoing dental extraction, also demonstrated that conventional pressure packing can achieve haemostasis in most patients, although the duration of pressure application influences bleeding control. The results suggest that active local haemostatic agents can provide more rapid control of post-extraction bleeding, although conventional pressure gauze remains a simple, inexpensive, and readily available method for routine bleeding control. Postoperative rebleeding was uncommon in the present study. No rebleeding was observed with Botroclot, chitosan, or tranexamic acid, whereas one patient (5%) in the adrenaline group and two patients (10%) in the pressure gauze group experienced rebleeding within 30 minutes. However, this difference was not statistically significant (p=0.20). The same three patients required additional haemostatic intervention, and no local or systemic adverse reactions were observed in any group. Patil et al. [13] reported no postoperative rebleeding or complications in any of their study groups. The low frequency of rebleeding in both studies suggests satisfactory short-term haemostatic control, although the small number of events in the present study limits definitive comparison of postoperative bleeding between agents. Overall, the present findings indicate that the major difference among the evaluated haemostatic approaches was the speed at which haemostasis was achieved. Botroclot and tranexamic acid produced the shortest haemostasis times, while chitosan also showed favourable performance. The consistency of these findings with previous clinical and experimental evidence supports the usefulness of active local haemostatic agents as adjuncts for rapid bleeding control following uncomplicated dental extraction. Limitations of the Study The present study has certain limitations. It was a single-centre study with 20 patients in each group and included only systemically healthy individuals undergoing uncomplicated dental extractions. Patients receiving anticoagulant or antiplatelet therapy and those with bleeding disorders were excluded; therefore, the findings may not be directly generalizable to higher-risk patients. Postoperative rebleeding was assessed primarily within 30 minutes, which limits evaluation of delayed bleeding. In addition, local anaesthesia containing adrenaline was used in all groups; although this was standardized across the study groups, its vasoconstrictive effect may have influenced local bleeding and should be considered while interpreting the effect of topical adrenaline. Larger multicentre studies with longer follow-up and inclusion of patients with different bleeding risks are required to further establish the comparative effectiveness and safety of these agents.

The present study demonstrated that local haemostatic agents were effective in achieving bleeding control following minor oral surgical procedures. Botroclot achieved the shortest haemostasis time, closely followed by tranexamic acid, whereas conventional pressure gauze required the longest time. The difference in haemostasis time among the five groups was statistically significant. Postoperative rebleeding was uncommon and showed no significant difference among the groups, while no local or systemic adverse reactions were observed. Overall, the findings indicate that the use of appropriate local haemostatic agents can facilitate rapid and predictable haemostasis following uncomplicated dental extraction. Their use may therefore be considered a useful adjunct to conventional measures for effective bleeding control in routine oral surgical practice.

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