I clinical report _ apical microsurgery series Fig. 3_An appropriately sized piece of Telfa Pad can be lightly streaked with ferric sulfate for crypt management. Fig. 4_Only a small amount of ferric sulfate is used on the Micro Applicator. Fig. 3 Fig. 4 much time as necessary to achieve the desired result. The clean and well-managed crypt is essential for good visibility and proper use of the retrofill materials. Ferric sulfate (Monsel’s Solution, Cutrol), calcium sulphate (Capset, SurgiPlaster), Telfa Pads, and epinephrine-soaked pellets (Epidry, Pascal) are the most commonly used and effective agents for this purpose. I don’t use CollaCote because the majority of the other materials mentioned are easier to use and provide a more efficient haemostasis. After all granulation tissue and other debris have been thoroughly removed from the crypt, haemostasis is often achieved as a result of proper haemostasis-staging injections, discussed in Part II of this series. If that is the case, only an appropriately sized piece of Telfa Pad, lining the floor of the crypt is necessary to enhance lighting. However, this is not always the case and even slight bleeding must be addressed in order to preserve optimum visibility. If the crypt exhibits slight haemorrhaging, the surface of a piece of Telfa Pad, trimmed to the correct size to fit, can be lightly streaked with Monsel’s Solution and pressed into the floor of the crypt for a short period of time until the haemorrhaging is completely controlled (Fig. 3). If there is a moderate haemorrhaging, the Monsel’s Solution is carefully applied with a Micro Applicator (Ultradent) directly to the problem area in the floor of the crypt. Keep in mind that only a small amount is necessary (Fig. 4). When ferric sulfate is used to achieve haemostasis, a thick brownish-black coagulum will usually result (Fig. 5). The resultant coagulum can be easily removed from the crypt with a clean Micro Applicator, gently flushed with water using a larger tip on a Stropko Irrigator as the scope assistant is evacuating any debris during irrigation of the crypt. The process is repeated until the bleeding is controlled. As soon as there is complete control of all bleeding in the crypt, the Telfa Pad should be removed and replaced with a fresh piece so there is as much ‘white surface’ as possible to facilitate light reflection and enhance vision. On condition that the coagulum resulting from the use of Monsel’s Solution has been cleaned out of the crypt after the completion of the surgery, its use has not been shown to affect the healing process.1 CAUTION: All forms of ferric sulfate must Fig. 5_When ferric sulfate is used for crypt management, a dark brown coagulum will result. Fig. 6_The Telfa Pad should be replaced as necessary to maintain good light reflection in the crypt. Fig. 5 Fig. 6 20 I roots 4_ 2009