The Prognosis of Altered Sensation after Extrusion of Root Canal Filling Materials: A Systematic Review of the Literature

Effectiveness of mineral trioxide aggregate on postoperative pain in non-surgical endodontic treatment: a systematic review of randomized controlled trials

INTRODUCTION

Postoperative endodontic pain can negatively influence the quality of life of the patients. Mineral Trioxide Aggregate (MTA) has gained attention as a potential medicament in various endodontic procedures. MTA has been shown to have desirable properties such as biocompatibility, marginal adaptation, and sealing ability compared to other materials. Limited evidence is available about the effectiveness of MTA on the reduction of postoperative pain following endodontic treatment. This article aimed to compare the non-surgical post-endodontic pain-relieving effect of MTA compared with other materials.

METHODS

Indexed databases (PubMed/Medline, EMBASE, OVID, Scopus, and Cochrane) were independently searched for relevant manuscripts published up to and until June 2023. Randomized controlled trials (RCTs) with a focus on teeth with pulp pathologies, with or without radiolucency, requiring primary endodontic treatment were included. Risk of bias across individual studies was performed using the Cochrane risk of bias tool for interventions.

RESULTS

Out of the initial 169 articles searched, 9 RCTs met the selection criteria. The protocols were like all the studies, but the pain rating scales, filling material, and restoration materials varied. Out of the 9 included studies, in 4 studies MTA significantly reduced postoperative pain levels, 5 studies showed no difference between MTA and other materials, whereas 1 study reported an adverse effect of grey discoloration after MTA.

CONCLUSION

The findings of the present review indicate that MTA may reduce postoperative pain following non-surgical endodontic treatment. However, future standardized studies should be conducted to validate the results.

Postoperative pain after root canal filling with bioceramic sealers: a systematic review and meta-analysis of randomized clinical trials

The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD - 0.17 [- 0.34; - 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.

Outcome of root canal treatment using warm vertical compaction with bioceramic and resin-based sealers: A randomised clinical trial

This study aimed to compare the effect of a bioceramic sealer (iRoot SP) and a resin-based sealer (AH Plus) on the outcome of root canal treatment in a 2-year follow-up. Seventy-six teeth with irreversibly or necrotic pulp were recruited. After instrumentation and disinfection, the root canals were obturated using warm vertical compaction with iRoot SP (n = 43) or AH Plus (n = 33). Patients were followed up by clinical and radiographic examination at 6 12 and 24 months with recall rates of 84.2%, 65.8% and 48.7%, respectively. During each recall session, the success rates were 80%, 85.2% and 85% in the iRoot SP group and 82.8%, 91.3% and 88.2% in the AH Plus group. The success rates of the two groups did not differ significantly (p > 0.05). The bioceramic sealer resulted in a similar clinical performance and success rate to the resin-based sealer in endodontic treatment during a 2-year follow-up.

Endodontic management of maxillary first molar with protostylid: a rare case report

BACKGROUND

A protostylid is a relatively rare dental developmental aberration characterized as an extra cusp located on the mesial half of the buccal surface of the molars. A protostylid is rarely to be reported due to its low rate of occurrence. This case report describes a patient referred for endodontic treatment due to the presence of a protostylid on the buccal surface of the maxillary first molar that induced apical periodontitis.

CASE PRESENTATION

A 53-year-old female reported a 3-month history of pain of chewing with her upper left posterior teeth over 3 months. In the clinical examination, an abraded anomalous cusp-like structure was found on the buccal surface of tooth 26, Cone beam computed tomography (CBCT) revealed a supernumerary cusp with an intact root canal inside, which was fused with the mesiobuccal (MB) root canal in the middle of the root. In addition, extensive periapical radiolucency was observed around tooth 26. The tooth was diagnosed as apical periodontitis, and endodontic treatment was performed. The initial lesion in tooth 26 gradually healed over 1 year of observation.

CONCLUSIONS

To our knowledge, this case is the first to describe the endodontic management of a maxillary first molar with a protostylid and advances our understanding of supernumerary cusps. This case provides a reference for the treatment of protostylid.

Tip and taper compatibility of accessory gutta-percha points with rotary and reciprocating instruments

Objectives

This study was conducted to evaluate and compare the tip and taper compatibility of accessory gutta-percha points (AGPs) with various rotary and reciprocating instruments.

Materials and Methods

Using a profile analyzer, tip and taper measurements were taken of 10 AGPs of each of the 14 models available from Odous de Deus and the 4 models available from Dentsply-Maillefer. Diameter measurements were taken at 1-mm intervals, from 3 mm from the tip (D3) to 16 mm.

Results

Based on the mean values obtained, 3-dimensional (3D) models of the AGPs were drawn in Autodesk Fusion 360 and superimposed on 3D models of each instrument selected (Mtwo, Reciproc, RaCe, K3, and ProDesign Logic) to determine the compatibility between the instrument and the AGP. Data corresponding to the tips and tapers of the various AGPs, as well as the tip and taper differences between the AGPs and the instruments, were analyzed using descriptive statistics. The tapers of the AGPs were subject to the American National Standards Institute/American Dental Association No. 57 standard. The Odous de Deus extra-long medium and extra-long extra-medium AGPs were shown to be compatible with Mtwo, K3, and ProDesign Logic instruments with taper 0.06 and tip sizes 25 and 30, while the Dentsply fine and fine medium cones were compatible with Mtwo, RaCe, and K3 instruments with conicity of 0.04 and tip sizes 35 and 40.

Conclusions

Both the Odous de Deus and Dentsply commercial brands included 2 AGP models with tip (D3) and taper compatibility with Mtwo, RaCe, K3, and/or Prodesign Logic instruments.

Evaluation of Cytotoxicity of Calcium Silicate-based Mineral Trioxide Aggregate Sealers: A Systematic Review of In Vitro Studies

AIM

This review aimed to evaluate the in vitro studies done with regard to the cytotoxicity associated with mineral trioxide aggregate (MTA)-based root canal sealers.

BACKGROUND

Root canal sealers are used during endodontic treatment as fillers to seal the gaps between the canal gutta-percha cone and canal walls. It is necessary to understand the cytotoxicity of these materials on human-derived cells as these materials interact with human cells periapically.

REVIEW RESULTS

Six in vitro studies were chosen for review. In these selected studies, along with MTA-based root canal sealers, other sealers were tested for cytotoxicity on human periodontal ligament (PDL) stem cells, human PDL fibroblasts, and human osteoblast cells. Regarding cytotoxicity, the studies were diverse, and most were based on 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazolium bromide) (MTT) assay. In general, the studies suggested that root canal sealers cause mild to severe cytotoxic effects and that several factors influence this effect, such as material setting time, concentration, and duration of exposure.

CONCLUSION

All studies in the review indicated that MTA. Fillapex must be used cautiously as it exhibited the highest cytotoxic effect compared to other MTA-based and non-MTA-based sealers.

CLINICAL SIGNIFICANCE

Endodontic sealers do serve the purpose of bridging the gaps between the gutta-percha cone and the canal wall but knowing its biocompatibility becomes important as the material is extruded beyond the apical foramen where it comes in contact with the surrounding tissues. The effect of sealers on the surrounding tissues affects the healing and prognosis of the treatment.

Clinical and medico-legal considerations in endodontics

Endodontic treatment can be challenging for a number of reasons, including the microscopic nature of the clinical environment, reliance on tactile sensation and lack of direct visualization of the work being performed. Commonly, endodontic patients present with pain and distress, which can exacerbate an already difficult clinical situation. Complications may might arise prior to, or during treatment, despite practising with the utmost care and skill. Preventing and managing these complications can take considerable time and energy, and oftentimes assistance from or referral to more experienced colleagues is required. The aim of this review is to discuss medico-legal considerations in endodontics, with clinical correlations and a focus on the Australian legal landscape. [Correction added on 18 October 2023, after first online publication: The abstract was amended from a structured to an unstructured abstract.].

Calcium Silicate-based Sealer Extrusion into the Mandibular Canal: Three Different Recovery Outcomes: A Report of Three Cases

The use of calcium silicate-based sealers (CSS) is increasing in dentistry as result of their favorable properties. The inadvertent extrusion of these sealers into the mandibular canal (MC) can result in temporary or permanent neurosensory alterations. Three different recovery outcomes of CSS extrusion into the MC after endodontic treatment of mandibular molars, confirmed by cone beam computed tomography (CBCT) imaging, are described. In Case 1, CSS from the mesiolingual canal of #31 was extruded into the MC during obturation. The patient reported paresthesia. The symptoms of paresthesia were completely resolved by nine months. In Case 2, CSS from the mesial canals of #30 was extruded into the MC during obturation. "Plasma-like spreading pattern" of the extruded sealer was observed on the radiographs. The patient reported paresthesia and dysesthesia. In addition, the patient complained of hyperalgesia with heat and mechanical allodynia. The symptoms continued to persist during follow up. At 22 months, the patient still reported persistent paresthesia, hyperalgesia and mechanical allodynia, affecting the ability to eat. In Case 3, CSS from the distal canal of #31 was extruded into the MC during obturation. The patient did not report any paresthesia or dysesthesia. All three patients elected a follow up approach and monitoring rather than surgical intervention. These cases illustrate the need for the development of guidelines for the management of iatrogenic CSS extrusion into the MC because such an occurrence may not necessarily result in permanent, temporary or no neurosensory alterations.

Treating Nerve Injury After Endodontic Microsurgery Using Laser Photobiomodulation: A Report of Two Cases

The purpose of this case report was to inform dentists and dental specialists about a non-invasive, viable treatment option that could aid in the recovery of patients who have experienced iatrogenic nerve injuries. Nerve injury is an inherent risk of many dental procedures, and a complication that can negatively impact a patient's quality of life and activities of daily living. Managing neural injuries presents a challenge for clinicians as there are no standard protocols reported in the literature. While spontaneous healing of these injuries can occur, the duration and degree of healing can vary greatly between individuals. Photobiomodulation (PBM) therapy is used as an adjunct in medicine for functional nerve recovery. Once target tissues are illuminated with a low-level laser during PBM, the light energy is absorbed by the mitochondria causing ATP production, modulation of reactive oxygen species, and the release of nitric oxide. These cellular changes explain why PBM has been shown to aid in cell repair, vasodilation, reduction in inflammation, accelerated healing, and an improvement in postoperative pain. This case report presents two patients with neurosensory alterations after endodontic microsurgery with significant improvement in their condition after PBM treatment using a 940 nm diode laser.

Effect of endodontic sealer on postoperative pain: a network meta-analysis

This systematic review and network meta-analysis aimed to answer the following focused research question: "Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?" Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration's tool. A random-effects meta-analysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I² = 0%; p > 0.05 and 8 studies: I² = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted.

Trial Registration

PROSPERO Identifier: CRD42020215314.

Comparison of Root Filling Quality of Two Types of Single Cone-Based Canal Filling Methods in Complex Root Canal Anatomies: The Ultrasonic Vibration and Thermo-Hydrodynamic Obturation versus Single-Cone Technique

This study aimed to assess the effectiveness of ultrasonic vibration and thermo-hydrodynamic obturation (VibraTHO) using two types of root canal sealers, in comparison to the single-cone (SC) technique and a calcium silicate-based root canal sealer in complex root canal anatomies. Thirty single-rooted human maxillary premolars with two canals that had a complex root canal anatomy of transverse anastomoses or ramifications were prepared and assigned to the following three experimental groups, according to the filling method: SE group, SC technique with Endoseal TCS; VE group, VibraTHO with Endoseal TCS; and VG group, VibraTHO with GuttaFlow 2. Each tooth was scanned using micro-computed tomography, and the volume percentages of the filling material were calculated. The analysis of variance was used to analyze the statistical differences between the three groups (p < 0.05). The mean volume of the filling material was higher in the VG and VE groups than that in the SE group (p < 0.05) along the apical to middle-to-coronal thirds, and significant differences were observed between each root canal area (p < 0.05), with the only exception being at the apical thirds between the VE and SE groups. The VibraTHO technique using GuttaFlow 2 can be a more effective root canal filling method for anatomically complex root canal systems than the SC technique with Endoseal TCS. On the other hand, the VibraTHO technique using Endoseal TCS has a limited effect on improving the quality of the root filling at the apical portion of anatomically complex root canal systems, compared to the SC technique with Endoseal TCS.

The influence of different NiTi instrumentation techniques on postoperative pain after single-visit root canal treatment

This study aimed to evaluate the effect of multi-file rotary (Protaper Universal) and reciprocating single-file (Reciproc Blue) root canal preparation techniques on the occurrence of postoperative pain in asymptomatic mandibular molar teeth with large periapical lesions in single-visit root canal treatment (RCT). A hundred and twenty teeth were randomly assigned to two groups: Protaper Universal (PTU) or Reciproc Blue (RB) instruments. Postoperative pain at 6, 12, 24, 48, 72 h and 7 days after obturation was measured. Mann-Whitney U-test was performed to compare the pain scores between the groups and to assess the relation of pain with patients' age and gender. Spearman's rank correlation was utilized to correlate the pain intensity and analgesic intake at different time points. There was no significant difference between the instrumentation techniques regarding postoperative pain at any time points evaluated (P > 0.05). There was a correlation between analgesic intake and intensity of pain (P < 0.05). No statistically significant difference was found among the groups assessed in the study in terms of analgesic intake (P > 0.05).

Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

Calcium Silicate-Based Sealers Do Not Reduce the Risk and Intensity of Postoperative Pain after Root Canal Treatment when Compared with Epoxy Resin-Based Sealers: A Systematic Review and Meta-Analysis

This review aims to evaluate whether root canal obturation with calcium silicate-based (CSB) sealers reduces the risk and intensity of endodontic postoperative pain when compared to epoxy resin-based (ERB) sealers. The review was registered at PROSPERO (CRD42020169255). Two independent reviewers conducted an electronic search in PubMed, Scopus, EMBASE, Web of Science, Cochrane Library and LILACS until November 2020 and included only randomized clinical trials with adult health participants undergoing root canal treatment. After selection, the JBI Critical Appraisal tool was used to assess the risk of bias. A fixed-effect meta-analysis was performed to summarize the results of pain risk and pain intensity at time intervals of 24 and 48 hours. Finally, the certainty of evidence was assessed using the GRADE approach. The search resulted in 1,206 records, of which five studies (n = 421 patients) met the eligibility criteria and presented moderate to low risk of bias. There was no significant difference between groups in the risk of pain in the first 24 hours (relative risk or RR = 0.83, 95% confidence interval or CI: 0.60, 1.16, I 2 =) or 48 hours (RR = 0.56, 95% CI: 0.26, 1.21, I 2 =). Silicate-based sealers led to lower pain intensity only at 48 hours (mean and standard deviation = 0.37, 95% CI: 0.69, 0.05). All analyses revealed low heterogeneity (I 2 < 25%). The evidence presented moderate level of certainty. Currently available evidence has shown that there is no difference between CSB and ERB sealers in the risk or intensity of postoperative pain.

Microsurgical Repair of Inferior Alveolar Nerve Injuries Associated With Endodontic Treatment: Results on Sensory Function and Relief of Pain

PURPOSE

An uncommon, but serious complication of endodontic treatment is inferior alveolar nerve (IAN) injury warranting operative intervention for exploration, debridement, and repair. The purpose of the study was to evaluate outcomes of microneurosurgical intervention for endotontic-related IAN injuries in terms of achievement of functional sensory recovery (FSR) and pain relief and to identify factors affecting outcomes.

METHODS

A retrospective cohort study of patients who had microsurgical exploration and repair of IAN injuries sustained during endodontic therapy was performed. The primary predictor variable is time to surgery and the primary outcome variables were time to FSR, whether or not the patient regained FSR, and postoperative pain level at 12 months (1-10 on a visual analog scale). Secondary variables include intraoperative findings, surgical treatment rendered, sensory recovery, and preoperative pain level. Analyses include Kaplan-Meier estimation, Fisher exact test, 1-way and mixed-design analysis of variance, and paired t-test.

RESULTS

The sample included 23 patients with a mean age of 48.6 years with a female:male ratio of 20:3. Painful sensation was present in 17 (73.9%) of 23 patients at initial consultation. Mean time to surgery was 10.9 months (median 4.8 months, standard deviation = ±16.9). FSR was achieved in 10 of 21 patients at 1 year. Pain level at 1 year following surgical intervention improved from 4.86 to 2.76 (P = .001) with no effect from other variables.

CONCLUSIONS

Surgical exploration and repair of endodontic-related IAN injuries is shown to improve neuropathic pain levels, while only delivering a modest recovery of sensory function. These injuries can be severe and debilitating and present with a variety of diagnoses and surgical findings. While this study fails to identify any particular factors affecting outcome, the data presented can help with clinician recommendations for treatment in patient-centered care.

Management of Discolored Failure Root Canal-Treated Upper Lateral Incisor

Root canal treatment failure can be determined based on a patient’s complaint and on the basis of clinical examination and radiographic findings. Most of the signs and symptoms for the failure are pain and discomfort, swelling and sinus formation at the surrounding soft tissue, and discoloration of the subjected tooth. Factors such as mechanical perforation during the procedures, overfilled or underfilled root canal, and missed or unfilled canals are the main factors for the failure outcome. This case report presents a discolored and infected upper lateral incisor which was previously root canal treated. The tooth was successfully managed under nonsurgical and surgical retreatment followed by an internal bleaching and full porcelain veneer. Apical tissue healing and acceptable tooth appearance was observed during a 12-month review.

Assessment of Extrusion and Postoperative Pain of a Bioceramic and Resin-Based Root Canal Sealer

Objectives  The objective of this study was to compare a bioceramic and a resin-based endodontic sealer with regard to extrusion and postoperative pain.

Materials and Methods  Sixty-four patients requiring endodontic treatment of single-rooted maxillary teeth with necrotic pulps were included in this study. The root canal treatments were performed in a single visit using a size 40.06 single-file reciprocating system under 2.5% NaOCl irrigation. After irrigation with 17% ethylenediaminetetraacetic acid (EDTA) and 2.5% NaOCl, the canals were dried and randomly divided into two different groups ( n = 32) depending on the sealer used: resin-based group (RG) in which the canals were filled with the AH Plus, and the bioceramic group (BG) in which the canals were filled with the Sealer Plus BC. Ibuprofen (600 mg) was prescribed every 6 hours if the volunteers experienced pain. The patients registered their pain sensation in a visual analog scale (VAS) card, ranging from 0 to 10 at 24-hour, 48-hour, 72-hour, and 1-week intervals. Statistical analysis  For statistical analysis, the level of significance was set at p < 0.05.

Results  Sealer extrusion occurred in nine patients of the RG and in 19 patients of the BG ( p < 0.05). The average pain level at 24-hour and 48-hour intervals was, respectively, 1.46 ± 1.96 and 0.44 ± 0.86 for RG, and 1.21 ± 2.09 and 0.09 ± 0.38 for BG. There was no report of pain after 48 hours. The mean number of tablets taken for pain relief was 0.03 ± 0.17 for RG and 0.06 ± 0.24 for BG. No statistically significant difference was found with regard to pain level and intake of pain killer tablets ( p > 0.05).

Conclusions  The BG sealer presented significantly more extrusion than the RG sealer. Sealer extrusion was not associated with pain. The average pain level and the mean number of tablets taken for pain relief were similar in both groups.

PRISMA for abstracts: best practice for reporting abstracts of systematic reviews in Endodontology

An abstract is a brief overview of a scientific, clinical or review manuscript as well as a stand-alone summary of a conference abstract. Scientists, clinician-scientists and clinicians rely on the summary information provided in the abstracts of systematic reviews to assist in subsequent clinical decision-making. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Abstracts checklist was developed to improve the quality, accuracy and completeness of abstracts associated with systematic reviews and meta-analyses. The PRISMA for Abstracts checklist provides a framework for authors to follow, which helps them provide in the abstract the key information from the systematic review that is required by stakeholders. The PRISMA for Abstracts checklist contains 12 items (title, objectives, eligibility criteria, information sources, risk of bias, included studies, synthesis of results, description of the effect, strength and limitations, interpretation, funding and systematic review registration) under six sections (title, background, methods, results, discussion, other). The current article highlights the relevance and importance of the items in the PRISMA for Abstracts checklist to the specialty of Endodontology, while offering explanations and specific examples to assist authors when writing abstracts for systematic reviews when reported in manuscripts or submitted to conferences. Strict adherence to the PRISMA for Abstracts checklist by authors, reviewers, and journal editors will result in the consistent publication of high-quality abstracts within Endodontology. This article is protected by copyright. All rights reserved.

Piezosurgical management of sealer extrusion-associated mental nerve anaesthesia: A case report

The present report describes a case where sealer extrusion (Sealapex) occurred during root canal obturation of a left lower second premolar tooth, and the patient experienced sudden pain and followed by complete anaesthesia of the lower lip. After 3 weeks of conservative therapy and an unaltered anaesthesia period, piezosurgical removal of the extruded sealer and root-end resection was performed despite the direct contact with the mental neurovascular bundle. At suture removal, 1 week after surgery, there was no improvement in sensation. Two weeks after the operation, the patient reported some changes, including a short paraesthesia period alternating with anaesthesia. At the fourth post-operative week, neurosensory function recovered completely. This case represents successful use of the piezoelectric technique for mental nerve decompression and periapical surgery of a lower second premolar with close contact of the mental nerve.

Extrusion of Root Canal Sealer in Periapical Tissues - Report of Two Cases with Different Treatment Management and Literature Review

Background: Extrusion of root canal sealers may cause damage to the surrounding anatomic structures. Clinical symptoms like pain, swelling and paresthesia or anesthesia may be present. The purpose of this presentation is to describe two cases of root canal sealer penetration into periapical tissues. A different treatment management was followed in each case.

Case reports: A 55 year-old man underwent root canal retreatment of the right mandibular first molar tooth due to a periapical lesion. Postoperative periapical radiographs revealed the presence of root canal sealer (AH26) beyond the apex in the distal root in proximity to the mandibular canal. The patient reported pain for the next 7 days. Radiographic examination after 1 year showed complete healing of the periapical area and a small absorption of the root canal sealer. A 42 year-old woman was referred complained of swelling and pain in the area of the right maxillary first incisor. Radiographic examination showed extrusion of root canal sealer in the periapical area associated with a periapical lesion. Surgical intervention was decided upon, which included removal of the sealer, apicoectomy of the tooth and retrograde filling with MTA. After 1 year, complete healing of the area was observed.

Conclusion: In conclusion, cases of root canal sealer extrusion, surgical treatment should be decided on only in association with clinical symptoms or with radiographic evidence of increasing periapical lesion.