Paresthesia following overextension of AH-26: report of two cases and review of the literature

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.

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion. Key words:Endodontics, inferior alveolar nerve, neuropathic pain, orofacial pain, paraesthesia, pregabalin.

Inferior alveolar nerve injury resulting from overextension of an endodontic sealer: non-surgical management using the GABA analogue pregabalin

AIM

  To describe a case of endodontic sealer (AH Plus) penetration within the mandibular canal after root canal treatment with resolution of pain and paraesthesia after a non-surgical approach, including treatment with prednisone and pregabalin.

SUMMARY

  A 37-year-old woman underwent root canal treatment of the left mandibular second molar tooth. Postoperative periapical radiographs revealed the presence of radiopaque canal sealer in the mandibular canal. The day after, the patient reported severe pain in the tooth and paraesthesia/anaesthesia in the region innervated by the left inferior alveolar and mental nerve. Diagnosis of injury to the inferior alveolar nerve because of extrusion of AH Plus was established. The non-surgical management included 1 mg kg(-1) per day prednisone, two times per day, in a regimen on a daily basis, and 150 mg per day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. One month after the incident, the signs and symptoms were gone.

KEY LEARNING POINTS

This case illustrates the care required when performing root canal treatment, especially when the root apices are in close proximity to the inferior alveolar nerve canal. The complete resolution of paraesthesia and the control of pain achieved in the present case suggests that a non-surgical approach combining prednisone and pregabalin is a good option in the management of the inferior alveolar when it is contacted by extruded root filling material.

Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal

The present study describes a case of endodontic sealer (AH Plus) penetration within and along the mandibular canal from the periapical zone of a lower second molar after endodontic treatment. The clinical manifestations comprised anesthesia of the left side of the lower lip, paresthesia and anesthesia of the gums in the third quadrant, and paresthesia and anesthesia of the left mental nerve, appearing immediately after endodontic treatment. The paresthesia and anesthesia of the lip and gums were seen to decrease, but the mental nerve paresthesia and anesthesia persisted after 3.5 years. This case illustrates the need to expend great care with all endodontic techniques when performing nonsurgical root canal therapy, especially when the root apices are in close proximity to vital anatomic structures such as the inferior alveolar canal.

Anesthesia following overfilling of a root canal sealer into the mandibular canal: A case report

The surgical treatment of a case of anesthesia that occurred with the extrusion of Endomethasone root canal sealer into the mandibular canal is presented. Endomethasone is a neurotoxic root canal sealer containing paraformaldehyde and eugenol. The literature indicates immediate surgical decompression on the extrusion of Endomethasone into the mandibular canal. In our case, the decompression surgery was done 3 weeks after the endodontic mishap. The nearly complete resolution of anesthesia 4 months following the decompression surgery suggests that the neurotoxic effects of Endomethasone are still reversible after 3 weeks.

Simultaneous paresthesia of the lingual nerve and inferior alveolar nerve caused by a radicular cyst

The inferior alveolar nerve is sometimes affected by periapical pathoses and mandibular cysts. However, mandibular intraosseous lesions have not been reported to disturb the lingual nerve. A case of simultaneous paresthesia of the right lingual nerve and the right inferior alveolar nerve is presented. The possible mechanisms of this extremely uncommon condition are discussed.

Endodontic implications of the maxillary sinus: a review

The anatomical and clinical significance of the maxillary sinus in relation to conventional and surgical endodontic therapy is considered. The discussion includes a review on the development, anatomy and physiology of the maxillary sinus, the diagnostic evaluation of the sinus and the differential diagnosis of sinusitis. Endodontic implications of the maxillary sinus include extension of periapical infections into the sinus, the introduction of endodontic instruments and materials beyond the apices of teeth in close proximity to the sinus and the risks and complications associated with endodontic surgery.

Mental nerve paresthesia associated with an amalgam filling: a case report

We present a case report in which a mental nerve paresthesia occurred in connection with an amalgam filling placed in direct contact with the pulp of a mandibular first molar. The main evidence for amalgam being the dominant etiological factor was the positive epicutaneous patch testing response to the components of the amalgam alloy, and the total remission of symptoms without further clinical complications after removal of the amalgam filling and subsequent endodontic therapy.

The effect of ultrasonics on sealer distribution and sealing of root canals

The purpose of this study was to compare the ultrasonic and hand methods of sealer placement using three types of sealers: Sultan "Grossman's formula," AH-26, and CRCS. The effect of these methods on radiographic density, sealer distribution, and on the apical seal of the different sealers was evaluated. The in vitro experiment was carried out using human extracted mandibular incisors and mesio-buccal roots of maxillary first and second molars. Following standardized canal instrumentation, 120 single canal mandibular incisors were randomly assigned to six groups, depending on the type of sealer and method of sealer placement (hand versus ultrasonic). An additional ten teeth were used as controls. In the molar groups 40 canals were randomly assigned to two groups, with the method of sealer placement as the variable. Eight canals were used as controls. Postsealer analyses using radiographic density scores transformed to mm of sealer indicated that ultrasonics was superior to manual placement only for CRCS. Taken together, our investigation suggests that ultrasonics may enhance the placement of some sealers (i.e. CRCS) but not of others (i.e. AH-26 or Sultan). Method of sealer placement had no effect on apical leakage and therefore apparently on apical seal.

Mental nerve paresthesia associated with a non-vital tooth

Apical periodontitis is a common development associated with teeth with necrotic pulp. Although rare, some cases may present further complications, such as neuropathies in areas adjacent to the affected tooth. A case is described in which mental nerve paresthesia was associated with a non-vital mandibular premolar. Endodontic therapy resolved the paresthesia completely without further clinical complications.

Calcium hydroxide paste in the maxillary sinus: a case report

A case is reported in which a perforation of the sinus floor of the maxillary sinus occurred with extrusion of a calcium hydroxide paste during routine root canal treatment of a maxillary premolar. All clinical manifestations are described as well as the results of a follow-up evaluation.

Effects of the penetration of a root canal filling material into the mandibular canal. 1. Tissue reaction to the material

The root canal filling paste Vitapex (Neo Dental Chemical Products Co., Tokyo), made of calcium hydroxide and iodoform with the addition of silicone oil, was experimentally introduced into the mandibular canals of 29 dogs. Tissue reactions to the paste were examined by radiography, histopathology, and electron microscopy. These examinations revealed that the paste was phagocytosed by macrophages and, in general, was gradually resorbed over time. The paste was also found to cause heterotopic calcification and/or ossification within the area of original penetration.

Disabling complications following inadvertent overextension of a root canal filling material

A case of pain and paresthesia of the mental nerve following inadvertent introduction of root canal filling material into the inferior alveolar nerve canal is described. The causes and treatments of this disabling complication are discussed.

The effect of newly developed root canal sealers on rat dental pulp cells in primary culture

Cytotoxicity was compared between new root canal sealers (New A, New B, and New B-2) and conventional root canal sealers (AH26, Diaket, Canals, Tubi-Seal, and Sealapex). Dental pulp cells of rats, obtained through primary cell culture, were used. In the experiments with the freshly prepared sealers, the incorporation of [3H]thymidine into cellular DNA was analyzed. In the experiments with the set sealers, the morphological changes of cells were microscopically examined. In the experiments with the fresh sealers, AH26 and Diaket showed strong inhibitive effects on the DNA synthesis, whereas no such effects were noted with the new sealers and Sealapex. On the other hand, in the experiments with the set sealers, the new sealers and Diaket exerted little influence on the cells. However, other sealers had considerable toxicity. These results suggest that the new sealers were the least toxic in vitro, compared with five conventional sealers.

Flare-up with associated paresthesia of a mandibular second premolar with three root canals

A case report is presented that deals with mental nerve paresthesia resulting from the "flare-up" of a mandibular second premolar with three root canals. A review of the literature and discussion follow, which suggest possible mechanisms that may be responsible for paresthesia as well as treatment regimens that may be used to minimize the incidence of this unexpected but occasional post-treatment endodontic sequela.

Paresthesia of the inferior alveolar nerve caused by periodontal-endodontic pathosis

Paresthesia, one of the more common complaints involving sensory disturbances, can be attributed to various causes. A case is reported in which paresthesia of the right lower buccal gingiva and lip occurred as a result of combined endodontic-periodontal pathosis associated with the right mandibular first molar.

Documentation method for inferior alveolar and lingual nerve paresthesias

The article presents a method of documenting paresthesias that is quick, accurate, and immediately part of the patient's record. The method uses a simplified anatomic drawing and a scale based on the patient's response to painful stimuli. Related anatomy and neurology are reviewed.

Determination of silver in biological samples using graphite furnace atomic absorption spectrometry based on Zeeman effect background correction and matrix modification

A method for the determination of silver in human body fluids and biological material is described. The silver in an acid digest of biological samples and diluted body fluids is quantified using Zeeman graphite furnace atomic absorption spectrometry (ZGFAAS). The effects of NH4H2PO4 as matrix modifier and standard addition are discussed. Atomization from the graphite tube wall and from the pyrolytical tube with platform is also discussed and the peak height and the peak area are compared. The best results were achieved by using matrix modification, stabilized temperature platform furnace, integrated absorbance and standard addition technique. The calibration was linear up to 15 micrograms X L-1; the between-run precision was 5.9% at 40 micrograms X kg-1 of silver.

Paresthesia of the mental nerve after overextension with AH26 and gutta-percha: report of case

Overfilling of a root canal with AH26 and gutta-percha resulted in paresthesia of the mental nerve. After 14 weeks, nerve function was restored.