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Singh NR, Mishra L, Pawar AM, Kurniawati N, Wahjuningrum DA. Comparative evaluation of the effect of two pulpal medicaments on pain and bleeding status of mandibular molars with irreversible pulpitis post-failure of inferior alveolar nerve block: a double-blind, randomized, clinical trial. PeerJ 2022; 10:e13397. [PMID: 35586130 PMCID: PMC9109695 DOI: 10.7717/peerj.13397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/16/2022] [Indexed: 01/14/2023] Open
Abstract
Background Complete relief of pain due to irreversible pulpitis is challenging to obtain with analgesic medications. The high incidence of an inferior alveolar nerve block (IANB) failure makes it difficult for practitioners to perform endodontic treatment without implementing other anesthetic techniques, especially mandibular molars. The aim of this study was to compare efficacies of two different quantities of paraformaldehyde based pulpal medicaments to relieve the pain and control hyperemic pulp post-failure of IANB and supplementary technique in patients experiencing this symptomatic irreversible pulpitis in the permanent mandibular tooth. Method Eighty-two participants with severe pain pre-operatively (Heft Parker Visual Analogue Scale, VAS > 114 mm) were enrolled, and pain responses were recorded at different time intervals using the Heft Parker visual analogue scale. To the patients experiencing pain even after the administration of the standard IANB and supplemental intraligamentary injection, one of the two paraformaldehyde based pulpal medicaments was placed in the pulp chamber and sealed. Participants were recalled after 24-48 h (second visit) to assess pain and bleeding reduction. Results Results showed a significant decrease in pain severity and bleeding score post medicament placement (p < .05). Hence judicious use within a recommended period, pulpal medicaments can be considered safe. Conclusion Paraformaldehyde based pulpal medicament can be used as an alternative to manage pain in patients having severe irreversible pulpitis and hyperalgesia.
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Affiliation(s)
- Naomi Ranjan Singh
- Department of Conservative Dentistry and Endoodntics, Institute of Dental Sciences, Bhubaneswar, Odisha, India
| | - Lora Mishra
- Department of Conservative Dentistry and Endoodntics, Institute of Dental Sciences, Bhubaneswar, Odisha, India
| | - Ajinkya M. Pawar
- Department of Conservative Dentistry and Endoodntics, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Nike Kurniawati
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya City, East Java, Indonesia
| | - Dian Agustin Wahjuningrum
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya City, East Java, Indonesia
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Influence of Commonly Used Endodontic Irrigants on the Setting Time and Metal Composition of Various Base Endodontic Sealers. Polymers (Basel) 2021; 14:polym14010027. [PMID: 35012047 PMCID: PMC8747268 DOI: 10.3390/polym14010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022] Open
Abstract
The present study aimed to evaluate if commonly used endodontic irrigants such as 3% sodium hypochlorite (NaOCl, Prime Dental, Thane, India), 2% chlorhexidine (CHX, Sigma-Aldrich Co., St. Louis, MO, USA), and 17% ethylenediaminetetraacetic acid (EDTA, Meta-Biomed Co. Ltd., Cheongju-si, South Korea) influenced the setting time and metal composition of different base endodontic sealers on exposure. AH Plus (Dentsply De Trey GmbH, Konstanz, Germany), Sealapex (SybronEndo, Orange, CA, USA), mineral trioxide aggregate (MTA) Fillapex (Angelus Soluções Odontológicas, Londrina, Brazil), and Tubli-Seal (Kerr Dental, Orange, CA, USA) were selected as the different base representatives of endodontic sealers. These sealers were exposed to 3% NaOCl, 2% CHX, and 17% EDTA, and the individual setting time of the sealers was analyzed. The samples were analyzed for heavy metal elements such as chromium (Cr), nickel (Ni), cobalt (Co), cadmium (Cd), arsenic (As), mercury (Hg), lead (Pb), and beryllium (Be) by using inductively coupled plasma mass spectrometry (ICP-MS) analysis. For statistical analysis, one-way ANOVA and post hoc Tukey’s tests were used. All selected sealers showed variation in setting time post-exposure to different irrigants. MTA Fillapex had the shortest mean setting time (215.7 min, post-exposure at 187.3 min) (p < 0.05). Mean setting time was also affected for AH Plus (479.6 min, post-exposure at 423.9 min) (p < 0.05) and Tubli-Seal (514.7 min, post-exposure at 465.2 min) (p < 0.05). Sealapex showed the maximum reduction of setting time (864.8 min, post-exposure at 673.4 min) (p < 0.05). All tested sealers showed heavy metals (Cr, Ni, Co, Cd, As, Hg, and Pb) in their composition, and the quantities were influenced by interaction with different irrigants. The heavy metal Be was not seen in any of the samples. Sealapex showed the longest setting time in comparison to other test sealers. Heavy metals were most present in Sealapex, followed by AH Plus, Tubli-Seal, and MTA Fillapex. MTA Fillapex was seen to have the shortest setting time, and heavy metal composition was least affected on interaction with different commonly used endodontic irrigants. Further, this study provides significant insight into the influence of different endodontic irrigants on interaction with different base endodontic sealers, which has not been reported previously, and future studies should emphasize endodontic irrigant-sealer interactions and their possible effects in the long run.
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Eltawila AM, Hassan MN, Safaan SM, Abd El-Fattah A, Zakaria O, El-Khordagui LK, Kandil S. Local treatment of experimental mandibular osteomyelitis with an injectable biomimetic gentamicin hydrogel using a new rabbit model. J Biomed Mater Res B Appl Biomater 2021; 109:1677-1688. [PMID: 33749111 DOI: 10.1002/jbm.b.34824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/27/2020] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
Mandibular osteomyelitis (OM) is a challenging disease. Our objective was to assess a new OM model in rabbits induced by arsenic trioxide and to assess the efficacy of local treatment of OM using injectable gentamicin-collagen hydrogels (GNT-COLL). OM was induced unilaterally by controlled confinement of arsenic trioxide paste to the root canal of lower incisors of rabbits, while OM progression was characterized for 16 weeks. On the other hand, two injectable COLL hydrogels functionalized with GNT were prepared and characterized for physicochemical properties; a simple GNT-COLL and a nanohydroxyapatite (nHA)- loaded hydrogel (GNT-COLL/nHA). The two hydrogels were evaluated to treat OM model, while a multidose intramuscular GNT solution served as positive control. Outcomes were assessed by standard methods at 4 and 12 weeks post-surgery. The clinical, radiographical, and histopathological findings provided evidence for the validity of the arsenic-induced OM. The results demonstrated that a single intra-lesional injection of the two hydrogels was more suppressive to OM compared to multidose systemic GNT. The composite GNT-COLL/nHA hydrogel proved to induce early preservation of alveolar bone (ridge) length and higher amount of bone area\total area at 4 weeks (40.53% ± 2.34) followed by GNT-COLL (32.21% ± 0.72). On the other hand, the positive control group revealed the least ridge length and bone area\total area (26.22% ± 1.32) at 4 weeks. Both hydrogels successfully arrested OM with no signs of recurrence for up to 12 weeks. Therefore, results support the greater advantages of the composite hydrogel as an osteogenic/antibiotic delivery system in OM treatment.
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Affiliation(s)
- Ahmed Maher Eltawila
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt.,Dental Biomaterials Department, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Egypt
| | - Mohamad Nageeb Hassan
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt.,Department of Dental Biomaterials, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Shimaa Mohamed Safaan
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
| | - Ahmed Abd El-Fattah
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt.,Department of Chemistry, College of Science, University of Bahrain, Sakhir, Kingdom of Bahrain
| | - Osama Zakaria
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Labiba K El-Khordagui
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Sherif Kandil
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
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Bjørklund G, Pivina L, Dadar M, Semenova Y, Chirumbolo S, Aaseth J. Long-Term Accumulation of Metals in the Skeleton as Related to Osteoporotic Derangements. Curr Med Chem 2021; 27:6837-6848. [PMID: 31333081 DOI: 10.2174/0929867326666190722153305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022]
Abstract
The concentrations of metals in the environment are still not within the recommended limits as set by the regulatory authorities in various countries because of human activities. They can enter the food chain and bioaccumulate in soft and hard tissues/organs, often with a long half-life of the metal in the body. Metal exposure has a negative impact on bone health and may result in osteoporosis and increased fracture risk depending on concentration and duration of metal exposure and metal species. Bones are a long-term repository for lead and some other metals, and may approximately contain 90% of the total body burden in birds and mammals. The present review focuses on the most common metals found in contaminated areas (mercury, cadmium, lead, nickel, chromium, iron, and aluminum) and their effects on bone tissue, considering the possibility of the long-term bone accumulation, and also some differences that might exist between different age groups in the whole population.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610 Mo i Rana, Norway
| | - Lyudmila Pivina
- Department of Internal Medicine, Semey Medical University, Semey, Kazakhstan,CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Yuliya Semenova
- Department of Internal Medicine, Semey Medical University, Semey, Kazakhstan,CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy,CONEM Scientific Secretary, Verona, Italy
| | - Jan Aaseth
- Research Department, Innlandet Hospital Trust, Brumunddal, Norway,Faculty of Health and Social Science, Inland Norway University of Applied Sciences,
Elverum, Norway
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Ximenez JPB, Zamarioli A, Kacena MA, Barbosa RM, Barbosa F. Association of Urinary and Blood Concentrations of Heavy Metals with Measures of Bone Mineral Density Loss: a Data Mining Approach with the Results from the National Health and Nutrition Examination Survey. Biol Trace Elem Res 2021; 199:92-101. [PMID: 32356206 DOI: 10.1007/s12011-020-02150-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
Osteoporosis and its consequence of fragility fracture represent a major public health problem. Human exposure to heavy metals has received considerable attention over the last decades. However, little is known about the influence of co-exposure to multiple heavy metals on bone density. The present study aimed to examine the association between exposure to metals and bone mineral density (BMD) loss. Blood and urine concentrations of 20 chemical elements were selected from 3 cycles (2005-2010) NHANES (National Health and Nutrition Examination Survey), in which we included white women over 50 years of age and previously selected for BMD testing (N = 1892). The bone loss group was defined as participants having T-score < - 1.0, and the normal group was defined as participants having T-score ≥ - 1.0. We developed classification models based on support vector machines capable of determining which factors could best predict BMD loss. The model which included the five-best features-selected from the random forest were age, body mass index, urinary concentration of arsenic (As), cadmium (Cd), and tungsten (W), which have achieved high scores for accuracy (92.18%), sensitivity (90.50%), and specificity (93.35%). These data demonstrate the importance of these factors and metals to the classification since they alone were capable of generating a classification model with a high prediction of accuracy without requiring the other variables. In summary, our findings provide insight into the important, yet overlooked impact that arsenic, cadmium, and tungsten have on overall bone health.
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Affiliation(s)
- João Paulo B Ximenez
- Laboratório de Toxicologia Analítica e de Sistemas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, 14040-903, Brazil.
| | - Ariane Zamarioli
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Fernando Barbosa
- Laboratório de Toxicologia Analítica e de Sistemas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, 14040-903, Brazil
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A Review of Metal Exposure and Its Effects on Bone Health. J Toxicol 2018; 2018:4854152. [PMID: 30675155 PMCID: PMC6323513 DOI: 10.1155/2018/4854152] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/28/2018] [Accepted: 11/20/2018] [Indexed: 12/21/2022] Open
Abstract
The presence of metals in the environment is a matter of concern, since human activities are the major cause of pollution and metals can enter the food chain and bioaccumulate in hard and soft tissues/organs, which results in a long half-life of the metal in the body. Metal intoxication has a negative impact on human health and can alter different systems depending on metal type and concentration and duration of metal exposure. The present review focuses on the most common metals found in contaminated areas (cadmium, zinc, copper, nickel, mercury, chromium, lead, aluminum, titanium, and iron, as well as metalloid arsenic) and their effects on bone tissue. Both the lack and excess of these metals in the body can alter bone dynamics. Long term exposure and short exposure to high concentrations induce an imbalance in the bone remodeling process, altering both formation and resorption and leading to the development of different bone pathologies.
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Marty M, Noirrit-Esclassan E, Diemer F. Arsenic trioxide-induced osteo-necrosis treatment in a child: mini-review and case report. Eur Arch Paediatr Dent 2016; 17:419-422. [PMID: 27613404 DOI: 10.1007/s40368-016-0250-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arsenic oxide compounds were traditionally used as devitalizing agents. Due to its toxicity, leakage of such compounds into the periodontium can cause gingival and osteo-necrosis. Their use is forbidden in Europe and the USA for decades, however, some dentists seem to still use it. CASE REPORT We report the case of a 14-year-old girl referred to the paediatric dentistry department of Toulouse University hospital, France, presenting a bone necrosis following the use of an arsenic trioxide product to accelerate pulp necrosis. TREATMENT The treatment included surgical removal of necrosis bone sequestrum, complete pulpectomy and an intermediate restoration of the tooth 27. FOLLOW-UP After 1 week, the clinical conditions greatly improved. A restoration using a ceramic crown was performed after 2 months, and complete healing was observed after 1 year follow-up. CONCLUSION Although arsenic trioxide is neither appropriate nor permitted for use in modern dentistry, especially in paediatric dentistry, some rare cases of arsenic-induced osteo-necrosis can still be encountered. A clearer message must be given to all dental practitioners against the use of arsenic trioxide in modern endodontic treatment.
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Affiliation(s)
- M Marty
- Department of Pediatric Dentistry, Faculté de Chirurgie-dentaire, Toulouse Dental School, University of Toulouse III, 3 chemin des Maraîchers, 31069, Toulouse, France.
| | - E Noirrit-Esclassan
- Department of Pediatric Dentistry, Faculté de Chirurgie-dentaire, Toulouse Dental School, University of Toulouse III, 3 chemin des Maraîchers, 31069, Toulouse, France
| | - F Diemer
- Department of Endodontics, Faculté de Chirurgie-dentaire, Toulouse Dental School, University of Toulouse III, 3 chemin des Maraîchers, 31069, Toulouse, France
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Acar YB, Ates M. Direct usage of miniscrew anchorage to intrude overerupted maxillary posterior teeth before prosthodontic preparation: a case report. J Istanb Univ Fac Dent 2016; 50:43-50. [PMID: 28955554 PMCID: PMC5573452 DOI: 10.17096/jiufd.24271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/11/2015] [Indexed: 11/18/2022] Open
Abstract
Overeruption of maxillary molars due loss of
opposing teeth creates occlusal and functional
interferences. Before reconstruction can be initiated,
intrusion of overerupted molars becomes essential.
This report illustrates treatment of overerupted
maxillary premolar and molar via direct use of
miniscrew anchorage. A 24-year old female had lost
first and second left mandibular molars due to pulpal
necrotizing agents, resulting with a large alveolar bone
defect and overerupted maxillary premolar and molar.
She had a history of unsuccessful alveolar distraction
of mandibular left premolars to increase the alveolar
bone height prior to implant placement. Patient was
satisfied with her smile and refused comprehensive
orthodontic treatment. Maxillary premolar and molar
were intruded segmentally for 4mm in 8 months,
using a combination of a mini-implant and partialfixed
edgewise appliances. Biological responses of
teeth and surrounding bony structures to intrusion
appeared normal and acceptable in radiographic
and clinical examination.
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Affiliation(s)
- Yasemin Bahar Acar
- Department of Orthodontics Faculty of Dentistry Marmara University Turkey
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Arsenic Trioxide-Induced Mandibular Osteomyelitis. J Oral Maxillofac Surg 2015; 73:1761-5. [PMID: 25896568 DOI: 10.1016/j.joms.2015.03.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 11/20/2022]
Abstract
Previously, arsenic was a popular devitalizing agent used to necrotize inflamed dental pulp to lower the pulp sensitivity owing to the unavailability of appropriate anesthesia. However, leakage from the apical foramen, lateral or accessory canals, or cracks in the tooth is common. This can be dangerous because of the reportedly high toxic effects of arsenic in both hard and soft tissues, leading to gingival and osseous necrosis and, consequently, osteomyelitis. Therefore, arsenic can prove fatal for both bones and teeth and is no longer used. We encountered a case involving a 50-year-old man who had developed mandibular osteomyelitis with lower lip paresthesia caused by arsenic trioxide used during endodontic treatment. The patient was treated with appropriate antibiotics, adjunctive hyperbaric oxygen therapy, and adequate surgical debridement. Hyperbaric oxygen therapy can induce neovascularization in necrosed tissues and improve bone and soft tissue healing. At a 4-year follow-up visit, bone healing was observed, with restoration of periodontal health, although the paresthesia had persisted. We describe this case, present a review of the relevant published data, and discuss the possible causes, diagnosis, treatment, and follow-up protocol of mandibular osteomyelitis caused by arsenic trioxide.
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Campisi G, Fede OD, Bedogni A, Vescovi P, Fusco V, Muzio LL. Osteonecrosi dei mascellari associata a bisfosfonati, denosumab e farmaci anti-angiogenetici nei pazienti oncologici e osteoporotici: prevenzione dentale e sicurezza dei trattamenti odontoiatrici. DENTAL CADMOS 2013. [DOI: 10.1016/s0011-8524(13)70110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mandibular bone and soft tissues necrosis caused by an arsenical endodontic preparation treated with piezoelectric device. Case Rep Dent 2013; 2013:723753. [PMID: 24062957 PMCID: PMC3766612 DOI: 10.1155/2013/723753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022] Open
Abstract
This paper describes a case of wide mandibular bone necrosis associated with significant soft tissues injury after using an arsenical endodontic preparation in the right lower second molar for endodontic purpose. Authors debate about the hazardous effects of the arsenic paste and the usefulness of piezosurgery for treatment of this drug related bone necrosis.
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Chen G, Sung PT. Gingival and localized alveolar bone necrosis related to the use of arsenic trioxide paste--two case reports. J Formos Med Assoc 2012; 113:187-90. [PMID: 24630037 DOI: 10.1016/j.jfma.2012.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/04/2010] [Accepted: 07/21/2010] [Indexed: 11/30/2022] Open
Abstract
The leakage of arsenic trioxide paste from tooth fillings has been associated with widespread necrosis of the supporting periodontal tissues. This report describes two cases of arsenic trioxide paste-induced gingival and localized alveolar bone necrosis in the mandible, following the use of arsenic trioxide paste as a pulp-devitalized agent. The first case was a 54-year-old female complaining of a painful white patch on the gingival tissue of the left mandibular second molar (tooth #37) after treatment by a private dentist. She underwent completely debridement of all necrotic soft tissue with physical saline irrigation. The gingival tissue was gradually replaced with vascular tissue and completely healed after 7 weeks. The second case was a 30-year-old female complaining of severe pain and continuous gingival bleeding from the right maxillary first bicuspid (tooth #14) following treatment by a private dentist. She finally accepted debridement of the sequestrum and necrotic alveolar bone with decortication to induce active bleeding. A partial thickness gingival flap was made to cover the wound. Four weeks later, the supporting tissues had completely healed. Arsenic trioxide paste is a cytotoxic agent and may cause harmful adverse effects on adjacent periodontium and supporting hard tissue if leakage occurs, or it is used carelessly. There is no indication for the use of arsenic trioxide paste in modern dental practice.
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Affiliation(s)
- Gin Chen
- Division of Endodontics and Periodontics, Department of Dentistry, Taichung Veterans General Hospital, Taichung, Taiwan; National Yang-Ming Medical University, College of Dentistry, Taipei, Taiwan; Chung Shan Medical University, College of Dentistry, Taichung, Taiwan.
| | - Po-Ta Sung
- Division of Endodontics and Periodontics, Department of Dentistry, Taichung Veterans General Hospital, Taichung, Taiwan
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14
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Yavuz MS, Kaya GS, Yalçin E, Aras MH. Mandibular bone necrosis caused by use of arsenic paste during endodontic treatment: two case reports. Int Endod J 2008; 41:633-7. [PMID: 18479373 DOI: 10.1111/j.1365-2591.2008.01406.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To report that arsenical pastes are still employed in endodontics and to highlight the potentially serious consequences of their use. SUMMARY Chemotherapeutic agents such as arsenic trioxide and paraformaldehyde were once commonly employed as pulp-necrotizing agents. Their cytotoxic effects are well recognized, and leakage from teeth has been associated with widespread necrosis of periodontal tissues and bone. This report describes two cases of severe bone necrosis affecting the mandible following the use of an arsenical paste. KEY LEARNING POINTS Pulp-necrotizing agents such as arsenic trioxide can cause severe bone necrosis. Arsenical pastes have no place in contemporary dental practice. Dentists should employ appropriate local anaesthetic techniques for pulp extirpation instead of relying on toxic necrotizing agents.
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Affiliation(s)
- M S Yavuz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.
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