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.
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1. Koseoglou BG Tanrikulu S Subay RK Sencer S. Anesthesia following overfilling of a root canal sealer into the mandibular canal: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101:803-806.
2. Conrad SM. Neurosensory disturbances as a result of chemical injury to the inferior alveolar nerve. J Oral Maxillofac Surg 2001; 13:255-263.
3. Froes FG Miranda AM Abad Eda C Riche FN Pires FR. Non-surgical management of paraesthesia and pain associated with endodontic sealer extrusion into mandibular canal. Aust Endod J 2009; 35:183-186.
4. Gonzalez-Martin M Torres-Lagares D Gutierrez-Perez JL Segura-Egea JJ. Inferior alveolar nerve paraesthesia after overfilling of endodontic sealer extrusion into the mandibular canal. J Endod 2010; 36:1419-1421.
5. Tilotta-Yasukawa F Millot S Haddioui AE Bravetti P Gaudy JF. Labiomandibular paraesthesia caused by endodontic treatment : an anatomic and clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102:47-59.
6. Pogrel MA. Damage to the inferior alveolar nerve as the result of root canal therapy. JADA 2007; 138:65-69.
7. Tennert Ch Jungback LI Wrbas KT. Comparison between two thermoplastic root canal obturation techniques regarding extrusion of root canal filling- a retrospective in vivo study. Clin Oral Invest 2013; 17:449-454.
8. Khabbaz MG Papadopoulos PD. Depositiion of calcified tissue around an overextended gutta-percha cone: case report. Int Endod J 1999; 32:232-235.
9. El Ayouti A Weiger R Lost C. Frequency of overintrumentation with an acceptable radiographic working length. J Endod 2001; 27:49-52.
10. Vier FV Figueiredo JAP. Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption. Int Endod J 2002; 35:710-719
11. Knowles KI Jergenson MA Howard JH. Paresthesia associated with endodontic treatment of mandibular premolars. J Endod 2003; 29:768-770
12. Khongkhunthian P Reichart PA. Aspergillosis of the maxillary sinus as a complication of overfilling root canal material into the sinus: Report of two cases. J Endod 2001; 27:476-478.
13. Beck-Mannagetta J Necek D. Radiologic findings in aspergillosis of the maxillary sinus. Oral Surg Oral Med Oral Pathol Oral Radio Endod 1986; 62:345-349.
14. Mensi M Salgarello S Pinsi G Piccioni M. Mycetoma of the maxillary sinus: Endodontic and microbiological correlations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98:119-123.
15. Odell E Pertl C. Zinc as a growth factor of Aspergillus sp. and the antifungal effects of root canal sealants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79:82-87.
16. Siqueira JF Jr. Rocas IN Favieri A Machado AG Gahyva SM Oliveira JCM Abad EC. Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. J Endod 2002; 28:457-460.
17. Alonso-Ezpeleta O Martin PJ Lopez-Lopez J Castellanos-Cosano L Martin-Gonzalez J Segura-Egea JJ. Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer. J Clin Exp Dent 2014; 6:197-202.
18. Spielman A Gutman D Laufer D. Anesthesia following endodontic overfilling with AH26. Oral Surg Oral Med Oral Pathol 1981; 52:554-556.
19. Tamse A Kaffe I Littner MM. Paraesthesia following overextension of AH26: report of two cases and review of the literature. J Endod 1982; 8:88-90.
20. Ahonen M Tjaderhane L. Endodontic-related paresthesia: a case report and literature review. J Endod 2011; 37:1460-1464.
21. Givol N Rosen E Bjorndal L Taschieri S Ofec R Tsesis I. Medico-legal aspects of altered sensation following endodontic treatment: a retrospective case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112:126-131.
22. Ahlgren FK Johannessen AC Hellem S. Displaced calcium hydroxide paste causing inferior alveolar nerve paraesthesia: report of a case. Oral Surg Oral Med Oral Pathol Radiol Endod 2003; 96;734-737.
23. Ektefaie MR David HT Poh CF. Surgical resolution of chronic tissue irritation caused by extruded endodontic filling materials. J Can Dent Assoc 2005; 71:487-490.
24. Brodin P Roed A Aars H Orstravik D. Neurotoxic effects of root filling materials on rat phrenic nerve in vitro. J Dent Res 1982; 61:1020-1023.
25. Brodin P. Neurotoxic and analgesic effects of root canal cements and pulp-protecting dental materials. Endod Dent Traumatol 1988; 4:1-11.
26. Serper A Ucer O Onur R Etikan I. Comparative neurototxic effects of root canal materials on rat sciatic nerve. J Endod 1998; 24:592-594.
27. Morinaga K Hara Y Huang C Hatogai H Kaneko S Ito A Asai Y. Supplemental studies of periodontal tissue reactions of furcation perforations treated with various materials in dogs teeth. Observation of long term cases using silver amalgam and calcium hydroxide preparations. J Conserv Dent 1986; 29:1772-1779.
28. Brkic A Gurkan-Koseoglu B Olgac V. Surgical approach to iatrogenic complications of endodontic therapy: A report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107:50-53.
29. Gambarini G. Plotino G. Grande N.M. Testarelli L. Prencipe M. Messineo D. Fratini L. & D’Ambrosio F. Different diagnosis of endodontic-related inferior alveolar nerve paraesthesia with cone beam computed tomography: a case report. Int Endod J 2011; 44:176-181.
30. Scolozzi P Lombardi T Jaques B. Successful inferior alveolar nerve decompression for dysesthesia following endodontic treatment: Report of 4 cases treated by mandibular sagittal osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97:625-631.
31. Leonardo MR Silva LAB Filho MT da Silva RS. Release of formaldehyde by 4 endodontic sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999b; 88:221-225.
32. Silva-Herzog D Ramirez T Mora J Pozos AJ Silva LA. Silva RAB Nelson-Filho P. Preliminary study of the inflammatory response to subcutaneous implantation of three root canal sealers. Int Endod J 2011; 44:440-446.
33. Segura-Egea JJ Jimenez-Rubio A Pulgar R Olea N Guerrero JM Calvo JR. In vitro effect of the resin component bisphenol A on macrophage adhesion to plastic surfaces. J Endod 1999; 25:341-344.
34. Bernath M. & Szabo J. Tissue reaction initiated by different sealers. Int Endod J 2003; 36:256-261.
35. Sari S Duruturk L. Radiographic evaluation of periapical healing of permanent teeth with periapical lesions after extrusion of AH Plus sealer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104:54-59.
36. Augsberger RA Peters DD. Radiographic evaluation of extruded obturation materials. J Endod 1990; 16:492-497.
37. Lin LM Skribner JE Gaengler P. Factors associated with endodontic treatment failures. J Endod 1992; 18:625-627.
38. Huang FM Tai KW Chou MY Chang YC. Cytotoxicity of resin- zinc oxide- eugenol- and calcium hydroxide-based root canal sealers on human periodontal ligament cells and permanent V79 cells. Int Endod J 2002; 35:153-158.
39. Tanomaru Filho M Leonardo MR Silva LAB Utrilla LS. Effect of different root canal sealers on periapical repair of teeth with chronic periradicular periodontitis. Int Endod J 1998; 31:85-89.
40. Leonardo MR Salgado AAM Silva LAB Filho MT. Apical and periapical repair of dog’s teeth with periapical lesions after endodontic treatment with different root canal sealers. Pesqui Odontol Bras 2003; 17:69-74.
41. Imura N Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J 1995; 28:261-265.
42. Siqueira JF Jr. Tratamento das infeccoes endodonticas. Rio de Janeiro Brazil: Medsi 1997.
43. Siqueira J.F. Microbial causes of endodontic flare–ups. Int Endod J 2003; 36:453-463.
44. Siqueira JF Jr Rocas IN Oliveira JCM Santos KRN. Molecular detection of black-pigmented bacteria in infections of endodontic origin. J Endod 2001a; 27:563-566.
45. Yoshida M Fukushima H Yamamoto K Ogawa K Toda T Sagawa H. Correlation between clinical symptoms and microorganisms isolated from root canals of teeth with periapical pathosis. J Endod 1987; 13:24-28.
46. Hashioka K Yamasaki M Nakane A Horiba N Nakamura H. The relationship between clinical symptoms and anaerobic bacteria from infected root canals. J Endod 1992; 18:558-561.
47. Muruzabal M Erausquin J. Response of periapical tissues in the rat molar to root fillings with Diaket and AH-26. Oral Surg Med Pathol 1966; 21:786-804.
49. Poveda R Bagan JV Fernandez JMD Sanchis JM. Mental nerve paresthesia associated with endodontic paste within the mandibular canal: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102:46-49.
50. Lopez-Lopez J Estrugo-Devesa A Jane-Salas E Segura-Egea JJ. Inferior alveolar nerve injury resulting from overextension of an endodontic sealer: non-surgical management using the GABA analogue pregabalin. Int Endod J 2012; 45:98-104.
51. Russell DI Ryan WJ Towers JF. Complications of automated root canal treatment. Brit Dent J 1982; 153:393-398.
52. Kothari P Cannell H. Bilateral mandibular nerve damage following root canal therapy. Br Dent J 1996; 180:189-190.
53. Rosen E Goldberg T Taschieri S Del Fabbro M Corbella S Tsesis I. The prognosis of altered sensation after extrusion of root canal filling materials: A systematic review of the literature. J Endod 2016; 42:873-879.
54. Orstavik D Brodin P Aas E. Paraesthesia following endodontic treatment: survey of the literature and report of a case. Int Endod J 1983; 16:167-172.
55. Yaltirik M Ozbas H Erisen R. Surgical management of overfilling of the root canal: a case report. Quintessence Int 2002; 33:670-672.
56. Yatsuhashi T Nakagawa K-I Matsumoto M Kasahara M Igarashi T Ichinohe T Kaneko Y. Inferior alveolar nerve paresthesia relieved by microscopic endodontic treatment. Bull Tokyo Dent Coll 2003; 44:209-212.
57. Lambrianides T Economides N. Extrusion of root canal sealer to the mandibular canal area. A case report. Balk J Dent Med 2005; 9:152-154.
58. Scarano A Di Carlo F Quaranta A Piattelli A. Injury of the inferior alveolar nerve after overfilling f of the root canal with endodontic cement: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104:56-59.
59. Escoda-Francoli J Canalda-Sahli C Soler A Figueiredo R Gay-Escoda C. Inferior alveolar nerve damage because of overextended endodontic material: A problem of sealer cement biocompatibility? J Endod 2007; 33:1484-1489.
60. Batur Y.B Ersev H. Five-year follow-up of a root canal filling material in the maxillary sinus: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106:54-56.
61. Coskunses FM Sinanoglu A Helvacioglu Yigit D Abbott PV. The extrusion of root canal cement containing paraformaldehyde into the inferior alveolar nerve canal resulting in infection and numbness. Int Endod J 2016; 49:610-617.