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

Download Article

1 / Nikolaos Economides2 / Vasilis Evangelidis3

1Undergraduate student, Aristotle University, Dental School, Thessaloniki, Greece
2Associate Professor, Aristotle University, Dental School, Thessaloniki, Greece
3Graduate student, Dental School, Thessaloniki, Greece

Summary

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.

Keywords: Extrusion; Root Canal Sealer; Symptoms; Treatment Management

References

  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  8. Khabbaz MG, Papadopoulos PD. Depositiion of calcified tissue around an overextended gutta-percha cone: case report. Int Endod J, 1999; 32:232-235.[Crossref]
  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[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  18. Spielman A, Gutman D, Laufer D. Anesthesia following endodontic overfilling with AH26. Oral Surg Oral Med Oral Pathol, 1981; 52:554-556.[Crossref]
  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.[Crossref]
  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.[Crossref]
  25. Brodin P. Neurotoxic and analgesic effects of root canal cements and pulp-protecting dental materials. Endod Dent Traumatol, 1988; 4:1-11.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.
  48. Nair PN. Non-microbial etiology: foreign body reaction maintaining post-treatment apical periodontitis. Endod Topics, 2003; 6:114-134.[Crossref]
  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.[Crossref]
  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.[Crossref]
  51. Russell DI, Ryan WJ, Towers JF. Complications of automated root canal treatment. Brit Dent J, 1982; 153:393-398.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
  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.[Crossref]
Citation Information: Balkan Journal of Dental Medicine. Volume 21, Issue 1, Pages 12–18, ISSN (Online) 2335-0245, DOI: https://doi.org/10.1515/bjdm-2017-0002, March 2017

 

COMMENTS