Restor Dent Endod.  2016 Feb;41(1):63-67. 10.5395/rde.2016.41.1.63.

Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report

• Shin Y
• Roh BD
• Kim Y
• Kim T
• Kim H

• KMID: 2316965
• DOI: http://doi.org/10.5395/rde.2016.41.1.63

Abstract

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

Keyword

Calcium hydroxide; Extrusion; Inferior alveolar nerve; Neurotoxic effects; Surgical debridement

MeSH Terms

Anesthesia, General
Calcium Hydroxide*
Calcium*
Debridement
Female
Humans
Mandibular Nerve*
Molar
Neuroma
Osteotomy
Paresthesia
Prognosis
Calcium
Calcium Hydroxide

Figure

• 

  Figure 1 (a) Panoramic view of the patient after extrusion of calcium hydroxide. Increased radiopacity around periapical area on left second molar; (b) Periapical view after canal cleaning and shaping; (c - e) On the cross sectional view of CBCT, excessive radiopaque material was spread into the left mandibular canal.

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  Figure 2 (a) Before debridement. Injured tissue was seen. It's hard to distinguish inferior alveolar nerve and other structures; (b) Inferior alveolar nerve was sutured, granulation tissues and destructed bones are removed; (c - e) Particles of foreign bodies and multiple fragment of bone and fibrous or fibroadipose tissue of varying size represented the curetted material submitted for histopathological examination (H-E staining); (f) S100 protein on nerve bundle was not seen on nerve staining.

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  Figure 3 Radiographic view of left mandibular area after surgical intervention. (a) 3 months follow up; (b) 20 months follow up; (c) Healing of bony fragments was found between separated block bones and mandibles.

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