Inferior alveolar nerve damage after extrusion of an endodontic sealer into the mandibular canal: a case report

Abstract

The essential steps for successful endodontic treatment consist of elimination of all diseased pulp and dentin tissues, adequate chemomechanical preparation and filling of the root canal system hermetically.[1] Moreover, it is crucial that root canal obturation has to be limited within root canal system. Minor apical foramen or minor apical constriction is known to be situated 0.5–1.5 mm coronally to the apical foramen and endodontic treatment is suggested to be finished in this constricted region.[2] A small wounded surface is created when endodontic procedures are restricted within the root canal system, as a result extrusion of the toxic constitutes of obturation materials beyond apical foramen is prevented. What is more, with the activation of the immune system, healing is elicited rapidly. On the other hand, accidental extrusion of canal ingredients may result in postoperative pain and delayed healing.[3–5] Miscalculation of working length, procedural errors, anatomical and morphological variations may cause apical extrusion even to the anatomical landmarks such as maxillary sinus and mandibular canal. Direct contact of the nerve with extruded materials may result in some abnormal sensations such as anesthesia, paresthesia, hypoasthesia and dysesthesia.[3,6–10] The present case report discusses the causes and treatment options of inferior alveolar nerve damage following the overextension of an endodontic sealer into the mandibular canal. The aim of this case report was to discuss the consequences and treatment options of inferior alveolar nerve damage after the overextension of an endodontic sealer into the mandibular canal. A 33-year-old female patient was referred to the clinic of endodontics with persistent numbness around her left commissura as a consequence of her initial endodontic treatment of a lower left first molar. The patient’s complaints started to occur after the anesthesia has worn off. An endodontic sealer was extruded and spread into the mandibular canal, which caused anesthesia, paresthesia and tingling sensation around the left part of lower lip. Performing an interdisciplinary framework with the department of oral surgery, it was decided to monitor the patient regularly without any surgical intervention in order not to cause more trauma to the inferior alveolar nerve and not to jeopardize the present health status of the patient. Although damage to the inferior alveolar nerve is a relatively rare complication in dental practice, longlasting consequences of such a complication stress the significance of showing absolute attention and care during all endodontic.