Department of Odonto-Stomatology, School of Dentistry, University of Barcelona, Barcelona, Spain.
Int Endod J. 2012 Jan;45(1):98-104. doi: 10.1111/j.1365-2591.2011.01939.x. Epub 2011 Aug 23.
To describe a case of endodontic sealer (AH Plus) penetration within the mandibular canal after root canal treatment with resolution of pain and paraesthesia after a non-surgical approach, including treatment with prednisone and pregabalin.
A 37-year-old woman underwent root canal treatment of the left mandibular second molar tooth. Postoperative periapical radiographs revealed the presence of radiopaque canal sealer in the mandibular canal. The day after, the patient reported severe pain in the tooth and paraesthesia/anaesthesia in the region innervated by the left inferior alveolar and mental nerve. Diagnosis of injury to the inferior alveolar nerve because of extrusion of AH Plus was established. The non-surgical management included 1 mg kg(-1) per day prednisone, two times per day, in a regimen on a daily basis, and 150 mg per day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. One month after the incident, the signs and symptoms were gone.
This case illustrates the care required when performing root canal treatment, especially when the root apices are in close proximity to the inferior alveolar nerve canal. The complete resolution of paraesthesia and the control of pain achieved in the present case suggests that a non-surgical approach combining prednisone and pregabalin is a good option in the management of the inferior alveolar when it is contacted by extruded root filling material.
描述根管治疗后下颌管内牙胶（AH Plus）渗透的病例，经非手术治疗（包括泼尼松和普瑞巴林治疗）后疼痛和感觉异常缓解。
一名 37 岁女性接受了左下颌第二磨牙的根管治疗。术后根尖片显示下颌管内有不透射线的根管封闭剂。术后第一天，患者报告该牙严重疼痛，并出现左侧下牙槽神经和颏神经支配区域的感觉异常/麻木。诊断为 AH Plus 外溢导致下牙槽神经损伤。非手术治疗包括每天 1 毫克/千克泼尼松，每日 1 次，每天 2 次，每天 150 毫克普瑞巴林，每日 2 次，并定期随访监测进展。事件发生一个月后，症状消失。
本例说明了进行根管治疗时需要注意的事项，特别是当根尖接近下牙槽神经管时。本病例中感觉异常完全缓解和疼痛控制提示，当接触到挤出的根充材料时，联合使用泼尼松和普瑞巴林的非手术治疗是下牙槽神经的一种较好的治疗选择。
