J Am Dent Assoc. 2020 May;151(5):317-326. doi: 10.1016/j.adaj.2020.01.026. Epub 2020 Mar 21.
Nowhere in the consideration of dental care involving endodontics does a patient become more vulnerable to potentially life-changing injuries than during a root canal procedure on the mandibular dentition that may invade and injure the neurovascular anatomy.
The authors present a series of 5 cases wherein using calcium hydroxide as a disinfection strategy in endodontics caused serious neurologic injury to the treated patients. The mechanism in all cases was the inappropriate use of needle applications resulting in significant overfill into the inferior alveolar nerve space. Although calcium hydroxide has been recognized and used as a meaningful disinfectant in endodontic therapy for many years, the dangers and risks associated with a needle delivery technique are discussed and analyzed with recommendations based on current research to minimize risk.
A literature search revealed that the 5 cases are not solitary cases; indeed, consequences of calcium hydroxide overfills have been described before. Therefore, a clinician initiating root canal therapy on a mandibular posterior tooth should always be mindful of the vital neurovascular anatomy, which commonly approximates the ends of these roots. Preoperative cone-beam computed tomographic imaging and the thoughtful delivery of medicaments in treatment can help the clinician manage close proximity to neural anatomy and avoid potential injuries.
在涉及牙髓学的牙科护理考虑中，没有哪个患者比在下颌牙齿根管治疗过程中更容易受到潜在改变生活的伤害，因为该过程可能会侵犯和损伤神经血管解剖结构。
作者介绍了一系列 5 例病例，其中在牙髓学中使用氢氧化钙作为消毒策略导致接受治疗的患者发生严重的神经损伤。所有病例的机制都是由于针剂应用不当导致明显过度填充到下颌神经空间。尽管氢氧化钙已被认可并多年来一直被用作牙髓治疗中有意义的消毒剂，但与针剂输送技术相关的危险和风险已被讨论和分析，并根据当前研究提出了建议，以尽量降低风险。
文献检索显示，这 5 例并非孤立病例；事实上，氢氧化钙过度填充的后果以前曾有过描述。因此，在下颌后牙开始根管治疗的临床医生应始终注意重要的神经血管解剖结构，这些结构通常接近这些根的末端。术前锥形束计算机断层扫描成像和在治疗中谨慎输送药物可以帮助临床医生处理接近神经解剖结构的问题，并避免潜在的损伤。
