Department of Endodontics, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas.
Department of Endodontics, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas.
J Endod. 2023 Jun;49(6):735-741. doi: 10.1016/j.joen.2023.04.006. Epub 2023 Apr 23.
The use of calcium silicate-based sealers (CSSs) is increasing in dentistry as a result of their favorable properties. The inadvertent extrusion of these sealers into the mandibular canal (MC) can result in temporary or permanent neurosensory alterations. Three different recovery outcomes of CSS extrusion into the MC after endodontic treatment of mandibular molars confirmed by cone-beam computed tomographic imaging are described. In Case 1, CSS from the mesiolingual canal of tooth #31 was extruded into the MC during obturation. The patient reported paresthesia. The symptoms of paresthesia were completely resolved by 9 months. In Case 2, CSS from the mesial canals of tooth #30 was extruded into the MC during obturation. A "plasmalike spreading pattern" of the extruded sealer was observed on the radiographs. The patient reported paresthesia and dysesthesia. In addition, the patient complained of hyperalgesia with heat and mechanical allodynia. The symptoms continued to persist during follow-up. At 22 months, the patient still reported persistent paresthesia, hyperalgesia, and mechanical allodynia, affecting the ability to eat. In Case 3, CSS from the distal canal of tooth #31 was extruded into the MC during obturation. The patient did not report any paresthesia or dysesthesia. All 3 patients elected a follow-up approach and monitoring rather than surgical intervention. These cases illustrate the need for the development of guidelines for the management of iatrogenic CSS extrusion into the MC because such an occurrence may result in permanent, temporary, or no neurosensory alterations.
由于其良好的性能，基于硅酸钙的密封剂（CSS）在牙科中的使用正在增加。这些密封剂意外地挤压到下颌管（MC）中会导致暂时或永久的神经感觉改变。通过锥形束计算机断层扫描成像确认，描述了下颌磨牙根管治疗后 CSS 挤压到 MC 中的三种不同的恢复结果。在病例 1 中，在牙 31 的近中舌侧根管的牙胶封闭过程中，CSS 被挤压到 MC 中。患者报告有感觉异常。9 个月后，感觉异常的症状完全缓解。在病例 2 中，在牙 30 的近中根管的牙胶封闭过程中，CSS 被挤压到 MC 中。在射线照片上观察到挤出的密封剂呈“类似血浆的扩散模式”。患者报告有感觉异常和感觉迟钝。此外，患者还抱怨热和机械性触诱发痛的痛觉过敏。在随访期间，症状仍持续存在。在 22 个月时，患者仍报告持续的感觉异常、痛觉过敏和机械性触诱发痛，影响进食能力。在病例 3 中，在牙 31 的远中根管的牙胶封闭过程中，CSS 被挤压到 MC 中。患者没有报告任何感觉异常或感觉迟钝。所有 3 名患者都选择了随访和监测而不是手术干预。这些病例说明了制定管理医源性 CSS 挤压到 MC 指南的必要性，因为这种情况可能导致永久性、暂时性或无神经感觉改变。
