Kablan Fares, Fahoum Abdallah, Moreinos Daniel, Srouji Samer, Slutzky-Goldberg Iris
Quintessence Int. 2024 Sep 27;55(8):608-614. doi: 10.3290/j.qi.b5316977.
An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal and provide a protocol for managing nerve injuries in such incidents.
A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into the inferior alveolar nerve canal during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was atraumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and mineral trioxide aggregate. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. After completion of the endodontic treatment, a stainless steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success.
Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes.
牙髓治疗过程中，牙髓材料的挤出可能导致感觉改变。本研究旨在探讨通过有意再植来解决因牙髓锉穿透下牙槽神经管而导致的感觉异常，并提供处理此类事件中神经损伤的方案。
一名12岁女孩在左下第一磨牙根管治疗期间，牙髓锉分离并意外从根尖孔被推入下牙槽神经管，随后出现感觉异常。CBCT扫描显示锉针朝向下颌骨下缘穿透神经管。在考虑各种治疗方案后，认为有意再植是合适的。牙齿被无创拔出并保存在无菌盐水中。外科医生随后仔细清理并冲洗牙槽窝。影像学评估证实锉针已成功从牙槽窝中取出。切除牙根末端，使用超声尖和三氧化矿物凝聚体进行倒充填预备和充填。然后将牙齿再植回牙槽窝。通过牙齿稳定性和可闻及的咔哒声确认再植成功。给患者开了抗生素和类固醇药物。牙髓治疗完成后，粘结了不锈钢冠。成功的有意再植手术使患者病情迅速改善。正常感觉得以恢复，表明神经已恢复。在15个月的随访中，观察到根尖周骨愈合及相邻第二磨牙萌出，证实了治疗方案的总体成功。
及时干预和立即进行有意再植有助于直接检查牙槽窝内分离的锉针。口腔颌面外科医生和牙髓病医生之间的协作确保了快速且有针对性的治疗，从而带来良好的治疗效果。
