Alfurhud Ahmed Ata
Oral and Maxillofacial Surgery and Diagnostic Sciences Department, College of Dentistry, Jouf University, King Khalid Road, Sakaka 72388, Saudi Arabia.
Diagnostics (Basel). 2025 May 12;15(10):1215. doi: 10.3390/diagnostics15101215.
Sodium hypochlorite (NaOCl) is widely used in root canal treatment for its potent antiseptic and antibacterial effects. However, its cytotoxicity-particularly at higher concentrations and in patients with low immune status-has been associated with serious postoperative complications. This case report describes the risks associated with NaOCl exposure in a medically compromised patient and reviews the relevant literature on NaOCl-related injuries, offering insights into potential current management strategies. This case report describes a challenging scenario of a 25-year-old male with a history of Hodgkin's lymphoma who developed a non-healing bone in the lower right first molar (LR6) region after NaOCl exposure. Several months after undergoing root canal treatment and an extraction of the LR6, the patient presented with exposed necrotic bone in the region. The case's complexity was heightened by the patient's medical and dental history, which included chemotherapy and NaOCl exposure. Following a detailed clinical, radiographic examination and biopsy, the patient was diagnosed with bone necrosis due to NaOCl exposure. The treatment involved the extraction of the LR6, the debridement of the necrotic bone, and long-term follow-up with antimicrobial therapy. Despite efforts to manage the complication, the healing process was prolonged, potentially due to the patient's immunocompromised state from chemotherapy. The patient's condition remained unresolved after nearly a year, and ongoing management, including regular follow-up, was necessary to monitor healing and prevent further complications. This case highlights the challenges of treating dental complications in immunocompromised patients, particularly those with Hodgkin's lymphoma, where delayed healing is a problem that might occur. : Given the complexity of this case, different adjunctive treatment options, such as leukocyte-platelet-rich fibrin (L-PRF), pentoxifylline and tocopherol (PENTO), and hyperbaric oxygen therapy (HBOT), were discussed as potential treatments to help manage non-healing sockets in patients with similar conditions.
次氯酸钠(NaOCl)因其强大的防腐和抗菌作用而被广泛应用于根管治疗。然而,它的细胞毒性——尤其是在高浓度时以及免疫状态低下的患者中——与严重的术后并发症有关。本病例报告描述了一名医学上存在缺陷的患者接触NaOCl所带来的风险,并回顾了与NaOCl相关损伤的相关文献,为当前潜在的管理策略提供见解。 本病例报告描述了一个具有挑战性的案例,一名25岁的男性,有霍奇金淋巴瘤病史,在接触NaOCl后,右下第一磨牙(LR6)区域出现了不愈合的骨质。在接受根管治疗和拔除LR6几个月后,患者该区域出现了暴露的坏死骨。患者的病史和牙科病史(包括化疗和接触NaOCl)增加了该病例的复杂性。经过详细的临床、影像学检查和活检,患者被诊断为因接触NaOCl导致的骨坏死。治疗包括拔除LR6、清除坏死骨以及长期的抗菌治疗随访。尽管努力处理该并发症,但愈合过程延长,这可能是由于患者化疗导致的免疫功能低下状态。患者的病情在将近一年后仍未解决,持续的管理(包括定期随访)对于监测愈合情况和预防进一步并发症是必要的。本病例突出了治疗免疫功能低下患者牙科并发症的挑战,尤其是那些患有霍奇金淋巴瘤的患者,在这类患者中延迟愈合是一个可能出现的问题。鉴于该病例的复杂性,讨论了不同的辅助治疗选择,如富含白细胞-血小板纤维蛋白(L-PRF)、己酮可可碱和生育酚(PENTO)以及高压氧治疗(HBOT),作为帮助处理类似情况下患者不愈合牙槽窝的潜在治疗方法。