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Case Reports
. 2012 Spring;7(2):102-8.
Epub 2012 Jun 1.

Overextension of nonsetting calcium hydroxide in endodontic treatment: literature review and case report

Arash Shahravan  1 , Shahrzad Jalali, Behrooz Mozaffari, Nasim Pourdamghan
Affiliations
Case Reports

Overextension of nonsetting calcium hydroxide in endodontic treatment: literature review and case report

Arash Shahravan et al. Iran Endod J. 2012 Spring.

Abstract

Premixed non-setting calcium hydroxide (CaOH(2)) paste in pressure syringe system is commonly used in root canal therapy. The aim of this paper is to present a case involving an iatrogenic extrusion of the medicament during endodontic treatment and a literature review of similar reports. The present case demonstrates severe tissue necrosis and other deleterious effects following the extrusion of CaOH(2) paste beyond root apex. A 21-year old female was referred for endodontic treatment of her maxillary left first premolar. After completion of the canal preparation, root canals were filled by premixed CaOH(2) paste. In the second appointment, a gingival detachment and an irregular zone of necrosis adjacent to the tooth apex was observed. To treat this complication, a mucoperiosteal flap was raised and the extruded material and necrotic tissues were currettaged and the area sutured. The patient was prescribed antibiotics and followed up at 2 weeks, 6 months and 2 years. Two week follow up showed good soft tissue healing. Two years postoperatively, complete radiographic and clinical healing was observed. We can conclude that the application of CaOH(2) should be carried out with care and preferably applied free hand or with a lentulo spiral rather than in a pressure syringe.

Keywords: Calcium Hydroxide; Case Report; Extrusion; Non-Setting; Root Canal Treatment.

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Conflict of interest statement

Conflict of Interest: ‘None declared’.

Figures

Table 1
Table 1
A brief review of reported cases
Figure 1
Figure 1
Orthopantomogram showing inadequate root canal filling of maxillary left first premolar
Figure 2
Figure 2
Radiographs showing radiopaque CaOH2 paste surrounding root of the premolars (A) and the tracing of gingival detachment by gutta-percha (B)
Figure 3
Figure 3
Radiograph showing complete root canal therapy
Figure 4
Figure 4
Discolored cortex due to an ischemia and decreased blood supply
Figure 5
Figure 5
Removal of foreign material and necrotic tissues around the roots
Figure 6
Figure 6
Photomicrographs of biopsy specimen showing foreign material surrounded by necrotic tissues and foreign body reaction (A, B)
Figure 7
Figure 7
Giant cells and macrophages
Figure 8
Figure 8
Photograph showing significant soft tissue healing two weeks after suture removal
Figure 9
Figure 9
Periapical radiograph showing normal hard tissue after 2 years
See this image and copyright information in PMC

References

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