Non‐surgical management of paraesthesia and pain associated with endodontic sealer extrusion into the mandibular canal

The aim of this report was to present a case of endodontic sealer extrusion into the mandibular canal in a 42‐year‐old woman. The patient was referred to the Endodontology and Stomatology Clinics, School of Dentistry, Estácio de Sá University, complaining of 5‐day duration intense spontaneous pain and paraesthesia, both arising after an endodontic intervention. Conventional radiographs and computed tomography of the mandible showed the presence of radiopacities inside the right mandibular canal. History and these radiographs confirmed extrusion of endodontic sealer. Treatment included an anti‐inflammatory drug, completion of endodontic treatment and follow up. The patient reported gradual improvement, becoming asymptomatic after 2 months. Radiographs 30 months after initial examination revealed partial resorption of the foreign material. In conclusion, iatrogenic extrusion of endodontic materials should be included in differential diagnosis of endodontic pain and can sometimes be managed through non‐surgical interventions in some cases.     

The impact of sealer extrusion on endodontic outcome: A systematic review with meta‐analysis

The purpose of this systematic review was to qualify and quantify the evidence regarding the effect of extruded sealers on endodontic treatment outcomes. Two reviewers independently conducted a comprehensive literature search. The EMBASE, MEDLINE, Cochrane, PubMed databases, bibliographies, grey literature of all relevant articles and textbooks were searched. Six articles met the inclusion criteria with a moderate risk of bias and were analysed for qualitative and quantitative synthesis. There was moderate‐certainty evidence that sealer extrusion can contribute to non‐healing outcomes, 95% confidence interval, risk ratio 1.32 (1.12–1.54) and P < 0.05. This indicates that the current authors are somewhat confident the true effect is likely to be close to the estimate of the effect. Sealer extrusion had a 32% higher risk of contributing to a non‐healing outcome than no extrusion. However, well‐conducted research would need to be conducted to confirm this causality claim.     

Mental nerve paresthesia associated with an amalgam filling: a case report

Hilú RE, Zmener O. Mental nerve paresthesia associated with an amalgam filling: a case report. Endod Dent Traumatol 1999; 15: 291–293.© Munksgaard, 1999.
Abstract — We present a case report in which a mental nerve paresthesia occurred in connection with an amalgam filling placed in direct contact with the pulp of a mandibular first molar. The main evidence for amalgam being the dominant etiological factor was the positive epicutaneous patch testing response to the components of the amalgam alloy, and the total remission of symptoms without further clinical complications after removal of the amalgam filling and subsequent endodontic therapy.     

Mandibular division trigeminal nerve injuries following primary endodontic treatment. A case series

The aim of this study is to report a series of patients with mandibular division trigeminal nerve (V₃) injuries secondary to endodontic treatment, evaluate presentation characteristics and identify prevention strategies. This article describes a retrospective review of patients referred to a tertiary clinic 2007–2015 with V₃ injury following endodontic treatment. The sample included 12 male and 16 female patients with a mean age of 41.5 years. Sixteen cases presented following endodontic treatment of the first and second molar, premolar teeth in eight cases and canine in two cases. Fifteen patients reported immediate post‐operative symptoms, in eleven cases there was a 24–48 h asymptomatic period. The average referral delay was 23.1 months. Twenty patients had permanent neuropathy. Four patients experienced resolution of symptoms within 8 weeks. V₃ injury following endodontic treatment is rare but can result in permanent neuropathy and functional impairment. This can be avoided through comprehensive pre‐operative radiographic examination, identification and referral of high‐risk cases.     

大量根充糊剂进入下颌管10年观察1例报告

根管治疗是通过机械和化学方法取出根管内的大部分感染物,并通过充填根管、封闭冠部,防止发生根尖周病变或促进已经发生的根尖周病变的愈合[1]。下颌后牙周围解剖结构接近下颌管,在根管治疗过程中,机械性、化学性或热刺激都有损伤下牙槽神经的潜在风险。如根管充填糊剂超出根尖孔,与神经组织接触,有病例报道会产生细胞毒性及机械挤压造成神经敏感性改变[2]。本文报道1例左下第二磨牙行根管治疗,大量根充糊剂进入下颌管10年观察,患者未出现下牙槽神经损伤症状的病例。     

Failure to obtain adequate anaesthesia associated with a bifid mandibular canal: a case report

The inferior alveolar nerve (IAN) block is the most common method for obtaining mandibular anaesthesia in dental practice but it is estimated to have a success rate of only 80 to 85 per cent. Causes of failure include problems with operator technique and anatomical variation between individuals. This case report involves a patient who received IAN blocks on two separate occasions that resulted in only partial anaesthesia of the ipsilateral side of the mandible. Radiographic assessment disclosed the presence of bifid mandibular canals that were present bilaterally and that may have affected the outcomes of the local anaesthetic procedures. Previous studies of bifid mandibular canals are reviewed and suggestions provided that should enable clinicians to differentially diagnose, and then manage, cases where IAN blocks result in inadequate mandibular anaesthesia.     

三氧化二砷颏孔注射后对兔颏神经影响的研究

目的观察三氧化二砷对兔颏神经的作用。方法将不同浓度的三氧化二砷0.5ml注入颏孔。从大体观察,神经动作电位测定和病理形态学3个方面分不同时期对兔颏神经的病理生理改变予以观察。结果在适当浓度的三氧化二砷作用下,颏神经动作电位振幅24h后降低或消失,72h后完全消失,2个月后观察无恢复。注射后2周时观察到明显病理改变,随时间延长而加重,2个月后无神经细胞再生表现。结论适当浓度的三氧化二砷可引起神经轴突的完全性损害。     

Push‐out bond strength of gutta‐percha with a new bioceramic sealer in the presence or absence of smear layer

The purpose of this study was to compare the bond strength of a new bioceramic sealer (EndoSequence BC Sealer) and AH Plus in the presence or absence of smear layer. Extracted single‐rooted human teeth were prepared and randomly divided into four groups. In groups 1 and 3, the root canals were finally irrigated with 5.25% NaOCl and smear layer was not removed, but in groups 2 and 4, the root canals were finally irrigated with 17% EDTA followed by 5.25% NaOCl in order to remove the smear layer. In groups 1 and 2, the root canals were obturated with gutta‐percha/AH Plus, but in groups 3 and 4, obturation was performed with gutta‐percha/EndoSequence BC Sealer. Push‐out bond strength and failure modes were evaluated. The bond strength of gutta‐percha/AH Plus and gutta‐percha/EndoSequence BC Sealer was not significantly different (P = 0.89). The presence or absence of smear layer did not significantly affect the bond strength of filling materials (P = 0.69). The mode of bond failure was mainly cohesive for all groups. In conclusion, the bond strength of the new bioceramic sealer was equal to that of AH Plus with or without the smear layer.     

Thin and thick layers of resin‐based sealer cement bonded to root dentine compared: Adhesive behaviour

This study aims to evaluate tensile and shear bond strengths of one epoxy (AH) and two methacrylate resin‐based sealers (EZ and RS) in thin and thick layers bonded to root dentine. An alignment device was prepared for accurate positioning of 20 root dentine cylinders in a predefined gap of 0.1 or 1 mm. Sealer was placed in the interface. Bond strength tests were conducted. Mode of failures and representative surfaces were evaluated. Data were analysed using anova and post‐hoc tests, with P < 0.05. The thick layer of sealer produced higher bond strength, except for the shear bond strength of EZ. Significant differences between thin and thick layers were found only in tensile bond strengths of AH and RS. Mixed type of failure was constantly found with all sealers. Bond strengths of thick layers of resin‐based sealers to root dentine tended to be higher than with thin layers.     

Effect of articaine on mental nerve anterior portion: Histological analysis in rats

Abstract

Objectives. The aim of this study was to evaluate the possible toxic effects of articaine and lidocaine on mental nerve, due to the increasing number of paresthesia cases after nerve blocks. Materials and methods. The drugs were injected in the anterior portion of mental nerve of 24 rats, divided into three groups: G1—4% articaine with 1:100,000 epinephrine; G2—2% lidocaine with 1:100,000 epinephrine and G3—plain 1:100,000 epinephrine solution. These solutions were injected in the right side of the rat's mandible and the left side was used as control (0.9% saline solution). Previously to the injections, the animals were anesthetized with thiopental and, 24 h after the injections, their jaws were removed and submitted to routine histological techniques. A histopathological analysis was performed by optical microscopy. Results. An inflammatory infiltration was found around mental nerve, classified as intense for G3, moderate for G1 and light for both G2 and control groups. No injuries were found in nervous structure, despite the inflammatory reaction observed around it. Conclusion. The results suggest that articaine is not toxic to the nervous structure and further studies are necessary to explain the possible relation between articaine injection and paresthesia.     

Anterior loop of the mental nerve: a morphological and radiographic study

Treatment planning for dental implant patients is often complicated by the unknown extent of the anterior loop of the mental neurovascular bundle. The aim of this study was to determine the correlation between the visual interpretation of the panoramic radiographs and the anatomical dissection findings in a cadaveric sample. Panoramic radiographs of the 22 randomly selected coronally sectioned human head specimens were taken using the Scanora (Soridex, Orinon Corporation Ltd, Helsinki, Finland) radiographic unit jaw panorama (Programme 001, magnification 1.3) and dental panorama (Programme 003, magnification 1.7) and interpreted by two calibrated observers. Bilateral anatomical dissection was then performed on all specimens. The anterior loop of the mental canal was only identified in six panoramic radiographs (27%) (range 0.5-3 mm). There was a significant positive correlation between both observers of the radiographs and between the two radiographic programmes used. Anatomical measurements of the anterior loop of the mental neurovascular bundle revealed its presence in eight dissected specimens (range 0.11-3.31 mm; mean 1.20, +/-0.90). Fifty percent of the radiographically observed anterior loops of the mental canal were misinterpreted by observers with both radiographic programmes and 62% of the anatomically identified loops were not observed radiographically. Clinicians should not rely on panoramic radiographs for identifying the anterior loop of the mental nerve during implant treatment planning. However, a safe guideline of 4 mm, from the most anterior point of the mental foramen, is recommended for implant treatment planning, on the basis of our anatomical findings.     

The effect of different sealer removal protocols on the bond strength of AH plus‐contaminated dentine to a bulk‐fill composite

The integrity of composite bonding for post‐endodontic restorations may be compromised by sealer contamination. This study assessed the effect of different sealer removal regimes on the bond strength of dentine to composite resin. Dentine surfaces were contaminated with AH Plus sealer (Dentsply DeTrey, Konstanz, Germany), followed by removal with either dry cotton pellets, cotton pellets saturated with 95% ethanol, AH Plus cleaner or external surface preparation. Dentine surfaces were not contaminated in a positive control group. A bulk‐fill composite (SDR; Dentsply) was bonded with Prime&Bond active universal adhesive (Dentsply) onto the prepared surface. Composite resin–dentine beams were produced, and tensile bond strength was determined using a universal testing machine. Using an etch‐and‐rinse adhesive, bond strengths varied from 21.34 to 29.11 MPa with no statistical differences among removal protocols. In conclusion, contamination by AH Plus sealer does not appear to substantially interfere with bond strength between dentine and a bulk‐fill composite/etch‐and‐rinse system.     

Maxillary nerve block anaesthesia via the greater palatine canal: A modified technique and case reports

A modification of the technique of maxillary nerve block (via the greater palatine canal) is discussed. This technique has been employed in the Exodontia and Oral Surgery Clinics of the United Dental Hospital of Sydney for more than 40 years. Clinical experience in that time has shown that once the greater palatine canal has been negotiated successfully, the palatal canal approach to the maxillary nerve is safe and reliable. The value of being able to anaesthetize the maxillary nerve and its branches is illustrated by the presentation of two clinical cases where local anaesthesia was achieved and the extractions performed in patients who would otherwise have required a general anaesthetic for the procedures.