Symptomatic and asymptomatic endodontic material extrusion involving the inferior alveolar canal: a case series

IF 1.9 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Oral Surgery Oral Medicine Oral Pathology Oral Radiology Pub Date : 2025-03-01 Epub Date: 2025-02-04 DOI:10.1016/j.oooo.2024.11.035

Dr. Victor Vinh , Dr. Peggy Lee

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Abstract

Clinical Presentation

Three cases of left jaw pain and numbness post-root canal treatment with follow-up up to 8 years with cone beam computed tomography and intraoral imaging.

Case 1: Endodontic material extrusion within surrounding trabecular bone approximating, but not within, the inferior alveolar canal (IAC) and mental foramen with neurosensory changes along V3 mental and long buccal nerve distribution.

Case 2: Endodontic material within the IAC with normal sensation distal of #19 and numbness/tingling extending from #19 to midline.

Case 3: Endodontic material along, but not within, the IAC in #30-#32 area with paresthesia for 10 years.

Two companion cases show endodontic material IAC approximation without symptoms.

Differential Diagnosis

Trigeminal neuropathic pain secondary to endodontic material extrusion vs IAN block with articaine, periapical inflammation-related pressure on the nerve, and trigeminal neuralgia.

Diagnosis and Management

Case 1: Initial retreat root canal treatment did not improve symptoms. Continued numbness and decreasing pain managed with pregabalin on periodic 6-month follow-up; 6 years later, reported isolated periods without pain and left lower lip numbness gone. Continued improvement to present.

Case 2: Managed with prednisone and antibiotics; same pain radiating anteriorly at 2-week follow-up with numbness of #24, left lower lip, and gingiva. Decreased numbness at 2-month follow-up.

Case 3: No treatment was rendered.

Both cases show minimal radiographic changes over time as symptoms diminish with management.

Conclusion

When patients are symptomatic, cone beam computed tomography may confirm the presence of endodontic material within the IAC, indicating that extrusion is the likely cause of symptoms. Symptomatic cases, both with and without direct IAC involvement, have been successfully treated in this series and reported in the literature. Endodontic material located at the IAC border, but not within it, may present with or without symptoms. Thus, it is important to localize endodontic material in relation to the IAC.

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累及下牙槽管的有症状和无症状的根管物质挤压：一个病例系列

临床表现：根管治疗后左颌疼痛和麻木3例，随访8年，采用锥形束计算机断层扫描和口内成像。病例1：牙髓材料挤压周围小梁骨，靠近但不在下牙槽管（IAC）和颏孔内，沿V3颏神经和长颊神经分布有神经感觉改变。病例2:IAC内的根管材料，19号远端感觉正常，从19号延伸到中线麻木/刺痛。病例3：根管材料沿30- 32区IAC，但不在IAC内，感觉异常10年。2例伴发病例显示牙髓材料IAC近似，无症状。鉴别诊断：三叉神经痛继发于根管材料挤压vs阿卡因IAN阻滞，根尖周围炎症相关神经压力和三叉神经痛。病例1：初始退缩根管治疗未改善症状。在6个月的定期随访中，普瑞巴林治疗持续麻木和减轻疼痛；6年后，报告说，孤立的时期没有疼痛，左下唇麻木消失了。持续改善至今。病例2：强的松联合抗生素治疗；在2周的随访中，同样的疼痛放射到前面，并伴有24号、左下唇和牙龈麻木。随访2个月，麻木感减轻。病例3：未进行治疗。随着时间的推移，这两个病例的放射学变化都很小，症状随着治疗而减轻。结论当患者出现症状时，锥束计算机断层扫描可证实IAC内存在根管物质，提示挤压可能是引起症状的原因。有或没有直接IAC参与的症状病例，在本系列和文献中都有成功的治疗。根管物质位于IAC边界，但不在IAC内，可能有或没有症状。因此，定位与IAC相关的根管材料是很重要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral Surgery Oral Medicine Oral Pathology Oral Radiology DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.80

自引率

6.90%

发文量

1217

审稿时长

2-4 weeks

期刊介绍： Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology is required reading for anyone in the fields of oral surgery, oral medicine, oral pathology, oral radiology or advanced general practice dentistry. It is the only major dental journal that provides a practical and complete overview of the medical and surgical techniques of dental practice in four areas. Topics covered include such current issues as dental implants, treatment of HIV-infected patients, and evaluation and treatment of TMJ disorders. The official publication for nine societies, the Journal is recommended for initial purchase in the Brandon Hill study, Selected List of Books and Journals for the Small Medical Library.