{"title":"Symptomatic and asymptomatic endodontic material extrusion involving the inferior alveolar canal: a case series","authors":"Dr. Victor Vinh , Dr. Peggy Lee","doi":"10.1016/j.oooo.2024.11.035","DOIUrl":null,"url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>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.</div><div>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.</div><div>Case 2: Endodontic material within the IAC with normal sensation distal of #19 and numbness/tingling extending from #19 to midline.</div><div>Case 3: Endodontic material along, but not within, the IAC in #30-#32 area with paresthesia for 10 years.</div><div>Two companion cases show endodontic material IAC approximation without symptoms.</div></div><div><h3>Differential Diagnosis</h3><div>Trigeminal neuropathic pain secondary to endodontic material extrusion vs IAN block with articaine, periapical inflammation-related pressure on the nerve, and trigeminal neuralgia.</div></div><div><h3>Diagnosis and Management</h3><div>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.</div><div>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.</div><div>Case 3: No treatment was rendered.</div><div>Both cases show minimal radiographic changes over time as symptoms diminish with management.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e80-e81"},"PeriodicalIF":2.0000,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2212440324008289","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0
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.
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.
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