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Fiorillo L, D'Amico C, Meto A, Mehta V, Lo Giudice G, Cervino G. Sodium Hypochlorite Accidents in Endodontic Practice: Clinical Evidence and State of the Art. J Craniofac Surg 2024; 35:e636-e645. [PMID: 39418527 DOI: 10.1097/scs.0000000000010407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 10/19/2024] Open
Abstract
Sodium hypochlorite (NaOCl) is widely utilized in endodontics for its effective antimicrobial properties and ability to dissolve necrotic tissues. However, its use is not devoid of risks, including potential severe tissue damage and chemical burns. This systematic review evaluates the documented risks of using NaOCl in endodontic treatments. It compares its safety and efficacy with other endodontic irrigants, such as EDTA and chlorhexidine. This review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines and registered with PROSPERO. Comprehensive searches were performed in PubMed, Scopus, Web of Science, and CENTRAL databases, with additional hand searches in grey literature. Studies were selected reporting adverse effects related to NaOCl used in endodontic procedures, ranging from randomized controlled trials to case reports. Data extraction and risk of bias assessment were systematically performed using standardized tools. Seventeen studies were included, detailing instances from chemical burns to severe allergic reactions and tissue necrosis associated with NaOCl use. The risk of bias was predominantly low across the studies. Sodium hypochlorite demonstrated a higher efficacy in microbial eradication and tissue dissolution than other irrigants, though it also showed a higher incidence of severe complications when mishandled. Sodium hypochlorite remains a cornerstone in endodontic disinfection due to its potent antimicrobial and tissue dissolution properties. However, its application must be meticulously managed to prevent complications. Future research should focus on optimizing concentrations and application techniques to enhance safety and effectiveness, potentially integrating safer alternatives or complementary solutions like EDTA to mitigate risks while preserving irrigant benefits.
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Affiliation(s)
- Luca Fiorillo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Dentistry, University of Messina, via Consolare Valeria, Messina
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Dental Cell Research, Dr D.Y. Patil Dental College and Hospital, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, MH, India
- Department of Dentistry, Faculty of Dental Sciences, University of Aldent, Tirana, Albania
| | - Cesare D'Amico
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Dentistry, University of Messina, via Consolare Valeria, Messina
- Department of Dentistry, Faculty of Dental Sciences, University of Aldent, Tirana, Albania
| | - Aida Meto
- Department of Dental Cell Research, Dr D.Y. Patil Dental College and Hospital, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, MH, India
- Department of Dentistry, Faculty of Dental Sciences, University of Aldent, Tirana, Albania
| | - Vini Mehta
- Department of Dental Cell Research, Dr D.Y. Patil Dental College and Hospital, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, MH, India
| | - Giuseppe Lo Giudice
- Department of Clinical and Experimental Medicine, Messina University, Messina, Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Dentistry, University of Messina, via Consolare Valeria, Messina
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Vivekananda Pai AR. Factors influencing the occurrence and progress of sodium hypochlorite accident: A narrative and update review. J Conserv Dent 2023; 26:3-11. [PMID: 36908722 PMCID: PMC10003279 DOI: 10.4103/jcd.jcd_422_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
Sodium hypochlorite (NaOCl) is one of the most commonly used irrigant because of its several advantages. However, it is highly cytotoxic and can lead to severe tissue damage. NaOCl accident occurs when it is extruded beyond root confines into periapical or periradicular tissues. It is an irrigant mishap which can be life threatening and/or cause residual or long term or permanent consequences with malpractice and medico-legal implications. There are many factors which can influence the occurrence and progress of NaOCl accident. These factors can be broadly categorized as patient (host)-, tooth-, operator-, and NaOCl-related factors. They can be further categorized as predisposing and extent factors. It is vital for a clinician to thoroughly understand and identify various influencing factors to prevent NaOCl accident with its associated consequences including any potential medico-legal issues. The purpose of this article is to provide a narrative review on various factors which predispose to the occurrence of NaOCl accident and influence its extent and/or outcome.
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Affiliation(s)
- A. R. Vivekananda Pai
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, 75150 Melaka, Malaysia
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Robaian A, Alqhtani NR, Alghomlas ZI, Alzahrani A, Almalki AK, Al Rafedah A, Al Abdulsalam A, Alzahrani KM. Vertical relationships between the divergence angle of maxillary molar roots and the maxillary sinus floor: A cone-beam computed tomography (CBCT) study. Saudi Dent J 2021; 33:958-964. [PMID: 34938038 PMCID: PMC8665178 DOI: 10.1016/j.sdentj.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/26/2021] [Accepted: 08/01/2021] [Indexed: 11/19/2022] Open
Abstract
AIM To assess the relations between the divergence angle of the maxillary molar roots and their proximity to the maxillary sinus floor using CBCT. METHOD This study comprised CBCT scans of the maxilla, including at least the inferior one-third of the maxillary sinus and at least one molar present in any quadrant with complete eruption and root formation. Evaluation included the vertical relations between the maxillary molar root apices and the maxillary sinus floor (MSF), and the root divergence was measured from the root apices to the floor of the pulp chamber. The chi-square test was used for the associations between the study parameters. For the correlation between root divergence angles and MSF vertical relationship types, the Spearman test was used. A P-value < 0.05 was considered significant. RESULTS A total of 100 scans were analyzed, including 316 permanent maxillary first and second molars. The MSF Type II vertical relationship was the most prevalent (39.6%), followed by Type I (31.3%). The highest divergence angle was found between the distobuccal and palatal roots (mean = 44.9 ± 10.5°). For the mesiobuccal-distobuccal angle groups, there were higher percentages of the MSF Type I and II relationships among the angle groups < 1° and 21-45°. For the mesiobuccal-palatal angle groups, a higher prevalence of the MSF Type II relationship was found in the <21⁰ and >45⁰ angle groups, and a higher prevalence of the Type I relationship was found in the 21-45⁰ angle group. For the distobuccal-palatal angle groups, higher percentages of the MSF Type II relationship were found in the three angle groups. For all teeth, there was a significant positive correlation between the MSF vertical relationship and the mesiobuccal-palatal angle (r = 0.116; P = 0.039). CONCLUSION There was a positive correlation between the divergence angle of the roots and their vertical relationship with the MSF. Clinicians should assess the divergence between the roots before performing extraction or endodontic treatments.
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Affiliation(s)
- Ali Robaian
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Nasser Raqe Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Adel Alzahrani
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | - Ali Al Rafedah
- Department of Oral and Maxillofacial Surgery and Diagnostic Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Khaled M. Alzahrani
- Department of Prosthetic Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
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Abstract
The clinical dentistry and endodontic procedures involve very technique-sensitive procedures, therefore exposing the operator to risks of causes not only damage to patients but also leads to malpractice. Among various disciplines of dentistry, endodontics-related cases witness the most frequently filed malpractice claims. This is due to the fact that the endodontic treatment procedures involve operative and surgical procedures, using a variety of medicaments and techniques. The endodontic procedural errors can be preoperative errors (such as incorrect diagnosis and misinterpretation), intraoperative errors including root canal and pulp chamber perforations, ledge formation leading to apical transportation or zipping, hypochlorite accidents, and fracture of instruments. More critically, failure to use rubber dam may result in inhalation or ingestion of endodontic instruments. Under such circumstances, the endodontist may have to face legal consequences. Due to the increased healthcare load and patients’ awareness, it is important to know the legal ramifications of adverse effects, failed restorations, or other complications, to avoid any legal ramifications of endodontic procedures and associated techniques. Therefore, precautions must be taken to prevent any postsurgical complications, patient complaints, and/or failures. For this purpose, the operator must consider ethical principles and adhere strictly to the standards of healthcare while performing the diagnosis and treatment. A referral toward a specialist or consultant endodontist is always an appreciable option and should be considered in the best interest of the patient. The aim of the article is to highlight various aspects of malpractice in clinical endodontics, and associated materials and challenges. In addition, commonly occurring operating errors during endodontic treatment, possible consequences, precautions, and management have been discussed.
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Affiliation(s)
- Mothanna Alrahabi
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Madinah Munnawara, Saudi Arabia
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Madinah Munnawara, Saudi Arabia.,Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad, Pakistan
| | - Necdet Adanir
- Department of Restorative Dentistry, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
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Dioguardi M, Gioia GD, Illuzzi G, Laneve E, Cocco A, Troiano G. Endodontic irrigants: Different methods to improve efficacy and related problems. Eur J Dent 2019; 12:459-466. [PMID: 30147418 PMCID: PMC6089055 DOI: 10.4103/ejd.ejd_56_18] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Shaping and cleaning a root canal system along with the preservation of the surrounding periodontal tissues are the principal goals of an endodontic treatment. While most of the attention is paid to the mechanical aspects of a root canal treatment, an essential feature of it is the irrigation. All over the years, many materials have been used to clean the root canal of a tooth, and certainly, the sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid solutions are the most used and most reliable ones. Putting them inside of a canal is mostly done using a normal syringe, but many techniques have been involved in this process, including the use of sonic/ultrasonic instruments, the use of shaping files, and even laser, to increase the efficacy of irrigant solutions, especially of NaOCl one. Each one of this technique faces some disadvantages, just as the vapor lock effect and the apical extrusion, and has a different action on features such as the reaction rate and the shear stress of an endodontic irrigant solution. In this narrative review, we describe the different features of many irrigant solutions and the different ways of upgrading their efficacy in the cleaning of a root canal system, with the use of tables to summarize the entire description, and drawing the readers' attention to a photographic illustration for a better understanding of the topic.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giovanni Di Gioia
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Gaetano Illuzzi
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Enrica Laneve
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Armando Cocco
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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Cai X, Wang XY, Santarcangelo F, Schoeffel GJ, Bergeron BE, Tay FR, Niu LN. Effect of simulated intraosseous sinusoidal pressure on NaOCl extrusion. J Dent 2018; 78:46-50. [PMID: 30077808 DOI: 10.1016/j.jdent.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 07/28/2018] [Accepted: 08/01/2018] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION The present study examined the effects of irrigant flow rate and simulated intraosseous sinusoidal pressure on the rate of NaOCl extrusion from the apical terminus of a faux root canal. METHODS An extrusion setup was designed to enable irrigant extrusion to be opposed by 30 mm Hg simulated intraosseous pressure. The faux canal apex was opposed by atmospheric + 30 mm Hg pressure (experimental) or atmospheric pressure only (control group). Using five irrigant delivery rates (15.6 8.0, 4.0, 3.4 or 3.0 mL/min), the extrusion rates of 2% NaOCl from the faux apex were measured in both groups (n = 16). Data were analysed with two-factor ANOVA and pairwise comparisons at α = 0.05. Correlation between NaOCl delivery rates and extrusion rates in both groups were analysed with the Pearson product-moment procedure. RESULT Irrespective of the presence or absence of simulated sinusoidal pressure, NaOCl extrusion rates were positively-correlated with irrigant flow rates. For the factor "irrigant flow rates", significant differences in NaOCl extrusion rates were identified among all flow rates (p < 0.05), except for the pairwise comparison between 4.0 and 3.4 mL/min in the control. For all irrigant flow rates, NaOCl extrusion rate was significantly lower in the presence of 30 mm Hg simulated sinusoidal pressure than that obtained in the absence of opposing pressure (p < 0.05). CONCLUSION In the presence of 30 mm Hg simulated intraosseous pressure, NaOCl delivered via a side-vented needle inserted to 1 mm short of working length may be prevented from extrusion when its flow rate is ≤ 3.0 mL/min. CLINICAL SIGNIFICANCE When opposed by intraosseous sinusoidal pressure, NaOCl delivered via a side-vented needle inserted to 1 mm short of working length may be prevented from extrusion when its flow rate is ≤ 3.0 mL/min.
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Affiliation(s)
- Xue Cai
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Yan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | | | - G John Schoeffel
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Brian E Bergeron
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA; Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China.
| | - Li-Na Niu
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA; Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China.
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Abstract
Sodium hypochlorite is widely used as an irrigating solution in dental practice. Despite its safe properties, serious complications can result from inadvertent use. We report a patient presenting to the accident and emergency department for sodium hypochlorite accident during dental root canal therapy. The management of this dental emergency condition is discussed.
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Costa T, Ferreira E, Antunes L, Dinis PB. Antral bony wall erosion, trigeminal nerve injury, and enophthalmos after root canal surgery. ALLERGY & RHINOLOGY 2016; 7:99-101. [PMID: 27465790 PMCID: PMC5010441 DOI: 10.2500/ar.2016.7.0161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: The frequently used irrigant in dental surgery, sodium hypochlorite, is occasionally the cause of minor, usually circumscribed, adverse effects. Severe, extensive complications, with lasting sequelae, however, also can occur, as in the case we report herein. Case Report: A 55-year-old woman underwent an endodontic procedure on a maxillary molar, whose roots, unknown to the surgeon, were protruding into the maxillary sinus. After sodium hypochlorite root canal irrigation, the patient immediately developed intense facial pain, facial edema, and periorbital cellulitis. An emergency department evaluation diagnosed an intense inflammatory disease of the maxillary sinus, with significant destruction of its bony walls, accompanied by midface paraesthesia due to infraorbital nerve injury. In the following weeks, the patient slowly developed enophthalmos due to bone erosion of the orbit floor. Treatment, besides prolonged oral steroids, required the endoscopic endonasal opening of the maxillary sinus for profuse irrigation. Two years later, the patient maintained a complete loss of function of the maxillary sinus, anesthesia-paraesthesia of the midface, and inferior dystonia of the eye with an enophthalmos. Conclusion: Dentists, maxillofacial surgeons, and otorhinolaryngologists should all be aware of the whole spectrum of complications of even the simplest dental work. Sodium hypochlorite irrigations should be used cautiously in root canal surgery, with the full awareness of its potential for causing soft-tissue damage.
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Affiliation(s)
- Tiago Costa
- Otorhinolaryngology Department, Hospital de Santa Maria, Lisbon, Portugal
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9
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Evaluation of the relationship between maxillary sinus floor position and maxillary sinusitis using cone beam computed tomography. Oral Radiol 2016. [DOI: 10.1007/s11282-016-0241-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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10
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Guidelines for management of sodium hypochlorite extrusion injuries. Br Dent J 2015; 217:679-84. [PMID: 25525012 DOI: 10.1038/sj.bdj.2014.1099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/09/2022]
Abstract
Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury.
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Wang Y, Xiao S, Ma D, Huang X, Cai Z. Minimizing Concentration of Sodium Hypochlorite in Root Canal Irrigation by Combination of Ultrasonic Irrigation with Photodynamic Treatment. Photochem Photobiol 2015; 91:937-41. [PMID: 25892274 DOI: 10.1111/php.12459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 04/13/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Yanhuang Wang
- School and Hospital of Stomatology; Fujian Medical University; Fuzhou Fujian China
- Key Laboratory of Stomatology (FMU); Fujian Province University; Fuzhou Fujian China
| | - Suli Xiao
- School and Hospital of Stomatology; Fujian Medical University; Fuzhou Fujian China
- Key Laboratory of Stomatology (FMU); Fujian Province University; Fuzhou Fujian China
| | - Dianfu Ma
- School and Hospital of Stomatology; Fujian Medical University; Fuzhou Fujian China
- Fujian Anxi County Hospital; Quanzhou Fujian China
| | - Xiaojing Huang
- School and Hospital of Stomatology; Fujian Medical University; Fuzhou Fujian China
- Key Laboratory of Stomatology (FMU); Fujian Province University; Fuzhou Fujian China
| | - Zhiyu Cai
- School and Hospital of Stomatology; Fujian Medical University; Fuzhou Fujian China
- Department of Stomatology; Fujian Medical University Union Hospital; Fuzhou Fujian China
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Ok E, Güngör E, Colak M, Altunsoy M, Nur BG, Ağlarci OS. Evaluation of the relationship between the maxillary posterior teeth and the sinus floor using cone-beam computed tomography. Surg Radiol Anat 2014; 36:907-14. [PMID: 24874032 DOI: 10.1007/s00276-014-1317-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to evaluate the relationship between each root of maxillary premolars and molars and the maxillary sinus floor according to sex, sinus position, and age by decade in a Turkish population by using cone-beam computed tomography (CBCT) scanning. METHODOLOGY We evaluated a database of 5,166 (2,680 maxillary premolars and 2,486 maxillary molars) CBCT scans obtained from 849 patients. The vertical relationship between each root of the molar and premolar teeth to the sinus floor was classified into three types: type 1, the roots penetrated into the sinus floor; type 2, the roots contacted the sinus floor; and type 3, the roots extended below the sinus floor. RESULTS The results of the classification of each root in relationship to the sinus floor were as follows: type 3 occurred most frequently in the first (92.4 %) and second (71.6 %) premolar teeth, type 1 (34.2 %) occurred most frequently in the palatinal roots of the first molar teeth, type 3 occurred most frequently in the mesiobuccal (39.9 %) and distobuccal (39.7 %) roots of the first molar teeth, and type 2 (36.7 %) occurred most frequently in the mesiobuccal roots of the second molar teeth. No significant differences were found between the left and right sides, but several differences were found between males and females. The relationship between the posterior teeth and the sinus floor differed according to the age decade interval (p < 0.05). CONCLUSIONS The maxillary first premolars have no relationship with the maxillary sinus floor, but the maxillary second molars are closer to the sinus floor. Also the second decade and males were most susceptible to undesirable results.
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Affiliation(s)
- Evren Ok
- Department of Endodontics, Faculty of Dentistry, Sifa University, Izmir, Turkey,
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13
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Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent 2013; 41:935-48. [PMID: 23994710 DOI: 10.1016/j.jdent.2013.08.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/12/2013] [Accepted: 08/17/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. METHODS To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. RESULTS By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. CONCLUSIONS Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.
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14
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Boutsioukis C, Psimma Z, van der Sluis LWM. Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int Endod J 2013; 46:599-618. [DOI: 10.1111/iej.12038] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Affiliation(s)
- C. Boutsioukis
- Physics of Fluids Group; Faculty of Science and Technology, and MESA+ Institute for Nanotechnology; University of Twente; Enschede; the Netherlands
| | - Z. Psimma
- Department of Endodontology; Dental School; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - L. W. M. van der Sluis
- Department of Conservative Dentistry and Endodontics; Paul Sabatier University; Toulouse; France
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15
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Bosch-Aranda ML, Canalda-Sahli C, Figueiredo R, Gay-Escoda C. Complications following an accidental sodium hypochlorite extrusion: A report of two cases. J Clin Exp Dent 2012; 4:e194-8. [PMID: 24558554 PMCID: PMC3917647 DOI: 10.4317/jced.50767] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 01/05/2012] [Indexed: 11/27/2022] Open
Abstract
Sodium hypochlorite (NaOCl) is the most commonly used solution in root canal treatments, as it is a low-cost method that displays a very effective antimicrobial activity against microbiota of infected root canals. However, this solution can cause complications especially due to its cytotoxic features. When this solution is injected into the adjacent tissues, the patient usually experiences intense pain, and an urgent treatment should be implemented in order to prevent a long-term sequelae.
This paper describes the clinical features of two patients that experienced an accidental extrusion of NaOCl after endodontic treatment of varying severity and with different treatments. Furthermore, it shows the long-term neurologic injuries that this type of accidents may cause and a treatment protocol for these situations will be suggested.
Key words:Nerve damage, root canal irrigation, root canal treatment, sodium hypochlorite.
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Affiliation(s)
- María L Bosch-Aranda
- DDS. Fellow of the Postgraduate Oral Surgery and Orofacial Implantology, School of Dentistry, University of Barcelona (Spain)
| | - Carlos Canalda-Sahli
- DDS, MD, PhD. Professor of Endodontics, School of Dentistry, University of Barcelona (Spain). Researcher of the IDIBELL Institute. Barcelona (Spain)
| | - Rui Figueiredo
- DDS. Associate Professor of Oral Surgery. Professor of the Master of Oral Surgery and Orofacial Implantology. School of Dentistry of the University of Barcelona. Researcher of the IDIBELL Institute. Barcelona (Spain)
| | - Cosme Gay-Escoda
- DDS, MD, PhD. Chairman and Professor of Oral and Maxillofacial Surgery. Director of the Master of Oral Surgery and Orofacial Implantology. School of Dentistry of the University of Barcelona. Coordinator/Researcher of the IDIBELL Institute. Oral and Maxillofacial Surgeon of the Teknon Medical Center, Barcelona (Spain)
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Bidar M, Hooshiar S, Naderinasab M, Moazzami M, Orafaee H, Naghavi N, Jafarzadeh H. Comparative study of the antimicrobial effect of three irrigant solutions (chlorhexidine, sodium hypochlorite and chlorhexidinated MUMS). J Contemp Dent Pract 2012; 13:436-9. [PMID: 23151688 DOI: 10.5005/jp-journals-10024-1164] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To compare the antimicrobial effect of 2% chlorhexidine, 2.5% sodium hypochlorite and MUMS containing 2% chlorhexidine. MATERIALS AND METHODS All of the above irrigants were examined on Enterococcus faecalis, Streptococcus mutans, Candida albicans, Lactobacillus casei and E. coli. A total of 0.5 CC of each solution and 0.5 CC of McFarland solution bacterium were added to each examination tube. After 15, 30 and 45 minutes, colony count was performed for each tube. The difference in the number of bacteria indicated the effect taken by disinfectant material. RESULTS MUMS containing chlorhexidine showed the antimicrobial properties just like chlorhexidine's effect against E. coli, Streptococcus mutans, Candida albicans, Enterococcus faecalis and Lactobacillus casei in preventing these entire microorganisms to incubate. Sodium hypochlorite was not effective against Enterococcus faecalis and Candida albicans incubated in 15, 30 and 45 minutes and Enterococcus faecalis in 15 minutes. CONCLUSION MUMS has antimicrobial properties similar to chlorhexidine. CLINICAL SIGNIFICANCE As MUMS containing chlorhexidine can transfer chlorhexidine through its own surfactant around apical area and it can open the dentinal tubules by its own chelator for more penetration of chlorhexidine, it may be a choice for canal irrigation.
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Affiliation(s)
- Maryam Bidar
- Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Pannkuk TF. A New Technique for Nonsurgical Retreatment of Teeth with Amalgam Root End Fillings: Case Series. J Endod 2011; 37:414-9. [DOI: 10.1016/j.joen.2010.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
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18
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Bactericidal activity of erbium, chromium:yttrium–scandium–gallium–garnet laser in root canals. Lasers Med Sci 2009; 25:805-10. [DOI: 10.1007/s10103-009-0693-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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19
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Motta MV, Chaves-Mendonca MAL, Stirton CG, Cardozo HF. Accidental injection with sodium hypochlorite: report of a case. Int Endod J 2009; 42:175-82. [PMID: 19134046 DOI: 10.1111/j.1365-2591.2008.01493.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM A case is reported in which sodium hypochlorite (NaOCl) was mistaken for anaesthetic solution and infiltrated into the buccal mucosa during routine root canal treatment. SUMMARY A 1.5% sodium hypochlorite solution, kept in an anaesthetic cartridge, was inadvertently injected in the buccal mucosa of a 56-year-old female during routine root canal treatment. Soft tissue necrosis, labial ptosis and paraesthesia occurred shortly after the injection. Tissues healed with scarring and lip paraesthesia persisted for 3 years. KEY LEARNING POINTS * NaOCl is highly irritant when introduced into oral tissues. * NaOCl solutions should not be kept in anaesthetic cartridges. * Accidents with NaOCl should be carefully assessed and when appropriate active hospital treatment should be sought. * Early recognition of NaOCl accidents may avert potentially more serious outcomes.
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Affiliation(s)
- M V Motta
- Faculdade de Odontologia, Departamento de Odontologia Social, Universidade de São Paulo, São Paulo, Brazil
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20
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21
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The Sodium Hypochlorite Accident: Experience of Diplomates of the American Board of Endodontics. J Endod 2008; 34:1346-1350. [DOI: 10.1016/j.joen.2008.07.021] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/22/2008] [Accepted: 07/27/2008] [Indexed: 11/19/2022]
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22
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Shabahang S, Aslanyan J, Torabinejad M. The Substitution of Chlorhexidine for Doxycycline in MTAD: The Antibacterial Efficacy Against a Strain of Enterococcus faecalis. J Endod 2008; 34:288-90. [DOI: 10.1016/j.joen.2007.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 12/17/2007] [Accepted: 12/17/2007] [Indexed: 11/29/2022]
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23
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Hauser V, Braun A, Frentzen M. Penetration depth of a dye marker into dentine using a novel hydrodynamic system (RinsEndo�). Int Endod J 2007; 40:644-52. [PMID: 17532774 DOI: 10.1111/j.1365-2591.2007.01264.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To investigate the efficiency of a hydrodynamic irrigation system compared with conventional cleansing techniques in root canals. METHODOLOGY Forty-five freshly extracted single-rooted teeth were de-coronated and their root canals were enlarged to size 30 at the apex. The teeth were randomly divided into three groups (n = 15) for the final rinsing sequence using 2% NaOCl plus acid fuchsin: group I: static application of irrigant, 3 min; group II: flushing with a syringe; 5-mL NaOCl, 1 min; group III: RinsEndo-system; 5-mL NaOCl, 50 s. Apical extrusion was documented photographically. The roots were sectioned at 2, 4, 6 and 8 mm from their apices and the penetration depths of dye into dentine measured, using a stereomicroscope. Wilcoxon's test and Pearson's chi-squared test were employed to prove statistic relevance. RESULTS Greater dye penetration depth into the dentinal tubules was achieved when employing hydrodynamic rinsing procedures. Using this technique, 23% of the specimens were penetrated for more than 50% of their dentine thickness, whereas the results for flushing with a syringe were 12% (static application, 7%). No penetration of dentine occurred in 63% of specimens with static application, 39% flushing with a syringe and 15% using the hydrodynamic system (P < 0.05 Pearson's chi-squared test). Apical extrusion occurred more frequently after hydrodynamic rinsing (extruded specimens: RinsEndo = 80%; static application/flushing with a syringe = 13%; P < 0.05 Pearson's chi-squared test). CONCLUSIONS Hydrodynamic rinsing demonstrated an improvement over conventional methods in terms of dentine penetration of a dye marker. A higher risk of apical extrusion with the RinsEndo-system was evident.
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Affiliation(s)
- V Hauser
- Department of Periodontology, Operative and Preventive Dentistry, University Dental Clinic, Bonn, Germany
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24
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Spencer HR, Ike V, Brennan PA. Review: the use of sodium hypochlorite in endodontics — potential complications and their management. Br Dent J 2007; 202:555-9. [PMID: 17496870 DOI: 10.1038/bdj.2007.374] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2006] [Indexed: 11/09/2022]
Abstract
Aqueous sodium hypochlorite (bleach) solution is widely used in dental practice during root canal treatment. Although it is generally regarded as being very safe, potentially severe complications can occur when it comes into contact with soft tissue. This paper discusses the use of sodium hypochlorite in dental treatment, reviews the current literature regarding hypochlorite complications, and considers the appropriate management for a dental practitioner when faced with a potentially adverse incident with this agent.
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25
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HÜLSMANN MICHAEL, RÖDIG TINA, NORDMEYER SABINE. Complications during root canal irrigation. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1601-1546.2009.00237.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Abstract
A case of accidental skin injury caused by leakage of sodium hypochlorite solution from the rubber dam during root canal preparation is reported. After placement of a rubber dam and initiation of root canal treatment, the patient complained of a burning sensation with sodium hypochlorite irrigation. The complaints were ignored by the practitioner, and a skin rash developed on and around the patient's chin, followed by scab formation. The patient required medical treatment with topical Hamamelis virginiana extract for 2 weeks, with full recovery.
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Affiliation(s)
- Ahmet Serper
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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27
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Abstract
The anatomical and clinical significance of the maxillary sinus in relation to conventional and surgical endodontic therapy is considered. The discussion includes a review on the development, anatomy and physiology of the maxillary sinus, the diagnostic evaluation of the sinus and the differential diagnosis of sinusitis. Endodontic implications of the maxillary sinus include extension of periapical infections into the sinus, the introduction of endodontic instruments and materials beyond the apices of teeth in close proximity to the sinus and the risks and complications associated with endodontic surgery.
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Affiliation(s)
- C H J Hauman
- Departments of Oral Rehabilitation and Stomatology, School of Dentistry, University of Otago, Dunedin, New Zealand
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Abstract
LITERATURE REVIEW AND CASE REPORTS: The literature concerning the aetiology, symptomatology and therapy of complications during root canal irrigation is reviewed. Three cases of inadvertent injection of sodium hypochlorite and hydrogen peroxide beyond the root apex are presented. Clinical symptoms are discussed, as well as preventive and therapeutic considerations.
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Affiliation(s)
- M Hülsmann
- Department of Operative Dentistry, University of Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen
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