Iranian Endodontic Journal

Abstract

Premixed non-setting calcium hydroxide (CaOH₂) 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 CaOH₂ 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 CaOH₂ 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 CaOH₂ should be carried out with care and preferably applied free hand or with a lentulo spiral rather than in a pressure syringe.