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SHORT COMMUNICATION  
Year : 2014  |  Volume : 25  |  Issue : 3  |  Page : 413-415
Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar


1 Dentistry and Maxillofacial Surgery Clinic, Faculty of Medicine, University of Verona, Italy
2 Department of Biomedical and Neuromotorial Science, University of Bologna, Italy
3 Private Dentist, Vicenza, University of Padua, Italy
4 Department of Neurosciences, University of Padua, Italy

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Date of Submission29-Jan-2010
Date of Decision03-May-2010
Date of Acceptance30-Jun-2010
Date of Web Publication7-Aug-2014
 

   Abstract 

Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN). We report a case of disabling dysesthesia and paresthesia of a 70-year-old man after endodontic treatment of his mandibular left third molar that caused leakage of root canal filling material into the mandibular canal. After radiographic evaluation, extraction of the third molar and distal osteotomy, a surgical exploration was performed and followed by removal of the material and decompression of the IAN. The patient reported an improvement in sensation and immediate disappearance of dysesthesia already from the first postoperative day.

Keywords: Dysesthesia, overfilling, paresthesia

How to cite this article:
Scala R, Cucchi A, Cappellina L, Ghensi P. Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar. Indian J Dent Res 2014;25:413-5

How to cite this URL:
Scala R, Cucchi A, Cappellina L, Ghensi P. Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar. Indian J Dent Res [serial online] 2014 [cited 2020 Jul 6];25:413-5. Available from: http://www.ijdr.in/text.asp?2014/25/3/413/138362
Endodontic treatment of third molars often becomes part of comprehensive treatment plan, as it represents a more conservative and less invasive approach than its therapeutic alternatives. [1]

Each endodontic procedure has an inherent risk; overfilling of root canals is one frequent complication of endodontic therapy and generally the result of over-instrumentation of the root canal. [2] In cases where overfilled teeth are in connection with anatomically important structures, such as nerves, blood vessels, or sinus space, the consequences can be severe. [3] Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN), resulting in disabling sensory disturbances such as pain, dysesthesia, paresthesia, hypoesthesia, or anesthesia. [4]

Treatment alternatives to correct the overfilling are not many: immediate apicectomy and decompression of the nerve with conservation of the tooth is often the treatment of choice; but in some cases, extraction of the tooth was suggested or recommended to ease surgery and to improve prognosis. [5],[6]


   Case report Top


A 70-year-old man was referred to the Department of Dentistry and Maxillofacial Surgery at the University of Verona for altered sensations of the left side of the lower lip, after he had undergone an endodontic treatment of his lower left third molar 2 weeks before in a private office. The private dentist had previously treated the patient with antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and carbamazepine for reducing distress and pain appeared after anesthesia dissolution, but they did not have any positive effects. After 14 days, the patient came to our department for a first visit, during which the radiographic and clinical evaluations were conducted to determine the reason and status of sensory disturbances.

Periapical radiograph, orthopantomography and computerized tomography showed root canal filling material over the apex of the third molar, located in the mandibular canal [Figure 1]. Clinical examination revealed reduced sensation to light touch in the area of the left mental nerve as well as dysesthesia with tingling and spontaneous pain sensation in the left molar and premolar area of the mandible. An electrophysiological evaluation of IAN was also prescribed as a reliable way to assess the degree of IAN dysfunction and to identify the injury of nerve integrity.
Figure 1: Preoperative radiograph showing overfilled material

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The nerve conduction study (NCS) showed a nerve conduction deficit for left side compared to the right side, which instead showed a normal conduction [Figure 2]. A wide-based, three-sided mucoperiosteal flap was raised, and extraction of the third molar and distal osteotomy of alveolar bone was done under general anesthesia to access and decompress the mandibular canal. The inspection of mandibular canal revealed the presence of guttapercha material above the IAN [Figure 3] and [Figure 4]. This caused foreign body reaction with consequent compression of the nerve. Meticulous fragmentation and removal of guttapercha to decompress the nerve was done to prevent permanent neurologic injury [Figure 5]. The surgical site was irrigated using physiologic solution (0.9% normal saline) and flap was repositioned and sutured with 3-0 silk suture material. A postoperative endoral radiograph was taken to assess the complete removal of root canal filling material [Figure 6]. The patient reported immediate disappearance of pain and a significant improvement in sensation on the first postoperative day. A complete recovery of neural functions was clinically assessed and confirmed by means of the NCS after 7 days of surgery. NCS revealed a complete resolution of the nerve conduction deficit for the left side, which is observable in [Figure 7].
Figure 2: Graph showing nerve conduction deficit for the left side compared to the right side

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Figure 3: Intraoperative radiograph after tooth extraction

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Figure 4: Clinical view of inferior alveolar nerve with guttapercha debris after exposure and management of the nerve

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Figure 5: Clinical view of inferior alveolar nerve after decompression and guttapercha removal

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Figure 6: Postoperative radiograph showing guttapercha removed

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Figure 7: Graph showing a complete resolution of the nerve conduction deficit for the left side

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   Discussion Top


The lesion of the inferior dental nerve after endodontic treatments represents a very rare complication in root canal therapy. [6] The symptomatology caused by the lesion can be temporary or permanent, depending on damage of nerve integrity. [7] The sensory dysfunctions associated with endodontic overinstrumentation or overfilling normally resolve within a few days; permanent paresthesia can result from unrepaired or poorly repaired laceration or avulsion of the nerve fibers, prolonged pressure on the nerve or extended/direct contact with toxic endodontic materials. [6] In the case presented here, persistent symptoms led to the treatment choice of surgical decompression. It is important to underscore the fact that this procedure caused an immediate pain relief and improvement in sensation, despite remarkable manipulation of the IAN, which was exposed, carefully freed, and cautiously scraped. Electrophysiological test was used before and after surgery in order to objectively assess the outcome of treatment. [8] This case report can be considered very interesting with regards to two aspects, which should be emphasized. First is the increased risk of neurosensory disturbance associated with contact between filling materials and IAN. In a number of patients, the mandibular canal and the radicular apex are in close proximity to each other and this should be evaluated before endodontic treatment is performed. Second, early surgical treatment seems to represent the best choice in these cases, considering extremely successful outcome, as demonstrated in other studies. [4],[9]


   Financial disclosure Top


The authors have no financial interest in any company or in any of the products mentioned in this article.

 
   References Top

1.Silberman A, Heilborn C, Cohenca N. Endodontic therapy of a mandibular third molar with 5 canals: A case report. Quintessence Int 2009;40:4535.  Back to cited text no. 1
    
2.Ektefaie MR, David HT, Poh CF. Surgical resolution of chronic tissue irritation caused by extruded endodontic filling material. J Can Dent Assoc 2005;71:487490.  Back to cited text no. 2
    
3.Yamaguchi K, Matsunaga T, Hayashi Y. Gross extrusion of endodontic obturation materials into the maxillary sinus: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:1314.  Back to cited text no. 3
    
4.Scolozzi P, Lombardi T, Jaques B. Successful inferior alveolar nerve decompression for dysesthesia following endodontic treatment: Report of 4 cases treated by mandibular sagittal osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:62531.  Back to cited text no. 4
    
5.Grötz KA, Al-Nawas B, de Aguiar EG, Schulz A, Wagner W. Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig 1998;2:736.  Back to cited text no. 5
    
6.GallasTorreira MM, ReboirasLópez MD, GarcíaGarcía A, GándaraRey J. Mandibular nerve paresthesia caused by endodontic treatment. Med Oral 2003;8:299303.   Back to cited text no. 6
    
7.Kothari P, Hanson N, Cannell H. Bilateral mandibular nerve damage following root canal therapy. Br Dent J 1996;180:18990.  Back to cited text no. 7
    
8.Nocini PF, De Sanctis D, Fracasso E, Zanette G. Clinical and electrophysiological assessment of inferior alveolar nerve function after lateral nerve transposition. Clin Oral Implants Res 1999;10:12030.  Back to cited text no. 8
    
9.Pogrel MA. Damage to the inferior alveolar nerve as the result of root canal therapy. J Am Dent Assoc 2007;138:65-9.  Back to cited text no. 9
[PUBMED]    

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Correspondence Address:
Paolo Ghensi
Department of Neurosciences, University of Padua
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.138362

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]

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