Professional Documents
Culture Documents
canal treatment
Ruth Fuentes de Sermeo, DDS,a La Assed Bezerra da Silva, DDS, PhD,b
Henry Herrera, DDS, PhD,c Helen Herrera, DDS, PhD,c Raquel Assed Bezerra Silva, DDS, PhD,d
and Mrio Roberto Leonardo, DDS, PhD,b San Salvador, El Salvador and Ribeiro Preto, Brazil
UNIVERSIDAD EVANGELICA DE EL SALVADOR AND UNIVERSITY OF SO PAULO
Sodium hypochlorite solution is toxic to vital tissues, causing severe effects if extruded during endodontic
treatment. This paper presents a report on the tissue damage related to inadvertent extrusion of concentrated sodium
hypochlorite solution during root canal treatment. A 65-year-old woman was referred with moderate pain, ecchymosis,
and severe swelling of the right side of the face. These symptoms appeared immediately after a root canal treatment of
the maxillary right canine, which had been started 21 hours earlier. It was diagnosed as air emphysema related to
sodium hypochlorite solution extravasation during the endodontic treatment. To avoid this, an initial radiograph
should be taken to determine the correct canal working length and confirm root canal integrity. (Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2009;108:e46-e49)
e46
OOOOE
Volume 108, Number 1
sodium hypochlorite solution and the biomechanical preparation was performed with NiTi rotary files (K3 Endo System;
SybronEndo Corporation, Orange, CA) used in the crowndown mode. The working length (23 mm) was determined to
1 mm short of the radiographic apex by using #30 K-files.
e48
OOOOE
July 2009
DISCUSSION
Sodium hypochlorite solution is considered to be an
effective endodontic irrigation solution used in different concentrations. This solution is able to disorganize
the endodontic biofilm12 but is an extremely tissuecytotoxic chemical solution.9
The endodontic literature contains several case reports on complications during root canal irrigation,
including inadvertent injection of NaOCl solution into
periapical tissues, emphysema, and allergic reactions to
this solution. The emphysema is caused by oxygen
liberation into the tissues.
When it comes into contact with vital tissue, NaOCl
causes hemolysis and ulceration, inhibits neutrophil
migration, and damages endothelial and fibroblast
cells.9,13 The toxic effect of NaOCl occurs because of
its alkalinity (pH 10.8-12.9) and hypertonicity, which
causes injury predominantly by oxidation of proteins
and lipid membranes.14,15 Clinically, the patients report
severe pain and present ecchymosis, hematoma, and
Fig. 5. Facial view 1 month after the first endodontic treatment. Most facial changes have resolved.
OOOOE
Volume 108, Number 1
8.
9.
10.
11.
12.
13.
14.
REFERENCES
1. Peters OA, Barbakow F, Peters CI. An analysis of endodontic
treatment with three nickel-titanium rotary root canal preparation
techniques. Int Endod J 2004;37:849-59.
2. Young GR, Parashos P, Messer HH. The principles of techniques
for cleaning root canals. Aust Dent J 2007;52:S52-63.
3. Naenni N, Thoma K, Zehnder M. Soft tissue dissolution capacity
of currently used and potential endodontic irrigants. J Endod
2004;30:785-7.
4. Baumgartner JC, Mader CL. A scanning electron microscopic
evaluation of four root canal irrigation regimens. J Endod
1987;13:147-57.
5. Radcliffe CE, Potouridou L, Qureshi R, Habahbeh N, Qualtrough
A, Worthington H, Drucker DB. Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic
microorganisms Actinomyces israelii, A. naeslundii, Candida
albicans and Enterococcus faecalis. Int Endod J 2004;37:438-46.
6. Zehnder M, Kosicki D, Luder H, Sener B, Waltimo T. Tissuedissolving capacity and antibacterial effect of buffered and unbuffered hypochlorite solutions. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2002;94:756-62.
7. Hlsmann M, Hahn W. Complications during root canal irriga-
15.
16.
17.
Reprint requests:
Profa. Dra. Raquel Assed Bezerra da Silva
Departamento de Clinica, Infantil, Odontologia Preventiva e Social
Faculdade de Odontologia de Ribeiro Preto
Universidade de So Paulo
Avenida do Caf s/n, Monte Alegre
14040-904 Ribeiro, Preto, SP
Brazil
raquel@forp.usp.br