Postoperative management cement sealant extrusion: a case report

Abstract

Introduction: Injury to the inferior alveolar nerve (IAN) represents a serious complication of endodontic treatment, since, due to over-instrumentation of the canals, subsequent extrusion of irrigating agents, and over- extension of filling material, the possibility of a perforation of the inferior alveolar canal could occur, which can cause an IAN injury and compromise the success of the treatment.
Case description: We present the clinical case of a 41-year-old woman who attended the clinic of the Faculty of Dentistry of the University of Cuenca. She presented with pain in tooth 4.7. Clinical and radiographic examination revealed a distal carious lesion close to the pulp horn and a leaking restoration. A symptomatic irreversible pulpitis was diagnosed and endodontic treatment was started, using AH Plus epoxy resin cement and a thermoplastic filling technique. Upon completion of the filling, the patient reported severe pain. A periapical x-ray was taken, revealing extrusion of sealant at the level of the inferior alveolar nerve canal. A diagnosis of inferior alveolar nerve injury due to extrusion
of sealant cement was established, and the
symptoms were controlled with  harmacological treatment. Treatment and results: The patient was treated with prednisone to control inflammation and mitigate symptoms. This pharmacological
approach successfully resolved the pain, and the patient made a full recovery without the need for neurosurgical intervention. Conclusions: This case highlights the importance of meticulous technique during endodontic procedures to prevent complications such as sealant extrusion. When complications occur, early recognition and appropriate pharmacological treatment can effectively mitigate symptoms and promote recovery, potentially avoiding invasive interventions.