Inferior alveolar nerve damage because of overextended endodontic material: a problem of sealer cement biocompatibility?
Damage to the inferior alveolar nerve is a relatively infrequent complication in dental practice. When root canal treatment of a lower molar or premolar surpasses and/or overextends beyond the apical foramen and invades the periapical zone, the foreign material introduced within such a sensitive anatomical space may mechanically or even chemically affect the inferior alveolar nerve. We describe a case of endodontic treatment of a permanent right lower first molar in which the sealer cement overextended in large amounts and damaged the right inferior alveolar nerve. The condition reverted a few months after the surgical removal of the material. Evaluation of the removed material, using powder x-ray diffraction and scanning electron microscopy with coupled dispersive energy spectroscopy, showed it to consist of calcium tungstate (scheelite [CaWO4]) and zirconium oxide (baddeleyite [ZrO2]), which were chemical components of the sealer cement.
Department of Oral Surgery and Implantology, Barcelona University Dental School, Barcelona, Spain.
Jaume
J
Escoda-Francoli
Carles
C
Canalda-Sahli
Albert
A
Soler
Rui
R
Figueiredo
Cosme
C
Gay-Escoda
D000328:Adult; D017610:Calcium Compounds / Q000009:adverse effects; D020209:Cranial Nerve Injuries / Q000139:chemically induced*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications* / Q000601:surgery; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology*; D006801:Humans; D008963:Molar; D012387:Root Canal Filling Materials / Q000009:adverse effects* / Q000737:chemistry; D012389:Root Canal Obturation / Q000009:adverse effects*; D061221:Trigeminal Nerve Injuries; D017973:Tungsten Compounds / Q000009:adverse effects; D015040:Zirconium / Q000009:adverse effects
D017610:Calcium Compounds; D012387:Root Canal Filling Materials; D017973:Tungsten Compounds; C018858:calcium tungstate; D015040:Zirconium; C028541:zirconium oxide