title: Alveolar mucosa necrosis induced by utilisation of calcium hydroxide as root canal dressing.
abstract: This case demonstrates the ability of calcium hydroxide to cause connective tissue necrosis. A patient with a history of trauma exhibited a large area of external inflammatory root resorption affecting the cervical and middle thirds of tooth 12. After root canal cleaning, a calcium hydroxide root canal dressing was applied to control the resorption process. After three days when the patient attended for replacement of the dressing an irregular zone of necrosis was observed on the buccal aspect of the alveolar mucosa. Careful curettage and irrigation was then performed to remove the extruded calcium hydroxide and necrotic tissue. After curettage, the root canal was accessed and irrigated with saline solution for removal of remnants of the dressing. The dressing was than replaced taking care to avoid contact with soft tissue, which might induce further damage, minimising the overflow of material. Improvement in healing was observed at 15-day follow-up, with complete closure of the lesion by soft tissue. At the 120-day follow-up, no scar was detected. At 180-day follow-up, the root canal was filled only with mineral trioxide aggregate (MTA) with aid of K files #20 and #50. At two-year follow-up, there were no symptoms and the resorption process seemed to have ceased. It is important to emphasise the damage that may occur when calcium hydroxide is in close and extended contact with the soft tissues, which could happen when dressing material is extruded through a root resorption.
authors.affiliation: Department of Endodontics, Brazillian Dental School-Ceará, Brazil.
authors.forename: Clóvis Monteiro
authors.initials: CM
authors.lastname: Bramante
authors.forename: Suyane Maria
authors.initials: SM
authors.lastname: Luna-Cruz
authors.forename: Carla Renata
authors.initials: CR
authors.lastname: Sipert
authors.forename: Noberti
authors.initials: N
authors.lastname: Bernadineli
authors.forename: Roberto Brandão
authors.initials: RB
authors.lastname: Garcia
authors.forename: Ivaldo Gomes
authors.initials: IG
authors.lastname: de Moraes
authors.forename: Bruno Carvalho
authors.initials: BC
authors.lastname: de Vasconcelos
mesh_terms: D000328:Adult; D002126:Calcium Hydroxide / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D005260:Female; D006801:Humans; D009061:Mouth Mucosa / Q000187:drug effects*; D009336:Necrosis / Q000139:chemically induced; D012388:Root Canal Irrigants / Q000009:adverse effects*; D012391:Root Resorption / Q000188:drug therapy*
chemical_list: D012388:Root Canal Irrigants; D002126:Calcium Hydroxide