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Management of Tooth and Observation of External Root Surface with Extrusion of Calcium Hydroxide-Containing Paste

Yoshiko Murakami Masuda*,Shigenori Suzuki,Yukiko Matsuda,Yuichi Kimura,Takashi Miyazaki

Introduction: Extrusion of the root canal filling materials is often absorbed and heals, which produces no irreversible changes. However, sometimes it causes the persisting pain and apical radiolucent. This case shows that extrusion of calcium hydroxide [Ca(OH)2] intracanal medicament caused the persistent percussion pain.

Methods: This case report describes the patient with extrusion of Ca(OH)2 into the periapical tissue in the mandibular right second premolar. A 48-year-old female presented with persistent occlusal pain. Radiographs revealed a radiolucent lesion in the periapical region of mandibular second premolar. The cone-beam computed tomography scan revealed the non-radiolucency root canal materials around the root apex and periapical radiolucency was present along with considerable external root resorption. After preparation, root canal was filled with gutta-percha cones and root canal sealer, and intentional replantation with apicoectomy was performed. The resected portion of root apex was observed by stereomicroscopy and scanning electron microscopy (SEM).

Results: The root surface contacted with Ca(OH)2 paste was observed by stereomicroscopy. SEM observation revealed that the area of the apical foramen was covered with the complex of the extended materials and resorption of apex was observed. At the 1-month recall appointment, the patient presented asymptomatically without tooth mobility. Five months after the surgery, radiograph showed new bone formation around periapical region. The patient had no clinical symptoms of pain.

Conclusions: The treatment had been successful, achieving adequate repair with 9 months of follow-up. Appropriate size of the apical foramen was essential for success of the root canal treatment. Extrusion of Ca(OH)2 paste caused persistent occlusal pain and the apical foramen coverage by the materials.