ENDODONTİK SODYUM HİPOKLORİT KOMPLİKASYONLARININ DEĞERLENDİRİLMESİ VE BİR OLGU BİLDİRİSİ
Bu makalede, NaOCl’in endodontik kullanımıma bağlı olarak gelişen, alerji ve kök ucundan periapikal dokulara taştığında oluşan komplikasyonlar değerlendirilmiştir. Makalede ayrıca bir olguda gelişen NaOCl taşkınlığı olgusu ve tedavisi sunulmuştur. Hastanın sol üst kanin dişinde eksik yapılmış kanal tedavisi ve periapikal lezyon varlığı saptanmış ve kanal tedavisinin tekrarlanmasına karar verilmiştir. Anestezi altında %5,25’lik NaOCl ile irrigasyon yapılırken, hasta yanma tarzında bir ağrı belirtmiştir, kanal bol miktarda steril salin solüsyonu ile yıkanmış ve kanal tedavisi aynı seansta tamamlanmıştır. Hastada tedavi sonrasında şişlik ve parastezi gelişmiştir. Oluşan şişlik 1 hafta sonra parestezi ise 3 ay sonra düzelmiştir. NaOCl’in periapikal dokulara taşması ile ciddi komplikasyonlar oluşabilmektedir. Uygun tedaviyle iltihaba bağlı şişlik, ekimoz gibi komplikasyonlar kısa sürede iyileşebilir fakat parestezinin çözülmesi uzun süre alabilmektedir. Diş hekimleri NaOCl kullanırken komplikasyonların gelişmemesi için çok dikkatli olmalı ve gerekli önlemleri almalıdır
This paper discusses the clinical complications of NaOCl solutions such as its extrusion through the root apex during canal irrigation and allergic reactions that may happen during the root canal treatments. In addition, a case of NaOCl extrusion that occurred during the treatment of a maxillary was presented left canine. During the treatment under local anesthesia, the patient reported a slight to moderate acute pain and burning around the tooth. The root canal was irrigated with copius sterile saline and the treatment was completed after cessation of the pain. The patient reported pain, swelling and paresthesia around the tooth following the treatment. The signs of chemical inflammation resolved in a week, but the paresthesia disappeared after 3 months. The extrusion of NaOCl into the periapical area may cause serious complications, such as acute severe pain, swelling and paresthesia. The dentists must apply the precautions of NaOCl irrigation during the root canal treatment and manage the treatment of this clinical complication
___
- [1] Crane A B. A practicable root canal
technique. Philadelphia: Lea & Febinger,
1920.
- [2] Alaçam T. Endodonti. Kök kanallarının
irrigasyonu. Nobel Kitabevi Adana,
2012, s 529-86.
- [3] Estrela C, Estrela R A C, Barbin E L et
al. Mechanism of action of sodium
hypochlorite. Braz Dent J 2002;13:113-7.
- [4] Sirtes G, Waltimo T, Schaetzle M et
al. The effects of temperature on sodium
hypochlorite short term stability,
pulp dissolution capacity and antimicrobial
efficacy. J Endod 2005; 31:669-71.
- [5] O’Hoy P Y, Messer H H, Palamara J E.
The effect of cleaning procedures on
fracture properties and corrosion of
NiTi files. Int Endod J 2003;36:724-32.
- [6] Ingram T A. Response of the human to
accidental exposure to sodium hypochlorite.
J Endod 1990;16:235-7.
- [7] Gatot A, Arbelle J, Leiberman A et al. Effects
of Sodium hypochlorite on soft tissues after
its inadvertent injection beyond the root apex.
J Endod 1991;17:573-4.
- [8] Spencer H.R, Ike V, Brennan P.A. Review:
the use of sodium hypochlorite in
endodontics — potential complications
and their management. British Dental Journal
2007;202:555-9.
- [9] Hülsmann M, Hahn W. Complications during
root canal irrigation – literature review and
case reports. Int Endod J 2000;33:186-93.
- [10] Marx, Hockberger, Wallis. Rosen’s
emergency medicine. Mosby Elsevier.UK
2006;6th ed: 931-3.
- [11] Becking A G. Complications in the use
of sodium hypochlorite during endodontic
treatment. Oral Surg Oral Med Oral Path
1991;71:346-8.
- [12] Bowden J R, Ethuandan M, Brennan P A.
Life threatening airway obstruction
secondary to hypochlorite extrusion during
root canal treatment. Oral Surg Oral Med
Oral Pathol Oral Radiol Oral Endod
2006;101:402-4.
- [13] Sulzberger M B. Dermatologic allergy:
an introduction in the form of a series of
lectures. Springfield, IL, USA: Charles C.
Thomas, 1940.
- [14] Cohen S, Burns R. Pathways of the pulp.
St Louis, MO, USA: CV Mosby
1984;3th ed:441-2.
- [15] Caliskan M K, Turkun M, Alper S. Allergy
to sodium hypochlorite during root canal
therapy: a case report. Int Endod
J 1994;27:163-7.
- [16] Kaufman A Y, Keila S. Hypersensitivity
to sodium hypochlorite. J Endod
1989;15:224-6.
- [17] Mehra P, Clancy C, Wu J. Formation of
a facial hematoma during endodontic therapy.
J Am Dent Assoc 2000;131:67-71.
- [18] Sabala G L, Powell S E. Sodium hypochlorite
injection into periapical tissues. J
Endod 1989;15:490-2.
- [19] Joffe E. Complication during root canal
therapy following accidental extrusion
of sodium hypochlorite through the
apical foramen. Gen Dent 1991;460-1.
- [20] Witton R, Henthorn K, Ethunandan M et
al. Neurological complications following
extrusion of sodium hypochlorite solution
during root canal treatment. Int Endod J
2005;38:843-8.
- [21] Kavanagh C P, Taylor J. Inadvertent injection
of sodium hypochlorite into the maxillary
sinus. Br Dent J 1998;185:336-7.
- [22] Gernhardt C R, Eppendorf K, Kozlowski
A et al. Toxicity of sodium hypochlorite
used as an endodontic irrigant. Int Dent J
2004;37:272-80.
- [23] Reeh E S, Messer H H. Long-term
paraesthesia following inadvertent forcing
of sodium hypochlorite through perforation
in maxillary incisor. Endod Dent Traumatol
1989;5:200-3.
- [24] Serper A, Ozbek M, Calt S. Accidental
sodium hypochlorite-induced skin injury
during endodontic treatment. J Endod
2004;30:180-1.
- [25] Hales J J, Jackson C R, Everett A P et al.
Treatment protocol for the management
of a sodium hypochlorite accident during
endodontic therapy. Gen Dent
2001;49:278-81.
- [26] Clarkson R M, Moule A J. Sodium
hypochlorite and its use as an endodontic
irrigant. Aust Dent J 1998;43:250-6.
- [27] Manogue M, Patel S, Walker R. The
principles of endodontics. Oxford, Oxford
University Press, 2005; s 138-9.
- [28] Mackie I C. UK National Clinical Guidelines
in Paediatric Dentistry. Management and
root canal treatment of non-vital immature
permanent incisor teeth. Faculty of Dental
Surgery, Royal College of Surgeons
Int J Paediatr Dent 1998;8:289-93.
- [29] Keçeci AD, Üreyen Kaya B, Çelik Ünal
G. Inadverdent injection of sodium
hypochlorite into periapical tissues: two case
reports. Clin Dent Res 2006;30:35-41.
- [30] Wang S-H, Chung M-P, Cheng J-C, et al.
Sodium hypochlorite accidentally extruded
beyond the apical foramen. J Med Sci
2000;30:61-5.
- [31] Linn JL, Messer HH. Hypochlorite injury to
the lip following injection via a labial
perforation. Case report. Aust Dent J
1993;38:280-2.
- [32] Guivarc’h M, Ordioni U, et al. Sodium
Hypochlorite Accident: A Systematic Review.
J Endod 2017;43:16-24.