Betül Aycan UYSAL, Tuğçe Yuca ÖZTÜRK, Mehmet Burak GUNESER

ENDODONTİK TEDAVİ SIRASINDA SODYUM HİPOKLORİTİN YANLIŞLIKLA APİKALDEN YUMUŞAK DOKULARA EKSTRÜZYONU: OLGU BİLDİRİMİ

Kök kanal tedavisi sırasında en çok kullanılan irrigasyon solüsyonu sodyum hipoklorittir. Sodyum hipokloritin antimikrobiyal özelliğine ek olarak en önemli avantajı iyi bir organik doku çözücü olmasıdır. Endodontide %0.5–6 konsantrasyon aralığında kullanılmaktadır ve yüksek konsantrasyonlarda, canlı dokular için son derece toksiktir. Dikkatsiz kullanımı ya da hastada mevcut olan anatomik/patolojik değişiklikler sonucu sodyum hipoklorit apikalden ekstrüze olabilir. Toksik etkisi nedeniyle dokuda ülserasyon, sinir hasarı, nekroz ve bazen geri dönüşümsüz hasarlara yol açabilir. Bu nedenle hastanın klinik ve radyolojik muayenesini detaylı yapmak, irrigasyon aşamasında dikkatli olmak ve oluşabilecek bir komplikasyonu yönetebilmek önemlidir.

Anahtar Kelimeler:

sodyum hipoklorit, sodyum hipoklorit kazası, kök kanal tedavisi

Inadvertently Extrusion of Sodium Hypochlorite During Endodontic Treatment From Apical to Soft Tissues: A Case Report

The most commonly used irrigation solution during root canal treatment is sodium hypochlorite. In addition to the antimicrobial properties of sodium hypochlorite, the most important advantage is that it dissolves the organic tissues. It is used in the concentration range of %0.5-6 in endodontics and is highly toxic to vital tissues at high concentrations. As a result of careless use or anatomical/pathological changes in patient, sodium hypochlorite may be extrusion from the apical. It may cause ulceration, nerve damage, necrosis and sometimes irreversible injury due to toxic effect. Therefore, it is important to perform detailed clinical and radiological examination of the patient, to be careful during the irrigation phase and to manage a possible complication.

Keywords:

sodium hypochlorite, sodium hypochlorite accident, root canal treatment,

PDF

___

1. Zehnder M. Root canal irrigants. J Endod 2006;32:389–98.
2. Gatot A, Arbelle J, Leiberman A, Yanai-Inbar I. Effects of sodium hypochlorite on soft tissues after its inadvertent injection beyond the root apex. J Endod. 1991;17:573- 4.
3. Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M. Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J 2004;37:272-80.
4. Pelka M, Petschelt A. Permanent mimic musculature and nerve damage caused by sodium hypochlorite: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:80-3.
5. Kaufman AY, Keila S. Hypersensitivity to sodium hypochlorite. J Endod 1989;15:224-6.
6. Serper A, Ozbek M, Calt S. Accidental sodium hypochlorite induced skin injury during endodontic treatment. J Endod 2004;30:180-1.
7. Farook SA, Shah V, Lenouvel D, et al. Guidelines for management of sodium hypochlorite extrusion injuries. Br Dent J 2014;217:679–84.
8. Witton R, Henthorn K, Ethunandan M, Harmer S, Brennan PA. Neurological complications following extrusion of sodium hypochlorite solution during root canal treatment. Int Endod J 2005;38:843-8.
9. Hülsmann M, Hahn W. Complications during root canal irrigation–literature review and case reports. Int Endod J 2000;33(3):186-93.
10. Zhu WC, Gyamfi J, Niu LN, Schoeffel GJ, Liu SY, Santarcangelo F, Khan S, Tay KC, Pashley DH, Tay FR. Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent 2013; 41(11):935- 48.
11. Clegg MS, Vertucci FC, Walker C, Belanger M, Britto LR. The effect of exposure to irrigant solutions on apical dentin biofilms in vitro. J Endod 2006;32:5:434–437.
12. Kleier DJ, Averbach RE, Mehdipour O. The sodium hypochlorite accident: experience of diplomates of the American Board of Endodontics. J Endod 2008;34,1346–1350.
13. Vertucci FJ, Haddix JE, Britto LR. Tooth morphology and access preparation. Pathways of the Pulp, S. Cohen and K.M.Hargreaves, Eds, Mosby, St. Louis, Mo, USA, 9th edition 2006; pp. 197–199.
14. Bowden JR, Ethunandan M, Brennan PA. Life-threatening airway obstruction secondary to hypochlorite extrusion during root canal treatment. Oral Surg Oral Med Oral PathoL Oral Radiol Endod 2006;101,402– 404.
15. Mehra P, Clancy C, Wu J. Formation of a facial hematoma during endodontic therapy. J Am Dent Assoc 2000; 131:1: 67–71.
16. Spangberg L, Engstrom B, Langeland K. Biologic effects of dental materials. 3. Toxicity and antimicrobial effect of endodontic antiseptics in vitro. Oral Surg Oral Med Oral PathoL Oral Radiol Endod 1973;36,6,856– 871.
17. Hülsmann M, Rödig T, Nordmeyer S. Complications during root canal irrigation: literature review and case reports. Endod Topics. 2009; 16:27-63.
18. Bosch-Aranda ML, Canalda-Sahli C, Figueiredo R, Gay-Escoda C. Complications following an accidental sodium hypochlorite extrusion: A report of two cases. J Clin Exp Dent. 2012;4:194-198.
19. Motta MV, Chaves-Mendonça MA, Stirton CG, Cardozo HF. Ac5. cidental injection with sodium hypochlorite: Report of a case. Int Endod J 2009;42:175-82.
20. Caliskan MK, Turkun M, Alper S. Allergy to sodium hypochlorite during root canal therapy: a case report. Int Endod J 1994;27:163-7.
21. Spencer HR, Ike V, Brennan PA. Review: the use of sodium hypochlorite in endodontics potential complications and their management. Br Dent J 2007;202:555-9.