Hypochlorite-induced severe cellulitis during endodontic treatment: case report

Resumo

Sodium hypochlorite is a solution used in endodontic
treatment, and if an accidental apical extrusion occurs, serious
complications may affect soft tissue. Objective: The aim of this
article is to present a case of apical extrusion of sodium hypochlorite
(NaOCl) during root canal system instrumentation. Case report:
A 28-year-old woman sought a local dental service for root canal
treatment of tooth #24. Conventional endodontic treatment was
adopted, which consisted of the use of 2.5% NaOCl solution as
irrigation solution applied with a 10-ml syringe and 22G hypodermic
needle. At that time, the patient reported extreme pain and a burning
sensation in the left maxillary region, followed by the formation of
intense edema. A clinical diagnosis of hypochlorite-induced cellulitis
was made. The patient was treated immediately with amoxicillin
(500 mg, orally) at intervals of 8 h for 7 days and dexamethasone
(4 mg, intramuscularly) at intervals of 24 h for 3 days. In the
subsequent endodontic treatment, 2% chlorhexidine gel applied
with a 5-ml syringe and 24G needle was used as irrigation for a
better control of treatment and to prevent new accidents. The root
canals were instrumented using adequate crown-down technique,
which provides a conical shape, and filled by lateral condensation
technique. The patient was symptom free at the 8-month clinical follow-up. Conclusion: Dentists should always carefully follow all
stages of dental treatment planning without neglecting any of them,
paying attention to the solutions used and their storage as well
as performing a specific technique with maximum accuracy. If an
accident occurs, the appropriate handling of the situation will enable
the satisfactory completion of treatment.