Calcium Silicate-based Sealer Extrusion into the Mandibular Canal: 3 Different Recovery Outcomes-A Report of 3 Cases.

The use of calcium silicate-based sealers (CSSs) is increasing in dentistry as a result of their favorable properties. The inadvertent extrusion of these sealers into the mandibular canal (MC) can result in temporary or permanent neurosensory alterations. Three different recovery outcomes of CSS extrusion into the MC after endodontic treatment of mandibular molars confirmed by cone-beam computed tomographic imaging are described. In Case 1, CSS from the mesiolingual canal of tooth #31 was extruded into the MC during obturation. The patient reported paresthesia. The symptoms of paresthesia were completely resolved by 9 months. In Case 2, CSS from the mesial canals of tooth #30 was extruded into the MC during obturation. A "plasmalike spreading pattern" of the extruded sealer was observed on the radiographs. The patient reported paresthesia and dysesthesia. In addition, the patient complained of hyperalgesia with heat and mechanical allodynia. The symptoms continued to persist during follow-up. At 22 months, the patient still reported persistent paresthesia, hyperalgesia, and mechanical allodynia, affecting the ability to eat. In Case 3, CSS from the distal canal of tooth #31 was extruded into the MC during obturation. The patient did not report any paresthesia or dysesthesia. All 3 patients elected a follow-up approach and monitoring rather than surgical intervention. These cases illustrate the need for the development of guidelines for the management of iatrogenic CSS extrusion into the MC because such an occurrence may result in permanent, temporary, or no neurosensory alterations.

Treating Nerve Injury after Endodontic Microsurgery Using Laser Photobiomodulation: A Report of 2 Cases.

The purpose of this case report was to inform dentists and dental specialists about a noninvasive, viable treatment option that could aid in the recovery of patients who have experienced iatrogenic nerve injuries. Nerve injury is an inherent risk of many dental procedures and a complication that can negatively impact a patient's quality of life and activities of daily living. Managing neural injuries presents a challenge for clinicians because there are no standard protocols reported in the literature. Although spontaneous healing of these injuries can occur, the duration and degree of healing can vary greatly between individuals. Photobiomodulation (PBM) therapy is used as an adjunct in medicine for functional nerve recovery. Once target tissues are illuminated with a low-level laser during PBM, the light energy is absorbed by the mitochondria causing adenosine triphosphate production, modulation of reactive oxygen species, and the release of nitric oxide. These cellular changes explain why PBM has been shown to aid in cell repair, vasodilation, a reduction in inflammation, accelerated healing, and an improvement in postoperative pain. This case report presents 2 patients with neurosensory alterations after endodontic microsurgery with a significant improvement in their condition after PBM treatment using a 940-nm diode laser.