Öz

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

Anahtar Kelimeler

• Sodium hypochlorite, irrigation solution, apical extrusion, root canal treatment

ENDODONTİK SODYUM HİPOKLORİT KOMPLİKASYONLARININ DEĞERLENDİRİLMESİ VE BİR OLGU BİLDİRİSİ

Öz

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

Anahtar Kelimeler

• Sodyum hipoklorit, apikal taşkınlık, irrigasyon solüsyonu, kanal tedavisi

Kaynakça

1. [1] Crane A B. A practicable root canal technique. Philadelphia: Lea & Febinger, 1920.
2. [2] Alaçam T. Endodonti. Kök kanallarının irrigasyonu. Nobel Kitabevi Adana, 2012, s 529-86.
3. [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. [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. [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. [6] Ingram T A. Response of the human to accidental exposure to sodium hypochlorite. J Endod 1990;16:235-7.
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. [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. [9] Hülsmann M, Hahn W. Complications during root canal irrigation – literature review and case reports. Int Endod J 2000;33:186-93.
10. [10] Marx, Hockberger, Wallis. Rosen’s emergency medicine. Mosby Elsevier.UK 2006;6th ed: 931-3.
11. [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. [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. [13] Sulzberger M B. Dermatologic allergy: an introduction in the form of a series of lectures. Springfield, IL, USA: Charles C. Thomas, 1940.
14. [14] Cohen S, Burns R. Pathways of the pulp. St Louis, MO, USA: CV Mosby 1984;3th ed:441-2.
15. [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. [16] Kaufman A Y, Keila S. Hypersensitivity to sodium hypochlorite. J Endod 1989;15:224-6.
17. [17] Mehra P, Clancy C, Wu J. Formation of a facial hematoma during endodontic therapy. J Am Dent Assoc 2000;131:67-71.
18. [18] Sabala G L, Powell S E. Sodium hypochlorite injection into periapical tissues. J Endod 1989;15:490-2.
19. [19] Joffe E. Complication during root canal therapy following accidental extrusion of sodium hypochlorite through the apical foramen. Gen Dent 1991;460-1.
20. [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. [21] Kavanagh C P, Taylor J. Inadvertent injection of sodium hypochlorite into the maxillary sinus. Br Dent J 1998;185:336-7.
22. [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. [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. [24] Serper A, Ozbek M, Calt S. Accidental sodium hypochlorite-induced skin injury during endodontic treatment. J Endod 2004;30:180-1.
25. [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. [26] Clarkson R M, Moule A J. Sodium hypochlorite and its use as an endodontic irrigant. Aust Dent J 1998;43:250-6.
27. [27] Manogue M, Patel S, Walker R. The principles of endodontics. Oxford, Oxford University Press, 2005; s 138-9.
28. [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. [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. [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. [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. [32] Guivarc’h M, Ordioni U, et al. Sodium Hypochlorite Accident: A Systematic Review. J Endod 2017;43:16-24.