Aim: The aim of this systematic review is to accumulate the available evidence on management approaches as well as factors resulting in the development of paresthesia due to sealer extrusion.
Materials and methods: A literature search was conducted in MEDLINE, EMBASE, and Web of Science and Cochrane Central Register of Controlled Trials up to March 2022, accompanied by a manual search of journals, textbooks, and grey literature. Inclusion criteria were studies on adult patients experiencing paresthesia related to sealer extrusion. The quality of included studies was appraised using a custom set of criteria.
Results: A total of 102 publications were identified, and 9 of them fulfilled the inclusion criteria. All of the included studies were case reports describing a total of 10 patients. The predetermined data were independently extracted and evaluated by four reviewers.
Conclusion: Because of the low amount and quality of available evidence, conclusions on the factors resulting in paresthesia due to sealer extrusion cannot be drawn. The management approach remains empirical. The need for prospective studies is highlighted. The future case reports in endodontics ought to be reported in a uniform and methodological way.
Clinical significance: Paresthesia as a result of endodontic sealer extrusion is an alarming complication of endodontic treatment that general dentists need to be aware of. Although worrying, for both clinician and patient, it is a manageable complication and early diagnosis is important; thus, dentists need to be educated on this topic.
Fonseca B, Coelho MS, Bueno CEDS, et al. Assessment of extrusion and postoperative pain of a bioceramic and resin-based root canal sealer. Eur J Dent 2019;13(3):343–348. DOI: 10.1055/s-0039-3399457.
Komabayashi T, Colmenar D, Cvach N, et al. Comprehensive review of current endodontic sealers. Dent Mater J 2020;39(5):703–720. DOI: 10.4012/dmj.2019-288.
Siqueira JF Jr, Rôças IN, Valois CR. Apical sealing ability of five endodontic sealers. Aust Endod J 2001;27(1):33–35. DOI: 10.1111/j.1747-4477.2001.tb00450.x.
Lee KW, Williams MC, Camps JJ, et al. Adhesion of endodontic sealers to dentin and gutta–percha. J Endod 2002;28(10):684–688. DOI: 10.1097/00004770-200210000-00002.
Köseoğlu BG, Tanrikulu S, Sübay RK, et al. Anesthesia following overfilling of a root canal sealer into the mandibular canal: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(6):803–806. DOI: 10.1016/j.tripleo.2005.07.015.
Escoda–Francoli J, Canalda–Sahli C, Soler A, et al. Inferior alveolar nerve damage because of over-extended endodontic material: a problem of sealer cement bio-compatibility? J Endod 2007;33(12):1484–1489. DOI: 10.1016/j.joen.2007.09.003.
Rosen E. The diagnosis and management of nerve injury during endodontic treatment. Evid.-based Endod 2017;2:7. DOI: 10.1186/s41121-017-0013-2.
Rosen E, Goldberger T, Taschieri S, et al. The prognosis of altered sensation after extrusion of root canal filling materials: a systematic review of the literature. J Endod 2016;42(6):873–879. DOI: 10.1016/j.joen.2016.03.018.
Rosen E. Nerve injury during endodontic surgical procedures. In: Tsesis I, editor. Complications in endodontic surgery. Berlin Heidelberg: Springer–Verlag; 2014. pp.137–151.
Grotz KA, Al-Nawas B, de Aguiar EG, et al. Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig 1998;2(2):73–76. DOI: 10.1007/s007840050048.
Gallas–Torreira MM, Reboiras–López MD, García–García A, et al. Mandibular nerve paresthesia caused by endodontic treatment. Med Oral 2003;8(4):299–303.
Ahmad M. The anatomical nature of dental paresthesia: a quick review. Open Dent J 2018;12:155–159. DOI: 10.2174/1874210601812010155.
Froes FG, Miranda AM, Abad Eda C, et al. Non-surgical management of paraesthesia and pain associated with endodontic sealer extrusion into the mandibular canal. Aust Endod J 2009;35(3):183–186. DOI: 10.1111/j.1747-4477.2009.00163.x.
Aminoshariae A, Kulild JC. The impact of sealer extrusion on endodontic outcome: a systematic review with meta-analysis. Aust Endod J 2020;46(1):123–129. DOI: 10.1111/aej.12370.
Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving BMJ; 310:1122. DOI: 10.1136/bmj.310.6987.1122.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 2021;10(1):89. DOI: 10.1186/s13643-021-01626-4.
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4(1):1. DOI: 10.1186/s13643-021-01626-4.
Murad MH, Sultan S, Haffar S, et al. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018;23(2):60–63. DOI: 10.1136/bmjebm-2017-110853.
Riley DS, Barber MS, Kienle GS, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol 2017;89:218-235. DOI: 10.1016/j.jclinepi.2017.04.026.
Fasoulas A, Boutsioukis C, Lambrianidis T. Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management. Int Endod J 2019;52(11):1586–1604. DOI: 10.1111/iej.13183.
Tamse A, Kaffe I, Littner MM, et al. Paresthesia following overextension of AH-26: report of two cases and review of the literature. J Endod 1982;8(2):88–90. DOI: 10.1016/S0099-2399(82)80265-3.
González–Martín M, Torres–Lagares D, Gutiérrez–Pérez JL, et al. Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal. J Endod 2010;36(8):1419–1421. DOI: 10.1016/j.joen.2010.03.008.
Alves FRF, Dias MCC, Mansa MGCB, et al. Permanent labiomandibular paresthesia after bioceramic sealer extrusion: a case report. J Endod 2020;46(2):301–306. DOI: 10.1016/j.joen.2019.11.005.
López–López J, Estrugo–Devesa A, Jané–Salas E, et al. Inferior alveolar nerve injury resulting from overextension of an endodontic sealer: non-surgical management using the GABA analogue pregabalin. Int Endod J 2012;45(1):98–104. DOI: 10.1111/j.1365-2591.2011.01939.x.
Alonso–Ezpeleta O, Martín PJ, López–López J, et al. Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer. J Clin Exp Dent 2014;6(2):e197–e202. DOI: 10.4317/jced.51420.
Buyukkurt MC, Arslan H, Topcuoglu HS, et al. Prognosis of a case with paresthesia associated with prolonged touching of an endodontic paste to the inferior alveolar nerve. J Clin Exp Dent 2011;3(Suppl 1):e377–e3781. DOI: 10.4317/jced.3.e377.
Poveda R, Bagán JV, Fernández JM, et al. Mental nerve paresthesia associated with endodontic paste within the mandibular canal: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Nov;102(5):e46–e49. DOI: 10.1016/j.tripleo.2006.03.022.
Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011;128(1):305–310. DOI: 10.1097/PRS.0b013e318219c171.
Manski RJ, Moeller JF, Maas WR. Dental services. An analysis of utilization over 20 years. J Am Dent Assoc 2001;132(5):655–664. DOI: 10.14219/jada.archive.2001.0243.
Givol N, Rosen E, Taicher S, et al. Risk management in endodontics. J Endod 2010;36(6):982–984. DOI: 10.1016/j.joen.2010.03.030.
Givol N, Taicher S, Halamish–Shani T, et al. Risk management aspects of implant dentistry. Int J Oral Maxillofac Implants 2002;17(2):258–262. PMID: 11958409.
Simonton JD, Azevedo B, Schindler WG, et al. Age- and gender-related differences in the position of the inferior alveolar nerve by using cone beam computed tomography. J Endod 2009;35(7):944–949. DOI: 10.1016/j.joen.2009.04.032.
Oliveira ACS, Candeiro GTM, Pacheco da Costa FFN, et al. Distance and bone density between the root apex and the mandibular canal: a cone–beam study of 9202 roots from a Brazilian population. J Endod 2019;45(5):538.e2–542.e2. DOI: 10.1016/j.joen.2019.01.004.
Satoh J, Yagihashi S, Baba M, et al. Efficacy and safety of pregabalin for treating neuropathic pain associated with diabetic peripheral neuropathy: a 14 week, randomized, double-blind, placebo-controlled trial. Diabet Med 2011;28(1):109–116. DOI: 10.1111/j.1464-5491.2010.03152.x. PMID: 21166852.
Givol N, Rosen E, Bjørndal L, et al. Medico–legal aspects of altered sensation following endodontic treatment: a retrospective case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112(1):126–131. DOI: 10.1016/j.tripleo.2011.01.007.
Neaverth EJ. Disabling complications following inadvertent overextension of a root canal filling material. J Endod 1989;15(3):135–139. DOI: 10.1016/S0099-2399(89)80136-0.
Kim YK, Yun PY, Kim JH, et al. The quantitative sensory testing is an efficient objective method for assessment of nerve injury. Maxillofac Plast Reconstr Surg 2015;37(1):13. DOI: 10.1186/s40902-015-0013-5.