Inferior alveolar nerve injury resulting from overextension of an endodontic sealer: non‐surgical management using the GABA analogue pregabalin

• Published in: International endodontic journal 2012-01, Vol.45 (1), p.98-104
• Main Authors: López‐López, J., Estrugo‐Devesa, A., Jané‐Salas, E., Segura‐Egea, J. J.
• Format: Article
• Language: English
• Subjects: Adult; Analgesics - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Dentistry; endodontic complications; endodontic pain; endodontic sealer; Epoxy Resins - adverse effects; Female; Follow-Up Studies; Foreign Bodies - complications; gamma-Aminobutyric Acid - analogs & derivatives; gamma-Aminobutyric Acid - therapeutic use; Humans; Hypesthesia - drug therapy; Hypesthesia - etiology; inferior alveolar nerve injuries; Mandibular Nerve - drug effects; Mandibular Nerve - pathology; paraesthesia; Paresthesia - drug therapy; Paresthesia - etiology; Periapical Periodontitis - therapy; Prednisone - therapeutic use; Pregabalin; Root Canal Filling Materials - adverse effects; Root Canal Therapy - adverse effects; Trigeminal Nerve Injuries - drug therapy; Trigeminal Nerve Injuries - etiology
• ISSN: 0143-2885; 1365-2591
• DOI: 10.1111/j.1365-2591.2011.01939.x

López‐López J, Estrugo‐Devesa A, Jané‐Salas E, Segura‐Egea JJ. Inferior alveolar nerve injury resulting from overextension of an endodontic sealer: non‐surgical management using the GABA analogue pregabalin. International Endodontic Journal, 45, 98–104, 2012. Aim  To describe a case of endodontic sealer (AH Plus) penetration within the mandibular canal after root canal treatment with resolution of pain and paraesthesia after a non‐surgical approach, including treatment with prednisone and pregabalin. Summary  A 37‐year‐old woman underwent root canal treatment of the left mandibular second molar tooth. Postoperative periapical radiographs revealed the presence of radiopaque canal sealer in the mandibular canal. The day after, the patient reported severe pain in the tooth and paraesthesia/anaesthesia in the region innervated by the left inferior alveolar and mental nerve. Diagnosis of injury to the inferior alveolar nerve because of extrusion of AH Plus was established. The non‐surgical management included 1 mg kg−1 per day prednisone, two times per day, in a regimen on a daily basis, and 150 mg per day pregabalin, two doses per day, monitoring the progress with periodic follow‐up visits. One month after the incident, the signs and symptoms were gone. Key learning points  •  This case illustrates the care required when performing root canal treatment, especially when the root apices are in close proximity to the inferior alveolar nerve canal. •  The complete resolution of paraesthesia and the control of pain achieved in the present case suggests that a non‐surgical approach combining prednisone and pregabalin is a good option in the management of the inferior alveolar when it is contacted by extruded root filling material.