Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review.

OBJECTIVES: Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. METHODS: To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. RESULTS: By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. CONCLUSIONS: Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.

In vitro evaluation of a Ceramicrete-based root-end filling material.

Ceramicrete is an impervious inorganic binder widely used for encapsulating radioactive and hazardous wastes. This study evaluated the feasibility of using a radiopaque Ceramicrete-based material for root-end fillings. Apical seals of root-end preparations filled with Super EBA (Harry J. Bosworth Co, Skokie, IL), White ProRoot MTA (Dentsply Tulsa Dental Specialties, Tulsa, OK), or Ceramicrete-D were evaluated using a computerized fluid filtration approach after the fillings were immersed in phosphate-containing fluid (PCF). The Ceramicrete-D fillings exhibited significantly (P < 0.05) better seals than the other two commercially available, frequently advocated root-end-filling materials. Scanning electron microscopy and x-ray diffraction of Ceramicrete-D after setting revealed a relatively nonporous KMgPO4.6H2O matrix that binds other incompletely reacted and new reaction phases such as CaHPO4.2H2O. Polished dentin slabs filled with Ceramicrete-D and immersed in PCF for 72 hours revealed depositions of acicular-shaped, apatite-like crystallite clusters on the material surface as the pH of the PCF increased with immersion time. The experimental Ceramicrete-based material is potentially bioactive in the presence of PCF.