Non-Surgical Management of Iatrogenic Extrusion of Calcium Hydroxide Based Intracanal Medicament in Clinical Endodontics – A Case Report

Calcium hydroxide is used as an intracanal medicament in endodontics as it reduces intracanal microbial load and exudate discharge from infected teeth. Reports have shown that extrusion of calcium hydroxide periapically leads to an increased incidence of swelling, delayed periapical healing, nerve paraesthesia and other complications. Teeth with immature apex or those undergoing apical resorption are prone to higher chances of periapical medicament extrusion, especially under high pressure delivery systems. This case report discusses nonsurgical management of periapically extruded non-setting calcium hydroxide by an innovative technique which is less invasive and comfortable both for the clinician and the patient. Calcium hydroxide is widely used as an intracanal medicament for the treatment of pulpal and periapical diseases.1 The intracanal placement of calcium hydroxide can be done with a lentulospiral or a syringe-based delivery system.2 If extruded periapically, there is an increased incidence of swelling, delayed periapical healing, nerve paraesthesia and other complications.3 Case reports in the past have suggested surgical management of periapically extruded calcium hydroxide. The purpose of this case report is to discuss an orthograde nonsurgical management of periapically extruded calcium hydroxide based intracanal medicament containing barium sulphate during endodontic treatment.