ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Overfilling Of Root Canal Materials Into The Mandibular Canal Shows High Incidence Of Paresthesia
Clinical Question What is the likelihood of paresthesia following overfilling of root canal obturating materials into the mandibular nerve canal?
Clinical Bottom Line The overall incidence of some degree of paresthesia following radiographic evidence overfilling of root canal materials into the mandibular canal was 87%.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17197403Pogrel/200761 humansCase Series
Key resultsSixty-one subjects were evaluated over an 8 year period for root canal overfilling into the mandibular canal. Fifty patients received no further treatment subsequent to the overfill evaluation, 8 never became symptomatic and only 4 of the remaining 42 had resolution of symptoms. Eleven patients underwent additional procedures (surgical intervention) to treat the parethesia/dysethesia. Five patients underwent surgery within 48 hours of injury and all experienced total resolution of parethesia during unspecified follow up. Six patients underwent surgical intervention a week or more following injury. Four achieved partial improvement, 2 no improvement, and all 6 never achieved total resolution of symptoms.
Evidence Search ("Root Canal Filling Materials"[Mesh] AND "Root Canal Therapy"[Mesh]) AND "Paresthesia"[Mesh] AND ("humans"[MeSH Terms] AND English[lang])
Comments on
The Evidence
There are not high levels of evidence regarding this question. The majority of published articles are single case reports. The above study is the largest case series on the issue. It has a single oral surgeon providing treatment. The study had the highest subject number, but had no mention of specific follow up timelines, and the treatment options presented in the article represent the opinion of the author. Thus, they may not be standardized throughout the oral surgery profession. The current best evidence is weak on this subject and the results must be interpreted with caution.
Applicability The results may apply to anyone who is undergoing root canal therapy of the mandibular posterior teeth and has radiographic evidence of overfilling of root canal materials into the mandibular canal.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Mandibular nerve paresthesia, root canal, overfilling
ID# 2083
Date of submission: 09/08/2011spacer
E-mail dietrichm@livemail.uthscsa.edu
Author Matthew Dietrich
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Fabricio Teixeira, DDS, MS, PhD
Faculty mentor/Co-author e-mail fabricio-teixeira@uiowa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Liliana Paz, Jennifer Diep (San Antonio, TX) on 11/30/2017
While there is an abundance of new case reports of patients that exhibit paresthesia due to overfilling of the root canal into the mandibular canal, there is still not a lot of high level of evidence available on its exact incidence. A search of the literature was done in November 2017 and a systematic review was found (Alves/2014; PMID: 24598329) that does not corroborate Dietrich's findings. Dietrich reported on a case series in which there was an 87% incidence of paresthesia after overfilling of root canal materials into the mandibular canal; however, this systematic review is more recent and concluded that the incidence of endodontic-related paresthesia is still unknown.
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