Severe tissue damage and neurological deficit following extravasation of sodium hypochlorite solution during routine endodontic treatment.

Endodontic therapy is a routinely practised clinical procedure with few reported complications. Sodium hypochlorite is often used as an irrigant during this procedure, but severe complications may occur if this solution extravasates beyond the root apex. We present a case demonstrating some of the severe sequelae that can occur following the misuse of sodium hypochlorite during endodontic treatment of an upper lateral incisor, which also resulted in the previously unreported complication of isolated facial nerve weakness

Three-year randomised clinical trial to evaluate the clinical performance, quantitative and qualitative wear patterns of hybrid composite restorations

The aim of the study was to compare the clinical performance, quantitative and qualitative wear patterns of conventional hybrid (Tetric Ceram), micro-filled hybrid (Gradia Direct Posterior) and nano-hybrid (Tetric EvoCeram, TEC) posterior composite restorations in a 3-year randomised clinical trial. Sixteen Tetric Ceram, 17 TEC and 16 Gradia Direct Posterior restorations were placed in human molars and evaluated at baseline, 6, 12, 24 and 36 months of clinical service according to US Public Health Service criteria. The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns. After 3 years of clinical service, the three hybrid restorative materials performed clinically well in posterior cavities. Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart. The three hybrid composites showed enamel-like vertical wear and cavity-size dependant volume loss magnitude. Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service

Effect of Needle Insertion Depth and Apical Diameter on Irrigant Extrusion in Simulated Immature Permanent Teeth

The aim of this study was to compare the amount of irrigant extrusion in simulated immature permanent teeth when the apical diameter and needle insertion depth were varied. Thirty single-rooted maxillary incisors with straight root canals were selected. The root length was standardized to a length of 9 mm. The teeth were divided into two experimental groups according to the degree of apical enlargement (n = 15). The apices were enlarged to a diameter of 1.10 mm or 1.70 mm by using a #3 or #6 peeso reamer, respectively, to simulate immature teeth. The irrigation solution was applied 2 or 4 mm short of the working length (WL) in each experimental group. The glass vial model was used for the collection of extruded irrigant beyond the root apex. A two-way repeated measures analysis of variance test showed that there was no significant difference between different needle insertion depths (2 and 4 mm short of the WL) in the group with an apical diameter of 1.70 mm (p > 0.05). In the group with an apical diameter of 1.10 mm, a 32% increase in irrigant extrusion was observed when the needle was positioned at 2 mm (p < 0.05). Regarding the effect of apical diameter, the group with a diameter of 1.70 mm showed more apical extrusion of the irrigant (34% increase for the needle positioned at 2 mm and 68% increase for the needle positioned at 4 mm). It was observed that the needle insertion depth and apical diameter have a significant effect on irrigant extrusion in immature permanent teeth.Wo