MASSIVE EXTRUSION OF CALCIUM HYDROXIDE PASTE CONTAINING BARIUM SULFATE DURING ENDODONTIC TREATMENT

A 31-year-old woman was referred for evaluation of persistent numbness on the left side of the lower lip, which began during endodontic treatment of the left mandibular first molar. Imaging exams showed a large amount of a radiopaque or hyperdense throughout the left mandibular body in close proximity to the lower alveolar nerve. Histologic analyses identified birefringent crystalloid foreign bodies widespread through soft tissue and bone leading to an inflammatory foreign body reaction, eventually demonstrated to be rich in barium and sulfur by the means of scanning electron microscopy coupled with energy dispersive x-ray detection. This scenario led to the diagnosis of lower alveolar nerve injury due to accidental extrusion of intracanal dressing material composed of calcium hydroxide (CaOH2) paste incorporated with BaSO4. The paresthesia was treated with the combination of citoneurin and prednisone, but no improvement in nerve sensitivity was noticed after 12 months of follow-up examination.