Some accidents during irrigation in endodontics are reported in the literature and are frequently observed in colleagues' reports. A case in which there was an acute inflammatory process after irrigation with both substances most commonly used for irrigation in endodontics. The literature is abundant regarding hypochlorite, but scarcer regarding chlorhexidine, although it exists.
Patient sought a colleague for treatment of a tooth 14 with restorative purpose. During irrigation with sodium hypochlorite 2.5%, there was strong pain in the apical region of the tooth, causing the professional to suspend treatment, irrigate abundantly with saline solution and place intracanal medication. She also prescribed a steroidal anti-inflammatory and an antibiotic.
After a week and all symptoms had regressed, irrigation was again performed during the treatment, with chlorhexidine gel 2%, and again pain, in the same way as mentioned above, with the procedures also repeated.
In the 3rd session, irrigation with saline solution and obturation was then performed, without any occurrence.
Risk Determination
The case alerts to the risk of accidents in endodontic irrigation. After all, the risk seems to be more associated with the position of the apices in relation to the bone plates, and consequently, soft tissues. The presented table shows the risk rates, dramatically higher in upper teeth. The apical position, close to the external cortical of the bone plate, or even outside it, in direct contact with the periosteum (apical fenestration), seems to be more relevant for complications than the substance used.
In these cases, it is desirable to perform more conservative treatments, with fewer interventions beyond the foramen, especially in treatments with preparations with foraminal enlargement, often performed with 35-types or even larger. Therefore, the careful observation of apex positioning by means of a CT scan is a very important resource for the prevention of this type of accident.
Case conducted by former endodontics specialization student Fernanda Furtado, from HPG Brasília.
