However, the accidental extrusion of intracanal medicaments, such as calcium hydroxide, into the periapical tissues presents a significant iatrogenic risk, potentially leading to chronic inflammation, delayed healing, and neurovascular complications.
While extrusion is often related to excessive pressure during placement or anatomical factors, this case report describes a unique scenario involving the extrusion of calcium hydroxide paste into an expansive cystic lesion that originated from an adjacent, non-intact molar.
We present the case of a 46-year-old male whose second premolar suffered pulp necrosis and apical root resorption—not due to its own pathology, but as a consequence of a large cystic lesion extending from the adjacent first molar.
This pathological loss of apical restriction allowed calcium hydroxide, placed as an interappointment dressing in the premolar, to inadvertently extrude into the cyst.
The diagnosis was significantly aided by Cone-Beam Computed Tomography (CBCT), which provided the essential three-dimensional detail necessary to accurately map the extent of the resorptive process, the location of the extruded radiopaque material, and its critical proximity to the inferior alveolar nerve.
This article highlights the rare mechanism of injury to an intact adjacent tooth, the diagnostic superiority of CBCT in complex periapical lesions, and the successful surgical management required to remove the foreign bodies and resolve the multi-tooth pathology.
We encourage endodontists and general practitioners worldwide to review this challenging and instructive clinical report.
👉 Read the full article in PDF to deepen your understanding of the complex interactions between periapical lesions, root resorption, and the potential for accidental material extrusion, ensuring preparedness for similar high-risk cases.
