Evaluation of irrigant extrusion in endodontic procedures
Keywords:
CAVIDAD PULPAR; ENDODONCIA; EXTRAVASACIÓN DE MATERIALES TERAPÉUTICOS Y DIAGNÓSTICOS; IRRIGACIÓN TERAPÉUTICA.; DENTAL PULP CAVITY; ENDODONTICS; EXTRAVASATION OF DIAGNOSTIC AND THERAPEUTIC MATERIALS; THERAPEUTIC IRRIGATION.; CAVIDADE PULPAR; ENDODONTIA; EXTRAVASAMENTO DE MATERIAIS TERAPÊUTICOS E DIAGNÓSTICOS; IRRIGAÇÃO TERAPÊUTICA.Abstract
Introduction: endodontics employs irrigants such as sodium hypochlorite and chlorhexidine to disinfect root canals, although their inappropriate use may cause clinical accidents with significant consequences for patient health.
Objective: to analyze the prevalence, complications, management, and preventive measures regarding accidental extrusion of endodontic irrigants among dentists in Ambato, Ecuador.
Methods: a quantitative, descriptive, non-experimental, cross-sectional study was conducted in 2024. Thirty dentists participated through convenience sampling. A structured questionnaire with closed and open-ended questions was administered electronically. Data were processed using descriptive statistics, respecting bioethical principles of informed consent and confidentiality.
Results: a total of 46,6 % of dentists reported having experienced irrigant extrusion. The most frequent complications were pain (43,3 %), edema (26,6 %), and bone necrosis (23,3 %). Management measures included rinsing with water (26 %), use of anti-inflammatory drugs and antibiotics (16,7 %), and suspension of irrigation with rest (16,7 %). For prevention, participants highlighted the importance of applying proper irrigation techniques (36,6 %) and controlling volume and pressure (23,4 %). The most frequently mentioned risk factors were complex canal anatomy (36,6 %) and iatrogenic perforations (22,4 %).
Conclusions: the study shows that irrigant extrusion is a frequent and potentially serious clinical event. The findings emphasize the need for continuous training, standardized protocols, and safe technologies to reduce risks. Identifying predisposing factors helps guide preventive strategies and improve safety in endodontic procedures, thereby strengthening the quality of dental care.
Downloads
References
1. Ruksakiet K, Hanák L, Farkas N, Hegyi P, Sadaeng W, Czumbel LM, et al. Antimicrobial efficacy of chlorhexidine and sodium hypochlorite in root canal disinfection: A systematic review and meta-analysis of randomized controlled trials. Journal of Endodontics [Internet]. 2020 [Citado 20/05/2025]; 46(8): 1032-1041.e7. Disponible en: https://www.jendodon.com/article/S0099-2399(20)30308-3/fulltext
2. Pałka Ł, Nowakowska-Toporowska A, Dalewski B. Is Chlorhexidine in Dentistry an Ally or a Foe? A Narrative Review. Healthcare [Internet]. 2022 [Citado 20/05/2025]; 10(5):764. Disponible en: https://doi.org/10.3390/healthcare10050764
3. Martins C, da Silva Machado N, Giopatto B, de Souza Batista V, Marsicano J. Post-operative pain after using sodium hypochlorite and chlorhexidine as irrigation solutions in endodontics: Systematic review and meta-analysis of randomised clinical trials. Indian Journal of Dental Research [Internet]. 2020 [Citado 20/05/2025]; 31(5): 774-781. Disponible en: https://journals.lww.com/ijdr/fulltext/2020/31050/post_operative_pain_after_using_sodium.18.aspx
4. Cai C, Chen X, Li Y, Jiang Q. Advances in the role of sodium hypochlorite irrigant in chemical preparation of root canal treatment. BioMed Research International [Internet]. 2023 [Citado 20/05/2025]; 8858283: 1–17. Disponible en: https://onlinelibrary.wiley.com/doi/10.1155/2023/8858283
5. Drews DJ, Nguyen AD, Diederich A, Gernhardt CR. The Interaction of Two Widely Used Endodontic Irrigants, Chlorhexidine and Sodium Hypochlorite, and Its Impact on the Disinfection Protocol during Root Canal Treatment. Antibiotics [Internet]. 2023 [Citado 20/05/2025]; 12(3): 589. Disponible en: https://doi.org/10.3390/antibiotics12030589
6. Instituto de Endodoncia Carlos Ferrari. Irrigación en endodoncia. Accidentes con hipoclorito y clorhexidina [Internet]. Instituto de Endodoncia Carlos Ferrari; 2020 [Citado 20/05/2025]. Disponible en: https://ferrariendodontia.com.br/es/acidente-irrigacao-na-endodontia
7. Shetty SR, Saaf AB, Narayanan A, Hamed MS, Abdemagyd HAE, Shetty P. Sodium hypochlorite accidents in dentistry. A systematic review of published case reports. Stomatologija [Internet]. 2020 [Citado 20/05/2025]; 22(1): 17-22. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32706342/
8. Salvadori M, Venturi G, Bertoletti P, Francinelli J, Tonini R, Garo ML, Salgarello S. Sodium Hypochlorite Accident during Canal Treatment: Report of Four Cases Documented According to New Standards. Applied Sciences [Internet]. 2022 [Citado 20/05/2025]; 12(17):8525. Disponible en: https://doi.org/10.3390/app12178525
9. Souza Santos Rodrigues G, da Silveira Bueno CE, Sigrist De Martin A, Fontana CE, Pinheiro SL, Andrea Pelegrine R. Evaluation of postoperative pain after endodontic treatment under irrigation with 2.5% or 5.25% Sodium Hypochlorite. Research, Society and Development [Internet]. 2022 [Citado 20/05/20]; 11(7): e16011729788. Disponible en: https://doi.org/10.33448/rsd-v11i7.29788
10. Campos P, Roa E, Montaño J, Tenorio F, de la Fuente J. Inadvertent Extrusion of Sodium Hypochlorite during Endodontic Treatment: Case Report. JSM Dent [Internet]. 2016 [Citado 20/05/2025]; 4(3): 1067. Disponible en: https://www.jscimedcentral.com/jounal-article-info/JSM-Dentistry/Inadvertent-Extrusion-of-Sodium--Hypochlorite-during-Endodontic--Treatment%3A-Case-Report-4434#section-74527
11. Beltran HS, Macedo-Serrano N, Baldarrago AC, Iuga MM, Laura LP. Accidental Injection of Chlorhexidine during Endodontic Therapy. Iran Endod J [Internet]. 2021 [Citado 20/05/2025]; 16(2): 123-126. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36704219/
12. Demenech LS, Tomazinho FSF, Baratto-Filho F, Brancher JA, Pereira LF, Gabardo MCL. Biocompatibility of the 8.25% sodium hypochlorite irrigant solution in endodontics: An in vivo study. Microsc Res Tech [Internet]. 2021 [Citado 20/05/2025]; 84(7):1506-1512. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33462926/
13. Marín Botero ML, Gómez Gómez B, Cano Orozco AD, Cruz López S, Castañeda Peláez DA, Castillo Castillo EY. Hipoclorito de sodio como irrigante de conductos. Caso clínico, y revisión de literatura. Av Odontoestomatol [Internet]. 2019 Abr [citado 10/03/2025]; 35(1): 33-43. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-12852019000100005&lng=es.
14. Arcos-Núñez NA, Arroyo-Lalama EM, Morales-Morales NE. Accidente por irrigación de hipoclorito de sodio, una revisión de la literatura. Rev Ciencias Médicas [Internet]. 15 de noviembre de 2023 [citado 10/03/2025]; 27(2): e6204. Disponible en: https://revcmpinar.sld.cu/index.php/publicaciones/article/view/6204
15. Balandrano Pinal F. SOLUCIONES PARA IRRIGACIÓN EN ENDODONCIA: HIPOCLORITO DE SODIO Y GLUCONATO DE CLORHEXIDINA. Revista Científica Odontológica [Internet]. 2007 [citado 10/03/2025]; 3(1): 11-14. Disponible en: https://www.redalyc.org/articulo.oa?id=324227906004
16. Palomeque Pomasqui DS, Carrillo Rengifo K, Vallejo Izquierdo LA. Comparación de la Efectividad del Hipoclorito de Sodio y Clorhexidina como Agentes de Desinfección en Conductos Endodónticos. Revisión bibliográfica. Ciencia Latina [Internet]. 11 de octubre de 2023 [citado 10/03/2025]; 7(5): 2344-57. Disponible en: https://ciencialatina.org/index.php/cienciala/article/view/7887
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Emma Maricela Arroyo Lalama
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who have publications with this journal agree to the following terms: Authors will retain their copyrights and grant the journal the right of first publication of their work, which will be publication of their work, which will be simultaneously subject to the Creative Commons Attribution License (CC-BY-NC 4.0) that allows third parties to share the work as long as its author and first publication in this journal are indicated.
Authors may adopt other non-exclusive license agreements for distribution of the published version of the work (e.g.: deposit it in an institutional telematic archive or publish it in a volume). Likewise, and according to the recommendations of the Medical Sciences Editorial (ECIMED), authors must declare in each article their contribution according to the CRediT taxonomy (contributor roles). This taxonomy includes 14 roles, which can be used to represent the tasks typically performed by contributors in scientific academic production. It should be consulted in monograph) whenever initial publication in this journal is indicated. Authors are allowed and encouraged to disseminate their work through the Internet (e.g., in institutional telematic archives or on their web page) before and during the submission process, which may produce interesting exchanges and increase citations of the published work. (See The effect of open access). https://casrai.org/credit/
