e-ISSN: 3051-6269 | ISSN: 2975-9293

Language

European Journal of Stomatology Oral and Facial Surgery

e-ISSN: 3051-6269 | ISSN: 2975-9293


Abstract

Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontic procedures due to its potent antimicrobial properties and ability to dissolve organic tissue. However, despite these advantages, sodium hypochlorite can pose significant risks when inadvertently extruded beyond the root canal system. One of the most severe complications occurs when NaOCl extravasates into the maxillary sinus, leading to a range of potential adverse outcomes. This article explores the pathophysiology, clinical implications, and management strategies associated with sodium hypochlorite extrusion into the maxillary sinus.

References

  • Ko, H.; You, H.; Park, D. A comparison of canal centering abilities of four root canal instrument systems using X-ray micro-computed tomography. Journal of Korean Academy of Conservative Dentistry 2007, 32, 61–68.
  • Versümer, J.; Hülsmann, M.; Schäfers, F. A comparative study of root canal preparation using Profile .04 and Lightspeed rotary Ni-Ti instruments. International Endodontic Journal 2002, 35, 37–46.
  • Peters, O.; Barbakow, F.; Peters, C. An analysis of endodontic treatment with three nickel-titanium rotary root canal preparation techniques. International Endodontic Journal 2004, 37, 849–859.
  • Yesilsoy, C.; Whitaker, E.; Cleveland, D.; Phillips, E.; Trope, M. Antimicrobial and toxic effects of established and potential root canal irrigants. Journal of Endodontics 1995, 21, 513–515.
  • Türkün, M.; Cengiz, T. The effects of sodium hypochlorite and calcium hydroxide on tissue dissolution and root canal cleanliness. International Endodontic Journal 1997, 30, 335–342.
  • Kuruvilla, J.; Kamath, M. Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and in combination on Enterococcus faecalis. Journal of Endodontics 1998, 24, 472–476.
  • Mohammadi, Z. Sodium hypochlorite in endodontics: an update review. International Dental Journal 2008, 58, 329–341.
  • Vianna, M.; Gomes, B.; Berber, V.; Zaia, A.; Ferraz, C.; de Souza-Filho, F. In vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2004, 97, 79–84.
  • Becker, G.; Cohen, S.; Borer, R. The sequelae of accidentally injecting sodium hypochlorite beyond the root apex. Report of a case. Oral Surgery, Oral Medicine, Oral Pathology 1974, 38, 633–638.
  • Behrents, K.; Speer, M.; Noujeim, M. Sodium hypochlorite accident with evaluation by cone beam computed tomography. International Endodontic Journal 2012, 45, 492–498.
  • Sabala, C.; Powell, S. Sodium hypochlorite injection into periapical tissues. Journal of Endodontics 1989, 15, 490–492.
  • Gernhardt, C.; Eppendorf, K.; Kozlowski, A.; Brandt, M. Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. International Endodontic Journal 2004, 37, 272–280.
  • Hales, J.J.; Jackson, C.R.; Everett, A.P.; Moore, S.H. Treatment protocol for the management of a sodium hypochlorite accident during endodontic therapy. General Dentistry 2001, 49, 278–281.
  • Mehdipour, O.; Kleier, D.; Averbach, R. Anatomy of sodium hypochlorite accidents. Compendium of Continuing Education in Dentistry 2007, 28, 544–546, 548, 550.
  • Pashley, E.; Birdsong, N.; Bowman, K.; Pashley, D. Cytotoxic effects of NaOCl on vital tissue. Journal of Endodontics 1985, 11, 525–528.
  • Kaufman, A.; Keila, S. Hypersensitivity to sodium hypochlorite. Journal of Endodontics 1989, 15, 224–226.
  • Serper, A.; Ozbek, M.; Calt, S. Accidental sodium hypochlorite-induced skin injury during endodontic treatment. Journal of Endodontics 2004, 30, 180–181.
  • Schuh, E.; Schmiedl, R.; Vogel, G. Anatomic limits of endosseous dental implantation. Z Stomatol 1984, 81, 81–90.
  • Hauman, C.; Chandler, N.; Tong, D. Endodontic implications of the maxillary sinus: a review. International Endodontic Journal 2002, 35, 127–141.
  • Zhu, W.; Gyamfi, J.; Niu, L.; Schoeffel, G.; Liu, S.; Santarcangelo, F.; Khan, S.; Tay, K.; Pashley, D.; Tay, F. Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. Journal of Dentistry 2013, 41, 935–948.
  • Costa, T.; Ferreira, E.; Antunes, L.; Dinis, P. Antral bony wall erosion, trigeminal nerve injury, and enophthalmos after root canal surgery. Allergy Rhinology 2016, 7, 99–101.
  • Low, T.; Seah, J.; Subramaniam, S.; Thirunavukarasu, V.; Ng, C. Bleach-Induced Chemical Sinusitis and Orbital Cellulitis Following Root Canal Treatment. Sinusitis 2023, 7, 6–11.
  • Markose, G.; Cotter, C.; Hislop, W. Facial atrophy following accidental subcutaneous extrusion of sodium hypochlorite. British Dental Journal 2009, 206, 263–264.
  • Becking, A. Complications in the use of sodium hypochlorite during endodontic treatment. Report of three cases. Oral Surgery, Oral Medicine, Oral Pathology 1991, 71, 346–348.
  • Mehra, P.; Clancy, C.; Wu, J. Formation of a facial hematoma during endodontic therapy. Journal of the American Dental Association 2000, 131, 67–71.
  • Naenni, N.; Thoma, K.; Zehnder, M. Soft tissue dissolution capacity of currently used and potential endodontic irrigants. Journal of Endodontics 2004, 30, 785–787.
  • Jeansonne, M.; White, R. A comparison of 2.0% chlorhexidine gluconate and 5.25% sodium hypochlorite as antimicrobial endodontic irrigants. Journal of Endodontics 1994, 20, 276–278.
  • Farook, S.; Shah, V.; Lenouvel, D.; Sheikh, O.; Sadiq, Z.; Cascarini, L. Guidelines for management of sodium hypochlorite extrusion injuries. British Dental Journal 2014, 217, 679–684.
  • Ehrich, D.; Brian, J.; Walker, W. Sodium hypochlorite accident: inadvertent injection into the maxillary sinus. Journal of Endodontics 1993, 19, 180–182.
  • Kavanagh, C.; Taylor, J. Inadvertent injection of sodium hypochlorite into the maxillary sinus. British Dental Journal 1998, 185, 336–337.

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2025 José Cunha Coutinho, Gonçalo Coutinho

Metrics

PlumX
Dimensions
Altmetric

Categories

Paper information

History

  • Received: 20/10/2024
  • Published: 23/07/2025

Current Issue

Open Journal Systems
Exclusive OJS theme plugin developed with by