Necrosis of the gingiva caused by calciumhydroxide: a case report
M. A. A. De Bruyne
, R. J. G. De Moor
& F. M. Raes
Department of Operative Dentistry and Endodontology; and
Department of Fixed Prosthodontics and Periodontology, DentalSchool, University Gent, Gent, Belgium
AbstractDe Bruyne MAA, De Moor RJG, Raes FM.
Necrosis of the gingiva caused by calcium hydroxide: acase report.
International Endodontic Journal,
The present case demonstrates the possibledetrimental effect of an overextension of a calcium hydroxideintracanal dressing into the periradicular and soft tissue afteriatrogenic buccal root perforation of a maxillary centralincisor.At first this perforation was not recognized by the dentist,which resulted in the introduction of a large amount of non-setting calcium hydroxide paste under the gingival tissuesthrough a dehiscence on the buccal side of the root.This report describes the consequences and management of the necrosis of the buccal gingiva and mucosa, and thesubsequent treatment and follow-up of the root perforation.
calcium hydroxide, glass ionomercement, necrosis, perforation, surgical repair.
Received 14 October 1998; accepted 5 March 1999
Since its introduction in dentistry, calcium hydroxide(Ca(OH)
) has been used for a wide variety of purposesincluding lining of cavities, indirect and direct pulpcapping, dressing after pulpotomy, dressing of the rootcanal between appointments, prevention of rootresorption, repair of iatrogenic perforations, treatment of horizontal root fractures and as a constituent of root canalsealers (Foreman & Barnes 1990). Few reports deal withthe negative side-effects of Ca(OH)
, that include bonenecrosis and continuing inflammatory response inrepaired mechanical perforations (Himel
. 1985), theneurotoxic effect of root canal sealers (Boiesen & Brodin1991), cytotoxicity on cell cultures (Ala
. 1993),damaged epithelium with or without cellular atypia whenapplied on hamster cheek pouches (Dunham
. 1966)and cellular damage following early calcium hydroxidedressing of avulsed teeth (Andreasen & Kristerson 1981).The following report describes the deleterious effects of Ca(OH)
A 27-year-old Caucasian male was referred by hisdental practitioner to the emergency clinic for furtherendodontic treatment of his maxillary left centralincisor. The patient presented with a swollen upper lipand, on clinical inspection, an extensive necrotic zoneon the buccal side of 21 and 11 was noted (Fig. 1).Tooth 21 was not painful on percussion.From the dental history it was clear that the practi-tioner had commenced the root canal treatment1 week earlier. Since the pulp chamber and thecoronal part of the root canal were obliterated withdentine, the dentist had difficulty locating the canal.Various radiographs were taken but these did notshow any evidence of incorrect angulation of the filecompared with the long axis of the tooth and themesiodistal location of the root canal (Fig. 2a,b). A
2000 Blackwell Science Ltd International Endodontic Journal,
Correspondence: Dr Mieke A. A. De Bruyne, Department of OperativeDentistry and Endodontology, Dental School, University Gent, DePintelaan 185 P8, 9000 Gent, Belgium.