PMC4751209_01
(a) Panoramic view of the patient after extrusion of calcium hydroxide. Increased radiopacity around periapical area on left second molar; (b) Periapical view after canal cleaning and shaping; (c - e) On the cross sectional view of CBCT, excessive radiopaque material was spread into the left mandibular canal.
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F1
Conventional radiographs and computed tomography of the mandible showed radiopacity around the left mandibular canal (Figure 1).
(a) Before debridement. Injured tissue was seen. It's hard to distinguish inferior alveolar nerve and other structures; (b) Inferior alveolar nerve was sutured, granulation tissues and destructed bones are removed; (c - e) Particles of foreign bodies and multiple fragment of bone and fibrous or fibroadipose tissue of varying size represented the curetted material submitted for histopathological examination (H-E staining); (f) S100 protein on nerve bundle was not seen on nerve staining.
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F2
Surgical treatment included neuroma (growth of nerve tissue), neurorrhaphy (end-to-end reconnection of nerve tissue), and foreign body removal under general anesthesia (Figures 2a and 2b). On histological examination, chronic nonspecific inflammatory cell infiltration without foreign body reaction was seen (Figures 2c and 2d). There were no findings of S100 protein which is used as cell markers for anatomic pathology in the nerve bundle (Figure 2f).
Radiographic view of left mandibular area after surgical intervention. (a) 3 months follow up; (b) 20 months follow up; (c) Healing of bony fragments was found between separated block bones and mandibles.
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F3
Radiograph after surgical intervention showed no foreign material (Figure 3a). At 3 months follow up after surgery, no improvement was seen in paresthesia, and the patient was sent to the Department of Prosthodontics for a provisional restoration in the treated area (Figure 3b). On 20 months follow up, healing of bony fragment was observed on panoramic x-ray, and the endodontically treated tooth was used as abutment for provisional fixed partial denture, without improvement of sensory nerve (Figure 3c).