Sodium Hypochlorite Accidents: A Retrospective Case-series Analysis of CBCT Imaging and Clinician Surveys

This case series study aims to investigate retrospectively the causes underlying sodium hypochlorite (NaOCl) accidents in endodontic practices through analysis of cone beam computed tomography (CBCT) imaging and comprehensive clinician surveys. Twenty-four dental practitioners who encountered a NaOCl accident during the treatment of a permanent tooth in adult patients provided deidentified patient data, facial photographs, and a limited field of view CBCT of the involved tooth. Providers also had to report patient's immediate presence of pain and swelling after root canal irrigation to include the dataset into the study. Modified surveys were administered to collect information on other demographic factors including age, sex, tooth involved, apical diagnosis, presence of ecchymosis, pain severity, among others. The CBCT volume was used to identify the presence of fenestration, root perforation, and apical pathosis. CBCT data were evaluated by 4 examiners. Among the 26 NaOCl accidents investigated, a higher incidence was observed in females (65.30%) and maxillary teeth (92.30%). All cases presented immediate swelling and edema; intracanal bleeding and hematoma were observed in 80.70 and 84.60% of the cases respectively. CBCT interpretation revealed that bone fenestrations were evident in all cases studied (100%), iatrogenic perforations were detected in 19.23% of the cases, and apical pathosis was noted in 30.70% of the cases. This case series study highlights that a direct communication between the root apex and surrounding soft tissues is highly prevalent in NaOCl accidents. Early identification of bone fenestrations or perforations identified in maxillary teeth of female patients can play a pivotal role in preventing NaOCl extrusion accidents during endodontic treatment.