Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Case Report : Non-surgical Treatment of Inferior Alveolar Nerve Injury as a Result of Overinstrumented Root Canal Treatment

근관 충전제의 과충전에 의한 하치조 신경손상에 관한 비수술적 치료 증례

  • Bae, Kook-Jin (Department of Oral medicine, School of Dentistry, Chosun University) ;
  • Ahn, Jong-Mo (Department of Oral medicine, School of Dentistry, Chosun University) ;
  • Yoon, Chang-Lyuk (Department of Oral medicine, School of Dentistry, Chosun University) ;
  • Cho, Young-Gon (Department of Operative Dentistry, School of Dentistry, Chosun University) ;
  • Ryu, Ji-Won (Department of Oral medicine, School of Dentistry, Chosun University)
  • 배국진 (조선대학교 치의학전문대학원 구강내과학교실) ;
  • 안종모 (조선대학교 치의학전문대학원 구강내과학교실) ;
  • 윤창륙 (조선대학교 치의학전문대학원 구강내과학교실) ;
  • 조영곤 (조선대학교 치의학전문대학원 보존학교실) ;
  • 유지원 (조선대학교 치의학전문대학원 구강내과학교실)
  • Received : 2011.08.03
  • Accepted : 2011.09.01
  • Published : 2011.09.30
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Abstract

During root canal treatment, overinstrumentation with hand or mechanically driven files can perforate the mandibular canal, allowing the extrusion of endodontic sealers, dressing agents, and irrigant solutions out of the tooth and into the canal. The patient may report symptoms such as pain, hyperesthesia, hypoesthesia, anesthesia, dysesthesia and paresthesia. Such problems must be resolved as quickly as possible to avoid irreversible sequelae caused by certain neurotoxic materials that form part of endodontic sealants. Although there have been no controlled trials of treatment protocols involving endodontically related injuries to the inferior alveolar nerve, the normal therapeutic sequence for this complication is the control of pain and inflammation and, whenever possible, the surgical elimination of the cause. However, total resolution of pain and reduction in or disappearance of paraesthesia after a non-surgical management have been reported. Antiepileptic drugs such as gabapentin or pregabalin have been used for the treatment of neuropathic pain. This article describes a case of inferior alveolar nerve(IAN) damage after endodontic treatment of a mandibular right second molar and the treatment with non-surgical approach using prednisone and gabapentin medication, monitoring the patient's condition with clinical neurosensory examination and current perception threshold test(Neurometer).

근관치료 중 수동 또는 엔진구동파일을 사용하다 과도한 기구 조작을 하게 되면, 근관충전제, 드레싱제 그리고 근관세척제가 근관에서 나와 하악관으로 확산될 수 있다. 이 때 환자는 통증, 지각과민, 지각감퇴, 무감각, 이상감각 등을 호소하게 될 것이다. 이런 문제들은 근관충전제에 포함되어 있으면서 생체적합성이 떨어지는 물질들에 의한 비가역적인 손상을 피하기 위해 가능한 빨리 해결되어야 한다. 비록 근관치료와 관련하여 발생한 하치조신경의 손상을 치료하는 진료지침이 비교연구 되어 있는 것이 없으나, 이 합병증에 대한 통상의 치료는 통증과 염증을 조절하는 것이고, 가능하다면 수술적인 치료로 근원을 처치하는 것이다. 그러나, 비수술적인 치료로 통증을 완전히 개선하거나 감소시키고 또는 감각이상을 치료하는 것이 보고되어왔다. 가바펜틴(gabapentin) 또는 프리가발린(pregabalin) 같은 항간질제는 신경병증 통증의 치료에 이용되어 왔다. 이번 논문에서는 하악 우측 제 2대구치의 근관치료 후의 하치조신경의 손상과 이에 대해 프레드니솔론과 가바펜틴으로 비외과적 치료를 시행한 것과 임상적으로 신경감각검사와 신경전류인지역치검사(Neurometer)를 통해 경과관찰을 시행하였다.

Keywords

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