OR20 - Retrospective Analysis of Factors Affecting the Incidence and Progress of Sodium Hypochlorite Accidents Using Cone Beam Computed Tomography Scans and a Modified Survey

Abstract:
The sodium hypochlorite accident (SHA) is a rare but serious complication in non-surgical root canal procedures that occurs when sodium hypochlorite (NaOCl) extrudes beyond the periapical tissues and can cause significant sequelae. Many earlier reports on SHAs have lacked three-dimensional imaging and systematic reporting of pertinent information on risk factors, demographics, management, and sequelae. Therefore, the aim of this study was to report the factors of SHAs using cone beam computed tomography scans and a modified survey. Twenty-four clinicians who experienced a SHA on an adult patient while undergoing endodontic treatment on a permanent mature tooth were recruited. All clinicians submitted anonymous patient information including age, sex, and small field CBCT scans, but only nineteen sent the additional modified surveys which collected supplementary information on patient demographics, clinician technique, and SHA manifestation and management. Descriptive statistics were used to identify patterns and correlations between cases and the risk factors involved. CBCT scans were analyzed for the presence of risk factors including presence of a perforation, apical radiolucency, fenestration or dehiscence, and other forms of direct communication with mucosal tissues. Of the SHA cases studied, females and maxillary molar teeth were found at a higher frequency. The CBCT scans showed fenestrations, dehiscences, iatrogenic perforations, and/or inflammatory resorption in all the cases studied.Within the limitations of this study, anatomical variations such as fenestrations and dehiscences are risk factors for SHA. The modified survey could be a useful tool for the systematic reporting of SHAs.