Inferior alveolar nerve injury following calcium hydroxide extrusion: a case report with preventive insights and three-year follow-up

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Background: Calcium hydroxide is commonly used in endodontics for its antimicrobial properties. However, accidental extrusion beyond the apex can cause severe complications, including injury to the inferior alveolar nerve (IAN), which provides sensory innervation to the lower lip, chin, and posterior mandibular region. Case presentation: A 35-year-old female undergoing root canal treatment of tooth 46 developed paresthesia of the lower lip and chin due to accidental extrusion of calcium hydroxide along the IAN canal, confirmed on initial cone-beam computed tomography (CBCT). Immediate management included anti-inflammatory therapy and vitamin B12 supplementation. Outcome: Over a three-year follow-up, symptoms markedly improved with partial sensory recovery and attenuation of hyperesthesia. Follow-up CBCT showed resorption of the extruded calcium hydroxide compared to the initial radiograph. Conclusion: This case highlights the critical importance of precise working length determination, controlled intracanal medicament delivery, and thorough anatomical knowledge of the IAN to prevent iatrogenic injuries during endodontic procedures.

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