Persistence of postoperative pain due to extrusion of endodontic obturator plastic carrier: A report of two cases treated with a periradicular microsurgical approach

Abstract

The aim of the present study was to describe two clinical cases showing postoperative pain
associated with the use of plastic carrier obturation system and apical bone fenestration. The
patients were treated by surgical access and apicoectomy through a modern technique (using
magnification and microsurgical approach), thus removing the direct contact between obturation
material and submucosal connective tissue. The surgical interventions were carried on without the
occurrence of any complication. Postsurgical adverse sequelae were negligible. After few weeks
from the surgery, all symptoms disappeared. Radiographic healing was observed after 48 months.
The presence of apical bone fenestration could be the cause of persistent pain after root canal
treatment. The contact between plastic carrier and submucosal connective tissue could be the
direct cause of spontaneous pain even in absence of periapical infection. Since the clinical diagnosis
could be difficult, the use of tridimensional radiology could be justified. Surgical approach, by the
removal of the contact between the carrier and connective tissues, can be considered a viable
option to treat these particular affections.
Key Words: Apicoectomy, endodontics, pain, root canal obturation