Permanent Labiomandibular Paresthesia after Bioceramic Sealer Extrusion: A Case Report

The present report describes a case of permanent labiomandibular paresthesia subsequent to a root canal treatment in a molar in which a bioceramic sealer extrusion occurred. A 23-year-old black woman attended the endodontics clinic at university, complaining of loss of sensation in the mucosa and skin on the right side of her face in the lower lip region, which began after an endodontic treatment in the second lower right molar. A bioceramic sealer (MTA; Angelus, Londrina, PR, Brazil) was used to fill the canals. The periapical radiographic examination revealed an amount of extruded sealer by mesial and distal roots reaching the interior of the mandibular canal. Then, treatment with a corticosteroid and a vitamin B complex was initiated, and demarcation of the affected area was performed. One week later, paresthesia was still present in equal intensity in the affected area. Thirty-nine days elapsed after the endodontic therapy; the paresthesia continued, encompassing the same area, although with a small reduction in intensity. In the following 6 months, a very subtle decrease in intensity but not in the affected area was noticed. From 6 months to 1 year, no changes were observed. According to the patient's report, the paresthesia affected her quality of life in several aspects. The short distance between the root apices and the upper cortical bone of the mandibular canal seemed to have acted as a predisponent factor to the present long-term paresthesia. In conclusion, bioceramic sealers may also induce permanent facial paresthesia, if extruded.