09/04/2025
The Hidden Danger in a Root Canal Treatment
You won’t believe how close one tiny mistake can come to a major nerve injury…
A routine root canal? Think again.
A patient presented with a large cavity and a periapical radiolucency involving teeth wrt 44 (open apex dure to external resorption) and 45. The X-ray told the real story — the root wrt 45 was right next to the inferior alveolar canal. That’s a red flag. Why? Because this isn’t just about saving a tooth — it’s about protecting a nerve that controls sensation in the lower lip and chin.
Here’s the kicker: in cases like this, even the smallest endodontic misstep can turn into a serious complication, risking paresthesia — a tingling or numbness that could last weeks… or even become permanent.
What can go wrong?
Over-instrumentation
Irrigation extrusion
Intracanal medication leaking beyond the apex
Sealer puff
And all of these errors? They can happen in seconds — even with experienced hands.
That’s why this case was managed with extreme precision:
Apex locator + X-ray confirmation of working length
Instrumentation done 0.5mm short of WL
Negative pressure irrigation only — no chance of irrigant getting extruded beyond the apex
Gentle, controlled application of sealer and medication
Minimal pressure during obturation
Why all the caution? Because endodontic-related nerve injuries, although rare, are real — and they’re mostly preventable.
The takeaway?
Endo isn’t just about the canal — it’s about the neighborhood. And when you’re working near the nerve, you’ve got zero room for error.
Think before you fill. Precision saves smiles — and sensation.
