Review finds limited evidence for predisposing factors for irrigant extrusion during root canal treatment


Irrigation of root canals is an integral part of root canal treatment. A range of irrigant materials have been used with sodium hypochlorite being the material most currently favoured.  However this and other agents can cause damage if not kept within the confines of the root canal system.  The aim of this review was to analyse the published data on irrigant extrusion to identify factors causing, affecting or predisposing to irrigant extrusion during root canal irrigation of human mature permanent teeth.

The Cochrane Library, LILACS, PubMed, SciELO, Scopus and Web of Knowledge databases were searched with additional hand searching of six endodontic journals and the relevant chapters of four endodontic textbooks. Eligibility criteria were set for three broad categories of papers, clinical studies, case reports and ex-vivo studies.  Screening and data abstraction was conducted independently by two reviewers.

  • 40 case reports and 10 ex vivo studies were included in the review.
  • Publication dates ranged from 1938 to 2012
  • Case reports focused mainly on the clinical manifestations and management of the accidents and did not provide adequate details on the possible factors that may influence irrigant extrusion.
  • Data from the included ex vivo studies were inconclusive due to major methodological limitations, such as not simulating the presence of periapical tissues and not assessing the validity of irrigant detection methods.

The authors concluded

There is a lack of clinical studies focusing on irrigant extrusion during root canal irrigation. Currently available case reports provide limited data on the possible factors that may influence irrigant extrusion. Ex vivo studies are inconclusive due to major methodological limitations and extensive variability in the protocols employed. The choice of factors investigated in ex vivo studies seems not to have been driven by the available clinical evidence. These issues need to be addressed in future studies.

Comment Adverse events are often under reported so it is good to see this review which pulls together information from a number of case reports of adverse events as a result of irritant extrusion.



Boutsioukis C, Psimma Z, van der Sluis LW. Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int Endod J. 2013 Jul;46(7):599-618. doi: 10.1111/iej.12038. Epub 2013 Jan 4. PubMed PMID: 23289914.


Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+