Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management.
air
factor
management
root canal
subcutaneous emphysema
Journal
International endodontic journal
ISSN: 1365-2591
Titre abrégé: Int Endod J
Pays: England
ID NLM: 8004996
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
24
08
2018
accepted:
30
06
2019
pubmed:
5
7
2019
medline:
30
10
2019
entrez:
5
7
2019
Statut:
ppublish
Résumé
Subcutaneous emphysema is an infrequent mishap during root canal treatment which, in rare cases, can lead to severe complications. To systematically review the literature on the factors affecting the development of subcutaneous emphysema during root canal treatment, and on its management. An electronic search was conducted in EMBASE (1947-2018), LILACS (1982-2018), PubMed (1950-2018), SciELO (1997-2018), Scopus (1970-2018), Web of Science (1900-2018) and two grey literature databases. Moreover, all issues of nine journals and four endodontic textbooks were hand-searched. The retrieved studies were screened by two reviewers to select clinical studies, case reports or case series describing subcutaneous emphysema that developed during or immediately after root canal treatment in adult patients. Included studies were critically appraised according to a custom list of quality requirements. The extracted data were arranged in tables, and combined through a narrative synthesis. The search retrieved 99 unique articles. Thirty six case reports and 15 case series describing a total of 65 cases of subcutaneous emphysema were included in this review. The methodological quality was medium. Reported cases of emphysema more often involved females and maxillary teeth. Drying of the root canal system with air under pressure, inadvertent extrusion of hydrogen peroxide through the apical foramen, the air-water spray produced by handpieces or laser devices, and the use of ozone gas were the most commonly suspected causes. Its management involved prescription of antibiotics and NSAIDs/analgesics, local application of ice packs or compresses and hospitalization. The signs and symptoms resolved completely within 1-17 days. Case reports and case series are a low level of evidence. Subcutaneous emphysema can develop during both nonsurgical and surgical root canal treatment. Pressurized air streams or air-water sprays should not be directed towards the root canals or areas with mucosal discontinuity. None of the management approaches were clearly related to expedited recovery. Guidelines should be developed in order to avoid unnecessary or potentially harmful interventions.
Sections du résumé
BACKGROUND
BACKGROUND
Subcutaneous emphysema is an infrequent mishap during root canal treatment which, in rare cases, can lead to severe complications.
AIM
OBJECTIVE
To systematically review the literature on the factors affecting the development of subcutaneous emphysema during root canal treatment, and on its management.
DATA SOURCES
METHODS
An electronic search was conducted in EMBASE (1947-2018), LILACS (1982-2018), PubMed (1950-2018), SciELO (1997-2018), Scopus (1970-2018), Web of Science (1900-2018) and two grey literature databases. Moreover, all issues of nine journals and four endodontic textbooks were hand-searched.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, INTERVENTIONS
UNASSIGNED
The retrieved studies were screened by two reviewers to select clinical studies, case reports or case series describing subcutaneous emphysema that developed during or immediately after root canal treatment in adult patients.
STUDY APPRAISAL AND SYNTHESIS METHODS
METHODS
Included studies were critically appraised according to a custom list of quality requirements. The extracted data were arranged in tables, and combined through a narrative synthesis.
RESULTS
RESULTS
The search retrieved 99 unique articles. Thirty six case reports and 15 case series describing a total of 65 cases of subcutaneous emphysema were included in this review. The methodological quality was medium. Reported cases of emphysema more often involved females and maxillary teeth. Drying of the root canal system with air under pressure, inadvertent extrusion of hydrogen peroxide through the apical foramen, the air-water spray produced by handpieces or laser devices, and the use of ozone gas were the most commonly suspected causes. Its management involved prescription of antibiotics and NSAIDs/analgesics, local application of ice packs or compresses and hospitalization. The signs and symptoms resolved completely within 1-17 days.
LIMITATIONS
CONCLUSIONS
Case reports and case series are a low level of evidence.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
CONCLUSIONS
Subcutaneous emphysema can develop during both nonsurgical and surgical root canal treatment. Pressurized air streams or air-water sprays should not be directed towards the root canals or areas with mucosal discontinuity. None of the management approaches were clearly related to expedited recovery. Guidelines should be developed in order to avoid unnecessary or potentially harmful interventions.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Systematic Review
Langues
eng
Pagination
1586-1604Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd.
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