During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

The purpose of this in vitro study was to compare the effects of root canal debridement following rotary Ni-Ti instruments with positive versus negative rake angle. Seventy sound, extracted human anterior teeth & premolars were randomly divided into four groups. The used rotary instruments were Ni-Ti HERO 642(Micro-Mega in France, 20 specimen), Ni-Ti ProFile(Maillefer, Ballaigues, Switzerland, 20 specimen), stainless steel engine reamer(Mani, Matsutani Seisakusho Co.,Japan, 20 specimen) and negative control group(10 specimen) was only extirpated with barbed broach(Mani, Matsutani Seisakusho Co.,Japan)

Group 1 & 2 teeth were prepared to a #40 at the apex followed by 1 mm using crown-down technique. Group 3 teeth were instrumented from a #15 to a #40 in sequential order. After preparation and final irrigation, the roots split longitudinally into a bucco-lingual direction. Root halves were cross-sectioned in apical third portion again. all root specimens were prepared for SEM investigation & photographed. Separate evaluations were undertaken for smear layer on prepared walls with a five score-index for each using reference photograph in root halves. the penetration depth of smear layer into dentinal tubules was also estimated in the other halves. the following results were obtained :

1. Smear layer was observed on all the prepared walls with three experimental groups except negative control group

2. Smear layer characteristics

1) HERO 642 groups showed snowy & dusty appearance & were observed only few some dentinal tubuli open on the prepared walls, and the penetration depth of it into dentinal tubules may be 1-2 µm thick.

2) ProFile groups showed shiny & burnished appearance & complete root canal wall covered by a homogenous smear layer with no open dentinal tubuli and penetration depth of it into dentinal tubules may be 1-2 µm thick.

3) Engine reamer groups showed obviously file's passed tracks on the prepared walls & were observed complete root canal wall covered by a homogenous smear layer with no open dentinal tubuli.

The results revealed that a completely clean root canal could not be achieved regardless of positive & negative rake angle, which is in accordance with the majority of studies on root canal cleanliness.

In conclusion, throughout irrigation with antibacterial solutions or chelating agents is recommended to remove the smear layer on prepared canal walls.