Arterial cerebral air embolism occurred during root canal treatment: a case report and literature review

Background: Root canal treatment is generally safe, but cerebral arterial air embolism (CAAE) is a rare, life-threatening complication. Case presentation: A 69-year-old male with apical periodontitis of teeth #31 and #41 suffered sudden loss of consciousness and coma during endodontic treatment. Cerebral computed tomography (CT) revealed multiple intracranial punctate gas densities with cervical and maxillofacial subcutaneous emphysema. Hyperbaric oxygen therapy (HBOT) led to complete neurological recovery. Conclusion: Clinicians must recognise the risk of arterial air embolism from high-pressure air syringes. Prevention hinges on minimising air pressure and duration, using the lowest effective pressure, and ensuring meticulous haemostasis. Acute neurological deterioration demands immediate imaging and urgent HBOT. Integrating these measures into dental safety standards is essential.