Endodontic sealer extrusion with secondary osteomyelitis-related bone sequestration: A case report

Endodontic treatment is a predictable therapeutic approach; however, procedural complications may significantly compromise biological healing and long-term tooth survival. This case report describes a severe post-endodontic complication resulting in tooth extraction and inflammatory bone sequestration. A 48-year-old male patient presented with persistent pain originating from the mandibular right second molar. Root canal treatment was performed over three sessions, including calcium hydroxide medication and definitive obturation using a single-cone technique. Radiographic verification revealed root perforation and extrusion of sealer into the periapical tissues of both roots. Despite conservative postoperative management, the clinical course was characterized by persistent pain, progressive tooth mobility, and radiographically evident osteolysis. Extraction was therefore indicated. Intraoperatively, the tooth was removed atraumatically together with a loosely attached bone sequestrum. Histopathological examination confirmed a purulent inflammatory process associated with foreign material and granulation tissue. Postoperative healing was uneventful, and radiographic follow-up demonstrated favorable bone regeneration. This case highlights the potential for obturation-related complications to trigger sustained inflammatory bone reactions and underscores the importance of timely risk-based decisionmaking. When biological deterioration and foreign-body–induced inflammation coexist, extraction may represent a justified and definitive therapeutic endpoint rather than a failure of endodontic care.