One-Year Follow-Up of Non-Healing Socket in Hodgkin’s Lymphoma Patient: Case Report and Literature Review on Management Strategies

Abstract

Background and Clinical Significance: Sodium hypochlorite (NaOCl) is widely used in root canal treatment for its potent antiseptic and antibacterial effects. However, its cytotoxicity—particularly at higher concentrations and in patients with low immune status—has been associated with serious postoperative complications. This case report describes the risks associated with NaOCl exposure in a medically compromised patient and reviews the relevant literature on NaOCl-related injuries, offering insights into potential current management strategies. Case Presentation: This case report describes a challenging scenario of a 25-year-old male with a history of Hodgkin’s lymphoma who developed a non-healing bone in the lower right first molar (LR6) region after NaOCl exposure. Several months after undergoing root canal treatment and an extraction of the LR6, the patient presented with exposed necrotic bone in the region. The case’s complexity was heightened by the patient’s medical and dental history, which included chemotherapy and NaOCl exposure. Following a detailed clinical, radiographic examination and biopsy, the patient was diagnosed with bone necrosis due to NaOCl exposure. The treatment involved the extraction of the LR6, the debridement of the necrotic bone, and long-term follow-up with antimicrobial therapy. Despite efforts to manage the complication, the healing process was prolonged, potentially due to the patient’s immunocompromised state from chemotherapy. The patient’s condition remained unresolved after nearly a year, and ongoing management, including regular follow-up, was necessary to monitor healing and prevent further complications. This case highlights the challenges of treating dental complications in immunocompromised patients, particularly those with Hodgkin’s lymphoma, where delayed healing is a problem that might occur. Conclusions: Given the complexity of this case, different adjunctive treatment options, such as leukocyte–platelet-rich fibrin (L-PRF), pentoxifylline and tocopherol (PENTO), and hyperbaric oxygen therapy (HBOT), were discussed as potential treatments to help manage non-healing sockets in patients with similar conditions.

Keywords

• delayed healing
• hodgkin disease
• immunocompromised host
• osteonecrosis
• sodium hypochlorite
• treatment outcome