CASE REPORT Mandibular bone necrosis caused by use of arsenic paste during endodontic treatment: two case reports M. S. Yavuz, G. S ¸ ims ¸ ek Kaya, E. Yalc ¸ın & M. H. Aras Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatu ¨ rk University, Erzurum, Turkey Abstract Yavuz MS, S ¸ ims ¸ ek Kaya G, Yalc ¸ ın E, Aras MH. Mandibular bone necrosis caused by use of arsenic paste during endodontic treatment: two case reports. International Endodontic Journal, 41, 633–637, 2008. Aim To report that arsenical pastes are still employed in endodontics and to highlight the potentially serious consequences of their use. Summary Chemotherapeutic agents such as arsenic trioxide and paraformaldehyde were once commonly employed as pulp-necrotizing agents. Their cytotoxic effects are well recognized, and leakage from teeth has been associated with widespread necrosis of periodontal tissues and bone. This report describes two cases of severe bone necrosis affecting the mandible following the use of an arsenical paste. Key learning points • Pulp-necrotizing agents such as arsenic trioxide can cause severe bone necrosis. • Arsenical pastes have no place in contemporary dental practice. • Dentists should employ appropriate local anaesthetic techniques for pulp extirpation instead of relying on toxic necrotizing agents. Keywords: arsenic, arsenic trioxide, endodontic treatment, mandible, necrosis. Received 24 August 2006; accepted 23 January 2008 Introduction The history of arsenic trioxide in endodontic treatment began with Haly Abbas in 1492 (cited by Smart & Barnes 1991). The agent was widely accepted after Spooner described the use of arsenic trioxide for devitalization of the pulp in 1836 (cited by Bataineh et al. 1997, Cruse & Bellizzi 1980). Because of the potential for leakage, the use of arsenic oxide for devitalizing pulp was always unsafe. For this reason, and after improvements in local anaesthesia, the use of doi:10.1111/j.1365-2591.2008.01406.x Correspondence: Dr M. Selim Yavuz, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatu ¨ rk University, 25240 Erzurum, Turkey (Tel.: +90 442 2311734; fax: +90 442 2360945; e-mail: mselimyavuz@gmail.com). ª 2008 International Endodontic Journal International Endodontic Journal, 41, 633–637, 2008 633