Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications

Abstract

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve.Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors.Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal.The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction.Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement.The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature.

Characteristics of Mandibular Canal Branches Related to Nociceptive Marker

“…Oral surgeons must acquire detailed information on the distribution of small nerves and blood vessels in this region of the mandible. The main goal of accurate implant placement is to adjust the position for the teeth implants (Boffano et al 2007; Tay and Zuniga 2007; Juodzbalys et al 2013) and other surgical treatments, such as endodontic treatment, oral surgery, and maxillofacial surgery (Valmaseda-Castellón et al 2001; Poort et al 2009; Long et al 2012; Biglioli et al 2015; Bianchi et al 2017), according to the risk factors related to nerves and blood vessels in the alveolar bone. Previous data of CBCT images provide useful data for planning the defined location of the oral surgical treatment.…”

Legal Liability of a Dentist: Inferior Alveolar Nerve Damage After Calcium Hydroxide Extrusion

“…It is accepted that early surgical intervention in nerve injuries improves the outcome. 1 Should a patient exhibit neuropathic indications in the first 24 to 58 hours after IAN injury due to endodontic treatment, an immediate microsurgical consultation is recommended. The cause if initial delay to appropriate referral relied on the dentist who performed the endodontic treatment.…”

“…Root canal treatments are frequent dental procedures. When endodontic materials are forced through the root apex into the mandibular canal, it can cause chemical, mechanical, and/or thermal injuries to the inferior alveolar nerve (IAN), which can lead to sensory disturbances 1 …”

Cbct analysis of apical distance between second lower premolars, first and second lower molars and mandibular canal

“…Povreda sadržaja mandibularnog kanala rotirajućim i hirurškim instrumentima moguća je u toku oralnohirurških zahvata. Takve povrede nekada zahtevaju terapiju u vidu mikrohirurške dekompresije donjoviličnog živca [7][8][9][10].…”

“…Injury to the content of the mandibular canal is also possible during oral surgery. Such injuries sometimes require treatment in the form of microsurgical decompression of the inferior alveolar nerve [7][8][9][10].…”