Microsurgical Repair of Inferior Alveolar Nerve Injuries Associated With Endodontic Treatment: Results on Sensory Function and Relief of Pain

Both Type I Bovine Collagen Conduits and Porcine Small Intestine Submucosa Conduits Result in Functional Sensory Recovery Following Peripheral Nerve Microsurgery: A Systematic Review and Meta-Analysis

PURPOSE

The study purpose was to measure and compare the time to functional sensory recovery (FSR) and incidence of FSR by 6 and 12 months between type I bovine collagen conduits versus porcine small intestine submucosa (SIS) conduits with primary neurorrhaphy for peripheral nerve injury repair.

METHODS

A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were conducted. The predictor variable was the type of conduit-either bovine collagen or porcine SIS. The primary outcome variable was the number of months between surgery and the patient achieving FSR. The secondary outcome variable was the proportion of patients who achieved FSR that did so by 6 and 12 months. A log-rank test was performed to evaluate the statistical significance of the differences observed in the overall time-to-FSR data and by 6 and 12 months.

RESULTS

We screened 67 publications of which 8 were included. The sample sizes were 137 and 96 patients for the bovine collagen and porcine SIS groups, respectively. The median time to FSR for the bovine collagen conduit group was 9 months (interquartile range: 6); the median time to FSR for the porcine SIS conduit group 6 months (interquartile range: 3 months) (P = .50). Of the patients who achieved FSR, 42% of patients with bovine collagen conduits and 64% of patients with porcine SIS conduits did so within 6 months (P < .01). Of the patients who achieved FSR, 94% of patients with bovine collagen conduits and 82% of patients with porcine SIS conduits did so within 12 months (P < .01).

CONCLUSION

Although a significant difference was found in the incidence of FSR at 6 and 12 months, no significant difference was found in overall time to FSR, supporting the use of either conduit for peripheral nerve repair.

Surgical outcomes of the surgical techniques following management of iatrogenic trigeminal nerve injuries: A systematic review

Objective

To investigate the effectiveness of the microsurgical treatment in restoring full sensory recovery following trigeminal nerve injuries caused by iatrogenic oral and maxillofacial surgical interventions.

Methods

A detailed search was conducted on the Cochrane central register of controlled trials, Medline and Embase. Clinical studies with at least twelve months of follow up were included and assessment of risks of bias was made using the Robbin I assessment tool.

Results

Six studies were identified in the searches which include 227 patients. The lingual nerve was the most common injured nerve, followed by the inferior alveolar nerve. Third molar removal was the most frequent cause of nerve injury, followed by root canal treatment, pathology excision, coronectomy, orthognathic surgery, dental implants and then local anaesthetic injections. Overall, surgical interventions for nerve injuries showed neurosensory improvement postoperatively in the majority of patients.

Conclusion

Direct neurorrhaphy is still the gold-standard technique when the tension at the surgical site is minimal. Promising results have been noted on conduit applications following traditional repair or grafting. Further research is needed on the efficacy of allografting and conduit applications in nerve repair.

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

ABSTRACT

During root canal treatments, calcium hydroxide can extrude through the apex causing chemical, mechanical, and/or thermal injuries to the inferior alveolar nerve, which can lead to neurological disorders. Unfortunately, dental practitioner negligence can produce this potentially life-changing injury that can compromise the patient's life. The aim of this study is present a case of dental negligence by calcium hydroxide extrusion causing inferior alveolar nerve damage, discuss the methods of prevention, and characterize the medico-legal aspects of complication.