Incidence of neurosensory disturbance in mandibular implant surgery - A meta-analysis

Therapeutic modalities for iatrogenic late paresthesia in oral tissues innervated by mandibular branch of trigeminal nerve: a systematic review

BACKGROUND

The present systematic review intended to evaluate the current evidence on the modalities used for treating iatrogenic late paresthesia in the oral tissues innervated by the mandibular branch of the trigeminal nerve.

MAIN TEXT

As a common side effect of dental procedures, paresthesia can exert a profound adverse effect on patients' quality of life. The inferior alveolar nerve (IAN) and lingual nerve (LN) have the highest chance of injury during several dental procedures, including mandibular orthognathic surgeries, implant placement, extraction of the third molar, anesthetic injections, flap elevation, and endodontic treatments. Moreover, several methods have been proposed for treating iatrogenic late paresthesia, including photobiomodulation (PBM), microsurgery, medication, and close observation until achieving spontaneous recovery of sensation. However, no gold standard treatment for iatrogenic paresthesia has been agreed upon up to now. The present study included a comprehensive search of the databases of PubMed, Embase, Scopus, and Web of Science up to December 04, 2023, resulting in a total of 3122 related studies. Then, the titles, abstracts, and full texts of the studies were evaluated. Ultimately, seven controlled randomized trials (RCTs) were included in the final analysis. Also, the risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Among all fields, randomization, allocation concealment, and data analysis were found to have the highest chance of bias in the included studies.

CONCLUSIONS

In conclusion, PBM, vitamin B12, and corticosteroids could accelerate the recovery of late paresthesia. However, considering the low sample size of the included studies and the high risk of methodological bias, it is recommended to perform further RCTs with robust study designs following Good Clinical Practice (GCP) guidelines to achieve more reliable results.

Posttraumatic Trigeminal Neuropathic Pain in Association with Dental Implant Surgery

Posttraumatic trigeminal neuropathy in association with dental implant surgery is preventable, and this should be the emphasis for all clinicians considering this treatment for a patient. Once the nerve injury and posttraumatic neuropathy with or without pain ensues, there is very little the clinician can do to reverse it and the high pain and permanency of the neuropathy will have a significant functional and psychological impact on the patient. Immediate implant removal is required, and home check should be routine for all cases. International diagnostic criteria are available and should be implemented in everyday practice.

Sensory Changes Related to Dental Implant Placement: A Scoping Review

AIMS

To perform a scoping review of the literature to elucidate the occurrence of nerve damage related to dental implant placement and the factors causing the sensory changes.

METHODS

An extensive electronic search was conducted using the Cochrane Library, Medline via Ovid, PubMed, Wiley Online, Science Direct, CINAHL, and the Google Scholar databases from the year 1950 to 2020.

RESULTS

The search resulted in 1,067 articles, out of which 76 were selected for this review. The articles were categorized as literature review articles, retrospective studies, prospective studies, and case series/case reports. Altogether, 2,526 subjects were assessed retrospectively, with 5.27% transient and 1.39% persistent sensory changes, and a cohort of 2,750 subjects were followed prospectively, with 6.22% transient and 1.31% persistent sensory changes. A total of 336 subjects were enrolled in various case reports and case series, with 5.95% transient sensory changes and 84.52% persistent neurosensory changes. The articles included were not of high quality and have variations in their study designs and reporting procedures, with limited sensory change data to include in this study.

CONCLUSION

After surgical placement of dental implants in 5,612 patients, the incidence of transient sensory changes was 5.63%, and the incidence of persistent sensory changes was 6.33%. Factors affecting the incidence were: mandibular location of the implant, with the inferior alveolar nerve as the most commonly affected nerve. The common symptoms reported were paresthesia and dysesthesia. Age and gender were among other factors, for which data were not available in all the articles.

Lingual foramina of the anterior mandible in edentulous patients: CBCT analysis and surgical risk assessment

OBJECTIVE

The mandible has various unnamed accessory foramina, and surgery is often performed in the symphyseal area. The aim of this study was to analyze the anatomical characteristics of mandibular lingual foramina with the objective of preventing clinical complications during implant surgery on an edentulous mandible.

STUDY DESIGN

A total of 100 cone beam computed tomography scans of completely edentulous patients were included in this study. For each canal, nine measurements were recorded in millimeters: seven length or height measurements and two diameter measurements. The placement of a standard implant was simulated and whether the implant passed through the canal was noted. The results were analyzed by t-test and chi-squared at a significance level of 0.05. Pearson correlation analysis was used to assess the relationship between variables.

RESULTS

We identified 309 foramina: 236 medial lingual foramina and 73 lateral lingual foramina. We found no significant relationship between the number of foramina and the age of the individuals, or between diameter and the age or gender of the individuals. The mandibular canal was injured in 32.7 % of implant placement simulations.

CONCLUSION

The risk of injury to neurovascular bundles is increased in edentulous patients due to vertical bone resorption.

Prevalence and extension of the anterior loop of the mental nerve in different populations and CBCT imaging settings: A systematic review and meta-analysis

Purpose

Materials and Methods

Results

Conclusion

Bilateral intraoral traumatic neuroma: Case report of a diagnostic challenge

Oral traumatic neuromas (TrNs) are relatively rare lesions and they originate from a damaged nerve. They present a diagnostic challenge, due to the complex clinical features that may mimic odontogenic, musculoskeletal, and other neuropathic pain conditions. We describe an interesting and challenging case of painful bilateral intraoral lesions in a 56-year-old South Indian female patient who presented with clinical features consistent with TrN lesions bilaterally, in relation to different branches of the trigeminal nerve. The patient had undergone numerous aggressive dental treatments and interventions over the past three decades, with little or no pain relief. Topical treatment with lidocaine gel utilizing a custom-made neurosensory stent rendered the patient significant and sustained pain relief.

Expect the unexpected: The course of the inferior alveolar artery - Preliminary results and clinical implications

INTRODUCTION

The anatomical position of the inferior alveolar artery (IAA) within the mandibular canal and in relation to the substructures of the neurovascular mandibular bundle has been sparsely described to date. More detailed information on the exact IAA position would be beneficial for both dental and maxillofacial surgical procedures to minimize complications such as bleeding, nerve compression hematoma, and sensory deficiency.

MATERIAL AND METHODS

In 31 Thiel-preserved and fresh-frozen cadaver hemimandibles the position of the IAA in relation to the structures of the inferior alveolar neurovascular bundle and the mandible borders was analyzed anatomically and histologically.

RESULTS

In 77.4% of the cases, rotation of the IAA around the mental nerve was apparent, resulting in a typical site-dependent IAA position. While the IAA was situated buccally within the pterygomandibular space, buccal-inferior in the mandibular foramen, superior in the molar region, and lingually in the premolar region. In 12.9% of the cases, a persistent lingual position of the IAA was observed for the entire mandibular canal. In one case, an additional mandibular canal and an accessory IAA were identified.

DISCUSSION

This study provides new and encompassing information on the complete course and position of the IAA. This course is of practical use for oral implantology and various surgical procedures in dental- and maxillofacial surgery. Variations in the typical IAA course and site-dependent positional changes may be referred to as mandible growth and functional adaption to occlusion anomalies. This report helps enhance the morphological and functional understanding of IAA relationship during mandible development.