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Assessing inferior dental nerve injury risk in orthograde root canal treatment Paul Cruci Allen Gaon St John Crean Jackie Brown John Rout Dental Update 2024 50:4, 707-709.
Clinical Lecturer in Endodontics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Specialist in Endodontics, Gerrards Cross, Buckinghamshire
Clinical Lecturer in Endodontics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Specialist in Endodontics, Edgware, Middlesex
Pro Vice Chancellor (Research, Innovation and Enterprise), Professor of Medicine in Dentistry, Consultant Oral and Maxillofacial Surgeon, University of Central Lancashire
Nerve injury associated with root canal treatment is relatively rare, but can lead to significant morbidity. The role of 2D and 3D radiography in case assessment is explored and a new three-tier grading system is proposed to aid in risk assessment and clinical decision-making. This grading system would assist dentists to fully appraise patients, gain appropriate informed consent and guide treatment of endodontic cases where there is an increased risk of nerve injury.
CPD/Clinical Relevance: A new three-tier grading system to assist in the pre-operative assessment and risk management of endodontic cases where there is an increased risk of nerve injury is proposed.
Article
Nerve injury is a relatively uncommon, but nonetheless serious, side effect of root canal treatment of mandibular posterior teeth.1,2 It can result in permanently altered sensation, which can have serious effects on a patient's quality of life, both functionally and psychologically.3 It is largely avoidable with correct pre-operative assessment and treatment protocols.
The diagnostic criteria and management protocols for post-traumatic neuropathy lie outside the scope of this article. Readers must familiarize themselves with established and published protocols to guide early post-treatment intervention to optimise treatment and nerve injury resolution.4 Advice on urgent recognition, diagnosis, referral and management of endodontic-related nerve injury, with or without pain, can be found at: trigeminalnerve.org.uk
Inferior dental nerve (IDN) and mental nerve (MN) injuries are most commonly (but not exclusively) reported in relation to mandibular second molars and premolars. An understandable desire to retain teeth, coupled with complex restorative histories, increasingly presents practitioners with challenging endodontic cases that may involve greater risk of nerve damage.
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