Caissie R, Goulet J, Fortin M, Morielle D. Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience. J Can Dent Assoc. 2005; 71:185-190
Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig. 2007; 11:133-142
Elian N, Mitsias M, Eskow R, Jalbout ZN, Cho SC, Froum S, Tarnow DP. Unexpected return of sensation following 4.5 years of paresthesia: case report. Implant Dent. 2005; 14:364-367
Loescher AR, Robinson PP. The effect of surgical medicaments on peripheral nerve function. Br J Oral Maxillofac Surg. 1998; 36:327-332
Hegedus F, Diecidue RJ. Trigeminal nerve injuries after mandibular implant placement – practical knowledge for clinicians. Int J Oral Maxillofac Implants. 2006; 21:111-116
Ziccardi VB, Assael LA. Mechanisms of trigeminal nerve injuries. Atlas Oral Maxillofac Surg Clin North Am. 2001; 9:1-11
Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain. 2011; 25:333-344
Renton T, Yilmaz Z. Managing iatrogenic trigeminal nerve injury: a case series and review of the literature. Int J Oral Maxillofac Surg. 2012; 41:629-637 https://doi.org/10.1016/j.ijom.2011.11.002
Mason DA. Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg. 1988; 17:290-294
Leung YY, Cheung LK. Longitudinal treatment outcomes of microsurgical treatment of neurosensory deficit after lower third molar surgery: a prospective case series. PLoS One. 2016; 11
Zuniga JR, Yates DM, Phillips CL. The presence of neuropathic pain predicts postoperative neuropathic pain following trigeminal nerve repair. J Oral Maxillofac Surg. 2014; 72:2422-2427
Zuniga JR, Yates DM. Factors determining outcome after trigeminal nerve surgery for neuropathic pain. J Oral Maxillofac Surg. 2016; 74:1323-1329
Renton T, Janjua H, Gallagher JE, Dalgleish M, Yilmaz Z. UK dentists' experience of iatrogenic trigeminal nerve injuries in relation to routine dental procedures: why, when and how often?. Br Dent J. 2013; 214:633-642 https://doi.org/10.1038/sj.bdj.2013.583
Pogrel MA, Schmidt BL, Sambajon V, Jordan RC. Lingual nerve damage due to inferior alveolar nerve blocks: a possible explanation. J Am Dent Assoc. 2003; 134:195-199
Smith MH, Lung KE. Nerve injuries after dental injection: a review of the literature. J Can. 2006; 72:559-564
Pogrel MA, Thamby S. Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Am Dent Assoc. 2000; 131:901-907
Haas DA, Lennon D. A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc. 1995; 61:319-330
Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig. 2007; 11:133-142 https://doi.org/10.1007/s00784-006-0089-5
Perez-Castro R, Patel S, Garavito-Aguilar ZV, Rosenberg A, Recio-Pinto E, Zhang J, Blanck TJ, Xu F. Cytotoxicity of local anesthetics in human neuronal cells. Anesth Analg. 2009; 108:997-1007
Kämmerer PW, Schneider D, Palarie V, Schiegnitz E, Daubländer M. Comparison of anesthetic efficacy of 2 and 4% articaine in inferior alveolar nerve block for tooth extraction – a double-blinded randomized clinical trial. Clin Oral Investig. 2017; 21:397-403
Daubländer M, Kämmerer PW, Willershausen B, Leckel M, Lauer HC, Buff S, Rösl B. Clinical use of an epinephrine-reduced (1/400,000) articaine solution in short-time dental routine treatments – a multicenter study. Clin Oral Investig. 2012; 16:1289-1295
Evans G, Nusstein J, Drum M, Reader A, Beck M. A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations. J Endod. 2008; 34:389-393
Oliveira PC, Volpato MC, Ramacciato JC, Ranali J. Articaine and lignocaine efficiency in infiltration anaesthesia: a pilot study. Br Dent J. 2004; 197:45-46
Vähätalo K, Antila H, Lehtinen R. Articaine and lidocaine for maxillary infiltration anesthesia. Anesth Prog. 1993; 40:114-116
Srinivasan N, Kavitha M, Loganathan CS, Padmini G. Comparison of anesthetic efficacy of 4% articaine and 2% lidocaine for maxillary buccal infiltration in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107:133-136
Meechan JG. The use of the mandibular infiltration anesthetic technique in adults. J Am Dent Assoc. 2011; 142:19S-24S
Zain M, Rehman Khattak SU, Sikandar H, Fayyaz Shah SA Comparison of anaesthetic efficacy of 4% articaine primary buccal infiltration versus 2% lidocaine inferior alveolar nerve block in symptomatic mandibular first molar teeth. J Coll Physicians Surg Pak. 2016; 26:4-8
Poorni S, Veniashok B, Senthikumar AD, Indira R, Ramachandran S. Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial. J Endod. 2011; 37:1603-1607
Kung J, McDonagh M, Sedgley CM. Does articaine provide an advantage over lidocaine in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. J Endod. 2015; 41:1784-1794
Thakare A, Bhate K, Kathariya R. Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: prospective, randomized crossover study. Acta Anaesthesiol Taiwan. 2014; 52:59-63
Etoz OA, Er N, Demirbas AE. Is supraperiosteal infiltration anesthesia safe enough to prevent inferior alveolar nerve during posterior mandibular implant surgery?. Med Oral Patol Oral Cir Bucal. 2011; 16
Dumbrigue HB, Lim MV, Rudman RA, Serraon A. A comparative study of anesthetic techniques for mandibular dental extraction. Am J Dent. 1997; 10:275-278
Renton T, Zakrzewska JM. Chapter 22: Orofacial Pain. In: Shaw I, Kumar C, Dodds C (eds). Oxford: Oxford University Press; 2010
Renton T, Adey-Viscuso D, Meechan JG, Yilmaz Z. Trigeminal nerve injuries in relation to the local anaesthesia in mandibular injections. Br Dent J. 2010; 209 https://doi.org/10.1038/sj.bdj.2010.978
Haas DA, Lennon D. A 21 year restrospective study of reports of paraesthetsia following local anaesthetic administration. J Can Dent Assoc. 1995; 61:319-330
The National Royal College of Anaesthetists. RCA Audit 2012.
Orr DL, Curtis WJ. Obtaining written informed consent for the administration of local anesthetic in dentistry. J Am Dent Assoc. 1939; 136:(11)1568-1571
Pogrel MA. Damage to the inferior alveolar nerve as the result of root canal therapy. J Am Dent Assoc. 2007; 138:65-69
Knowles KI, Jergenson MA, Howard JH. Paresthesia associated with endodontic treatment of mandibular premolars. J Endod. 2003; 29:768-770
Scolozzi P, Lombardi T, Jaques B. Successful inferior alveolar nerve decompression for dysesthesia following endodontic treatment: report of 4 cases treated by mandibular sagittal osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97:625-631
Grötz KA, Al-Nawas B, de Aguiar EG, Schulz A, Wagner W. Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig. 1998; 2:73-76
Devine M, Modgill O, Renton T. Mandibular division trigeminal nerve injuries following primary endodontic treatment. A case series. Aust Endod J. 2017; 43:56-65 https://doi.org/10.1111/aej.12209
Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain. 2011; 25:333-344
Giuliani M, Lajolo C, Deli G, Silveri C. Inferior alveolar nerve paresthesia caused by endodontic pathosis: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92:670-674
Devine M, Yilmaz Z, Hirani M, Renton T. A case series of trigeminal nerve injuries caused by periapical lesions of mandibular teeth. Br Dent J. 2017; 222:447-455 https://doi.org/10.1038/sj.bdj.2017.268
Oshima K, Ishii T, Ogura Y, Aoyama Y, Katsuumi I. Clinical investigation of patients who develop neuropathic tooth pain after endodontics procedures. J Endod. 2009; 35:958-961
Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J. 2005; 38:169-178
Campbell RL, Parks KW, Dodds RN. Chronic facial pain associated with endodontic therapy. Oral Surg Oral Med Oral Pathol. 1990; 69:287-290
Brodin P, Roed A, Aars H, Orstravik D. Neurotoxic effects of root filling materials on rat phrenic nerve in vitro. J Dent Res. 1982; 61:1020-1023
Brodin P. Neurotoxic and analgesic effects of root canal cements and pulp-protecting dental materials. Endod Dent Traumatol. 1988; 2:1-11
Serper A, Ucer O, Onur R, Etikan I. Comparative neurotoxic effects of root canal materials on rat sciatic nerve. J Endod. 1998; 24:592-594
Kozam G, Newark NJ. The effect of eugenol on nerve transmission. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1977; 44:799-805
Fanibunda K, Whitworth J, Steele J. The management of thermomechanically compacted gutta percha extrusion in the inferior dental canal. Br Dent J. 1998; 184:330-332
Leckel M, Kress B, Schmitter M. Neuropathic pain resulting from implant placement: Case report and diagnostic conclusions. J Oral Rehabil. 2009; 36:543-546 https://doi.org/10.1111/j.1365-2842.2009.01950
Patel S, Durack C, Abella F, Roig M, Shemesh H, Lambrechts P, Lemberg K. European Society of Endodontology position statement: the use of CBCT in endodontics. Int Endod J. 2014; 47:502-504
Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, Kurabayashi T. A comparative study of cone-beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Oral Surg Oral Med Oral Pathol. 2007; 103:253-259
Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007; 40:818-830
Tilotta-Yasukawa F, Millot S, El Haddioui A, Bravetti P, Gaudy JF. Labiomandibular paresthesia caused by endodontic treatment: an anatomic and clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:47-59
Chikvashvili J. Overcoming unforeseen incidents: what to do when an unlikely event occurs. Compend Contin Educ Dent. 2011; 32:44-48
Fishel D, Buchner A, Hershkowith A, Kaffe I. Roentgenologic study of the mental foramen. Oral Surg Oral Med Oral Pathol. 1976; 41:682-686
Phillips JL, Weller RN, Kulild JC. The mental foramen: 2. Radiographic position in relation to the mandibular second premolar. J Endod. 1992; 18:271-274
Denio D, Torabinejad M, Bakland LK. Anatomical relationship of the mandibular canal to its surrounding structures in mature mandibles. J Endod. 1992; 18:161-165
Helvacıoğlu Kıvanç B, Deniz Arısu H, Yanar NÖ, Silah HM, İnam R, Görgül G. Apical extrusion of sodium hypochlorite activated with two laser systems and ultrasonics: a spectrophotometric analysis. BMC Oral Health. 2015; 15
Scarano A, Di Carlo F, Quaranta A, Piattelli A. Injury of the inferior alveolar nerve after overfilling of the root canal with endodontic cement: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104:56-59
Escoda-Francoli J, Canalda-Sahli C, Soler A, Figueiredo R, Gay-Escoda C. Inferior alveolar nerve damage because of overextended endodontic material: a problem of sealer cement biocompatibility?. J Endod. 2007; 33:1484-1489
Blanas N, Kienle F, Sándor GK. Inferior alveolar nerve injury caused by thermoplastic gutta-percha overextension. J Can Dent Assoc. 2004; 70:384-387
Köseoğlu BG, Tanrikulu S, Sübay RK, Sencer S. Anesthesia following overfilling of a root canal sealer into the mandibular canal: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101:803-806
von Ohle C, ElAyouti A. Neurosensory impairment of the mental nerve as a sequel of periapical periodontitis: case report and review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110:84-89
Shadmehr E, Shekarchizade N. Endodontic periapical lesion-induced mental nerve paresthesia. Dent Res J (Isfahan). 2015; 12:192-196
Kruse A, Hellmich N, Luebbers HT, Grätz KW. Neurological deficit of the facial nerve after root canal treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108:46-48
Mohammadi Z. Endodontics-related paresthesia of the mental and inferior alveolar nerves: an updated review. J Can Dent Assoc. 2010; 76
Campbell RL, Parks KW, Dodds RN. Chronic facial pain associated with endodontic therapy. Oral Surg Oral Med Oral Pathol. 1990; 69:287-290
Oshima K, Ishii T, Ogura Y, Aoyama Y, Katsuumi I. Clinical investigation of patients who develop neuropathic tooth pain after endodontics procedures. J Endod. 35; 7:958-961
Klasser GD, Kugelmann AM, Villines D, Johnson BR. The prevalence of persistent pain after nonsurgical root canal treatment. Quintessence Int. 2011; 42:259-269
Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Ann Rev Neurosci. 2009; 32:1-32
Truelove E. Management issues of neuropathic trigeminal pain from a dental perspective. J Orofac Pain. 2004; 18:374-380
Kiyak HA, Beach BH, Worthington P, Taylor T, Bolender C, Evans J. Psychological impact of osseointegrated dental implants. Int J Oral Maxillofac Implants. 1990; 5:61-69
Khawaja N, Yilmaz Z, Renton T. Case studies illustrating the management of trigeminal neuropathic pain using topical 5% lidocaine plasters. Br J Pain. 2013; 7:107-113
Khawaja N, Renton T. Case studies on implant removal influencing the resolution of inferior alveolar nerve injury. Br Dent J. 2009; 206:365-370 https://doi.org/10.1038/sj.bdj.2009.258
Fukuda K, Ichinohe T, Kaneko Y. Pain management for nerve injury following dental implant surgery at Tokyo Dental College Hospital. Int J Dent. 2012; https://doi.org/10.1155/2012/209474
Renton T, Dawood A, Shah A, Searson L, Yilmaz Z. Post-implant neuropathy of the trigeminal nerve. A case series. Br Dent J. 2012; 212 https://doi.org/10.1038/sj.bdj.2012.497
Isaacson TJ. Sublingual hematoma formation during immediate placement of mandibular endosseous implants. J Am Dent Assoc. 2004; 135:168-172
Juodzbalys G, Kubilius M. Clinical and radiological classification of the jawbone anatomy in endosseous dental implant treatment. J Oral Maxillofac Res. 2013; 4 https://doi.org/10.5037/jomr.2013.4202.N
Harris D, Horner K, Gröndahl K, Jacobs R, Helmrot E, Benic GI, Bornstein MM, Dawood A, Quirynen M. EAO guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the European Association for Osseointegration at the Medical University of Warsaw. Clin Oral Implants Res. 2012; 23:1243-1253
Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol. 2006; 77:1933-1943
Thoma DS, Cha JK, Jung UW. Treatment concepts for the posterior maxilla and mandible: short implants versus long implants in augmented bone. J Periodontal Implant Sci. 2017; 47:2-12
Bartlett G, Mansoor J. Articaine buccal infiltration vs lidocaine inferior dental block – a review of the literature. Br Dent J. 2016; 220:117-120
Al-Ani O, Nambiar P, Ha KO, Ngeow WC. Safe zone for bone harvesting from the interforaminal region of the mandible. Clin Oral Implants Res. 2013; 24:(Suppl A100)115-121
Van Assche N, van Steenberghe D, Guerrero ME, Hirsch E, Schutyser F, Quirynen M, Jacobs R. Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam images: a pilot study. J Clin Periodontol. 2007; 34:816-821 https://doi.org/10.1111/j.1600-051X.2007.01110
De Kok IJ, Thalji G, Bryington M, Cooper LF. Radiographic stents: integrating treatment planning and implant placement. Dent Clin North Am. 2014; 58:181-192 https://doi.org/10.1016/j.cden.2013.09.008
Burstein J, Mastin C, Le B. Avoiding injury to the inferior alveolar nerve by routine use of intraoperative radiographs during implant placement. J Oral Implantol. 2008; 34:34-38
Greenstein G, Greenstein B, Desai RN. Using drill stops on twist drills to promote safety and efficiency when creating osteotomies for dental implants. J Am Dent Assoc. 2014; 145:371-375
Strauss ER, Ziccardi VB, Janal MN. Outcome assessment of inferior alveolar nerve microsurgery: A retrospective review. J Oral Maxillofac Surg. 2006; 64:(12)1767-1770 https://doi.org/10.1016/j.joms.2005.11.111
Susarla SM, Kaban LB, Donoff RB, Dodson TB. Does early repair of lingual nerve injuries improve functional sensory recovery?. J Oral Maxillofac Surg. 2007; 65:1070-1076 https://doi.org/10.1016/j.joms.2006.10.010
Zuniga JR, Yates DM, Phillips CL. The presence of neuropathic pain predicts postoperative neuropathic pain following trigeminal nerve repair. J Oral Maxillofac Surg. 2014; 72:2422-2427 https://doi.org/10.1016/j.joms.2014.08.003
Ziccardi VB, Zuniga JR. Nerve injuries after third molar removal. Oral Maxillofac Surg Clin North Am. 2007; 19:105-115
Zuniga JR, Renton T. Managing post-traumatic trigeminal neuropathic pain: is surgery enough?. J Neurol Neuromed. 2016; 1:10-14
Trigeminal nerve injuries related to restorative treatment Tara Renton Dental Update 2024 45:6, 707-709.
Authors
TaraRenton
BDS, MDSc, PhD
Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
Abstract: Restorative dentistry provides many opportunities to cause trigeminal nerve damage. Chronic post-surgical pain, resulting from nerve damage, is rarely associated with dentistry as a result of local anaesthetic (LA) infiltration injections but is more commonly associated with injuries to the nerve trunks of division two and three caused by LA blocks, implants and endodontics.
In dentistry, the term paraesthesia is often used inappropriately to mean neuropathy. Paraesthesia is only a descriptive term of symptoms, meaning altered sensation, and not a diagnosis. When sensory nerves are injured, a neuropathy (malfunction) may arise and this may be painful or non-painful. Fortunately, painful post-traumatic neuropathy, caused by injury to nerves, is rare in dentistry compared with other common general surgical procedures, where up to 20–40% of patients experience chronic post-surgical pain after limb amputation, thoracotomy and breast surgery. This article aims to highlight how to prevent nerve injuries using strategies for risk assessment, appropriate surgical techniques and suitable follow-up protocols to allow urgent management to optimize resolution of the nerve injuries when they occur.
CPD/Clinical Relevance: Prevention of rare nerve injuries arising from common dental procedures is key, as many high risk procedures can cause lifelong neuropathic pain, functional and immense psychological impact for the patients involved, for which there is no simple remedy.
Article
Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications.1 The incidence of lingual nerve injury has remained static in the UK over the last 30 years, however, the incidence of inferior alveolar nerve injury has increased; the latter being due to implant surgery and endodontic therapy.2 Causes of trigeminal nerve injury (TNI) are varied but many occur in relation to restorative dentistry. These include TNIs caused by local anaesthetic injections, implants and endodontics. The inferior alveolar nerve (IAN) neuropathy related to third molar surgery or inferior alveolar block injections is usually temporary but can persist and become permanent (by definition at 3 months). There are rare reports of resolution of implant-related IAN neuropathies at over 4 years,3 but these do not comply with normal reports of peripheral sensory nerve injuries.4 Many authors recommend referral of injuries after 6 months,5 but this may be too late for many peripheral sensory nerve injuries related to restorative care. We now understand that many dentally induced nerve injuries require intervention ideally immediately, within 30 hours, or within 3 months, dependent upon the mechanism of injury, to optimize resolution from injury and prevent the permanent central and peripheral changes within the nervous system.6
Register now to continue reading
Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
