Abstract
ObjectivesThe aim of this publication is to provide a concept for prevention and a standardized step-by-step clinical approach to this rare but serious and potentially preventable complication of dental local anesthesia.Materials and methodsWe collected data with a PUBMED search using the key words “local anesthesia,” “dental anesthesia/anesthesia” OR “mandibular block anesthesia,” “complication,” “hypodermic needle,” “needle breakage” OR “needle fracture,” and “foreign body AND removal” OR “retrieval.” The existing literature was systematically evaluated from 1980 to date using Microsoft Excel 2007 (Microsoft Corporation).ResultsAfter analysis of the literature, we included 36 reports documenting 59 needle breakage events and defined possible risk factors and preventive measures. All relevant reported parameters were listed in tabular form. The main result of this article is a treatment algorithm for this complication.ConclusionsPrevention of a needle fracture should be the main goal during local dental anesthesia. Use of longer hypodermic needle can obviate complex retrieval surgery. If immediate removal of the fragment fails, localization, planning, and the necessary surgical procedure should be arranged promptly.Clinical relevanceFollowing a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.
Highlights
Stephan Acham and Astrid Truschnegg contributed to this work.As the basis for patient-centered pain-free dental therapy, local anesthesia is one of the most frequent interventions in dentistry and one of the main factors that has allowed an image shift from dentistry as a very anxiety-driven necessity to a modern doctor-patient partnership.Local anesthesia is associated with a low overall incidence of serious complications [1, 2]
We further investigated mode of detection of the foreign body, use of two-dimensional (2D) and three-dimensional (3D) imaging ± reference markers or metal detectors, surgical parameters, and reported complications
Needle breakage in dental anesthesia is a rare complication, it does attract a certain amount of attention in the scientific literature
Summary
Local anesthesia is associated with a low overall incidence of serious complications [1, 2]. Possible risks and complications include systemic reactions such as hypertension, collapse, and toxic or allergic reactions, or local events such as pain, hemorrhage, infections, soft tissue damage, and ophthalmic or nerve disorders, as well as dislodgement of fractured hypodermic needles. The latter can lead to serious and potentially life-threatening consequences by violating adjacent vital anatomical structures [3,4,5,6,7]. Extraction of the broken fragment is—with very few exceptions—generally recommended and should be undertaken as soon as possible
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