Inferior Alveolar Nerve Damage Research Articles

Investigation of the relationship between the mandibular third molar teeth and the inferior alveolar nerve using posteroanterior radiographs: a pilot study

BackgroundThe most severe complication that can occur after mandibular third molar (MM3) surgery is inferior alveolar nerve (IAN) damage. It is crucial to have a comprehensive radiographic evaluation to reduce the possibility of nerve damage. The objective of this study is to assess the diagnostic accuracy of panoramic radiographs (PR) and posteroanterior (PA) radiographs in identifying the association between impacted MM3 roots and IAN.MethodsThis study included individuals who had PR, PA radiographs, and cone beam computed tomography (CBCT) and who had at least one impacted MM3. A total of 141 impacted MM3s were evaluated on CBCT images, and the findings were considered gold standard. The relationship between impacted MM3 roots and IAN was also evaluated on PR and PA radiographies. The data was analyzed using the McNemar and Chi-squared tests. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of PR and PA radiographies were determined.ResultsConsidering CBCT the gold standard, the relationship between MM3 roots and IAN was found to be statistically significant between PR and CBCT (p = 0.00). However, there was no statistically significant relationship between PA radiography and CBCT (0.227). The study revealed that the most prevalent limitation of the PR in assessing the relationship between MM3 roots and IAN was the identification of false-positive relationship.ConclusionsPA radiography may be a good alternative in developing countries to find out if there is a contact between MM3 roots and IAN because it is easier to get to, cheaper, and uses less radiation.

Investigation of the efficacy of two different laser types in the treatment of lower lip paresthesia after sagittal split ramus osteotomy

Orthognathic surgery involves invasive and major surgical procedures commonly used to correct maxillofacial deformities. Bilateral sagittal split ramus osteotomy (BSSO) is often used to treat dentofacial anomalies related to the mandible, but it can result in various complications, the most common of which is inferior alveolar nerve damage. Nerve damage–induced paresthesia of the lower lip significantly affects patient comfort. Medical treatments such as steroids and vitamin B, low-level laser therapy (LLLT), and platelet-rich fibrin (PRF) can be used as supportive therapies for nerve regeneration after damage. This study aimed to investigate the effectiveness of two different types of lasers in treating lower lip paresthesia after BSSO. This clinical trial was a controlled, single-center, prospective, single-blind, randomized study. Thirty patients were included in the study and randomly assigned to three groups: Group I (laser GRR, n = 10) received transcutaneous and transmucosal GRR laser treatment, Group II (Epic10 laser, n = 10) received transmucosal and transcutaneous Epic10 laser treatment, and Group III (vitamin B, n = 10) received B-complex vitamin tablets orally once a day. Two-point and brush tests were performed six times at specific intervals, and a visual analog scale was used to evaluate pain and sensitivity. Both vitamin B and laser therapies accelerated nerve regeneration. The contribution of the laser groups to the healing rate was better than that of the vitamin B group. Although there was no statistically significant difference between the two laser groups, clinical observations indicated better results in the GRR laser group.

Coronectomy? A case report following coronectomy of a ‘high-risk’ mandibular third molar

Background The surgical removal of mandibular third molar (M3M) is a common procedure performed by oral and maxillofacial surgeons, oral surgeons, and general dental practitioners. Apart from risks such as pain, swelling, bruising, bleeding, trismus, alveolar osteitis, post-op infection, and damage to adjacent structures which are common to all surgical extractions, M3M removal includes the risk of permanent or temporary damage to the inferior alveolar nerve (IAN) or the lingual nerve. IAN damage can significantly impact the quality of life due to altered sensation of the lip and chin area. As such, the alternative surgical option of coronectomy, which is the sectioning of the crown from the tooth and deliberate retention of the roots, can be offered to high-risk cases to avoid IAN damage. Case presentation 36-year-old female was diagnosed with recurrent pericoronitis of her left M3M. Her left M3M was partially erupted and horizontally impacted with bulbous roots that were in close proximity to the IAN. Due to a higher risk of IAN damage, she underwent a coronectomy procedure of her left M3M instead of a complete removal. She experienced typical post-operative pain and swelling but no other complications such as altered nerve sensation were reported. The surgical site was healed with full mucosal coverage after 12 weeks. Conclusion Coronectomy provides a viable alternative surgical option to removal for mandibular third molars that are at high risk of IAN damage. This is due to the significant reduction of risk of IAN damage and low incidence of failure.

Occurrence of inferior alveolar nerve damage after internal fixation and open reduction in patients visiting Ayub Medical College with mandibular fractures

One of the most frequent injuries to the maxillofacial area is a fractured mandible. Multiple places can experience fractures. The inferior alveolar nerve is commonly injured by mandibular fractures. Objective: The study's objective was to determine the frequency of inferior alveolar nerve damage in patients who had internal fixation and open reduction of a mandibular fracture at the Ayub Teaching Hospital in Abbottabad. Methodology: With approval from the institution's ethics committee and CPSP, this descriptive case series was finished at the Department of Maxillofacial of the Ayub Teaching Hospital in Abbottabad. The method to evaluate percentage with absolute precision and the accompanying assumption were used to compute the sample size using the WHO programme for computing sample sizes in health research. Results: The mean age of the participants was 35.81+5.63 years, with a range of ages from 26 to 45. The age categories with the highest incidence were 26-30 (n=23, 23.96%), followed by the age ranges 36-40 and 41-45 (n=26, 27.08%). 75 (78.12%) men and 21 (21.88%) women participated in the research. General anaesthesia was used by the majority of patients (n=90; 93.75%), whereas local anaesthesia was used by the remaining patients (n=6; 6.25%).

Frequency of Inferior Alveolar Nerve Damage After Open Reduction and Internal Fixation in Mandibular Fractures

One of the most frequent injuries to the maxillofacial region is mandibular fracture. Numerous places experience fractures. The inferior alveolar nerve is often injured as a result of mandibular fractures. Objective: To ascertain how frequently patients in the oral and maxillofacial department of the Ayub Teaching Hospital in Abbottabad experienced inferior alveolar nerve injury following open reduction and fixation of a mandibular fracture. Methods: This was a Descriptive case series carried out at Oral and Maxillofacial Department, Ayub Teaching Hospital, Abbottabad after approval from the IRB of the institution and CPSP vide number (CPSP/REU/DSG-2018-010-2532). Using the formula to evaluate proportion with absolute precision and the following premises, the sample size was determined to be 96 using the WHO software for sample size computation in health studies: The expected percentage of inferior alveolar nerve injury following fixation in mandibular fracture is 45%, the confidence level is 95%, and the absolute precision is 10%. Results: The mean age of participants was 35.81±5.63 years with range from 26 to 45 years. Most common age group was 36-40 years and 41-45 years (n=26, 27.08%) followed by 26-30 years (n=23, 23.96%). There were 70 (72.92%) males and 26 (27.08%) females in the study. Majority (n=88; 91.67%) of the patients were given general anesthesia while the remaining (n=8; 8.33%) received local anesthesia. Perioperative inferior alveolar nerve injury was observed in 56 (58.33%) patients while permanent inferior alveolar nerve injury was diagnosed in 39 (40.63%) patients. Conclusions: Damage to inferior alveolar nerve is a frequent problem of open reduction and fixation of mandibular fracture. However, utmost care should be exercised to reduce its occurrence in patients with mandibular fracture.

FREQUENCY OF PARESTHESIA DUE TO INFERIOR ALVEOLAR NERVE DAMAGE AFTER EXTRACTION OF MANDIBULAR THIRD MOLAR AMONG PATIENTS SHOWING DARKENING OF ROOT IN ORTHOPANTOMOGRAM

Background: Paresthesia is an abnormal dermal sensation with no apparent physical cause. One of the everyday practices in any oral surgery setup is the extraction of the impacted mandibular third molars surgically. Precise measurement of the bone present for support of the implant coronal to the inferior alveolar nerve (IAN) canal is the pertinent way to prevent IAN injuries.
 Objective: To assess the frequency of paresthesia due to IAN damage after mandibular third molar’s surgical extraction in patients with darkening of root on orthopantomogram.
 Material & Methods: It was a descriptive case series study which took place in the department of Oral and Maxillofacial Surgery at Sharif Medical and Dental College, Lahore in a time frame of 6 months i.e. from December 2020 till May 2021. After meeting the inclusion/exclusion criteria, 200 patients were made part of the study program. Informed consent and demographic information was recorded. Surgical procedure of all these patients was done. Assessment was done post-operatively first after one week when patient came for suture removal by inquiring about the subjective perception of abnormal feeling or sensation on lower lip and chin area. Patients were then reappointed for a follow-up visit after 1 month as well.
 Results: Patients’ mean age was 28.05±3.94 years. There were 104 (52%) males and 96 (48%) females in the study population. There were 38 (19%) patients of distoangular impaction, 39 (19.5%) had horizontal impaction, 55 (27.5%) had mesioangular impaction while 68 (34%) had vertical impaction. The IAN paresthesia after 1st month of surgery was found in 13 (6.5%) patients.
 Conclusion: According to this study, the frequency of paresthesia after 1st month of surgery was 6.5% due to IAN injury after mandibular third molar surgery in patients with darkening of root as observed on orthopantomogram.
 Keywords: Inferior Alveolar Nerve, Orthopantomogram, Paresthesia, Third Molar Surgery.

Surgical Removal of Dental Implants Dislocated Into the Mandibular Body

With the recent advances in dental implantology, the number of implant surgeries is rapidly increasing. Unfortunately, along with considerable success, several complications have been reported. Regarding inferior alveolar nerve damage, the severity of damage is the most critical factor affecting the prognosis. Patients with poor-quality bone are at risk for nerve damage even if the distance from the alveolar crest to the inferior alveolar nerve canal is sufficient to prevent nerve damage. Herein, we report two cases of accidental insertion of a dental implant into the inferior alveolar canal. In both cases, the displaced implant was removed using a piezosurgery device without causing excessive bone defects. Therefore, good bone healing was achieved without plate fixation. Inferior alveolar nerve damage recovered in both patients.

Computed tomography‐based morphological analysis for intraoral vertical ramus osteotomy in patients with mandibular prognathism

AbstractAimIntraoral vertical ramus osteotomy (IVRO) is an orthognathic surgery for patients with jaw deformity. To avoid complications associated with IVRO, understanding the position of the mandibular foramen and shape of the mandibular ramus in patients with mandibular prognathism is important, which only few studies have reported. Most studies have been performed with dry skulls of older people without jaw deformity. This study aimed to examine the position and shape of the mandibular foramen and ramus, respectively, using computed tomography in patients with mandibular prognathism.MethodsThe study was performed on 50 Japanese patients who underwent IVRO. We examined the position of the mandibular foramen against the occlusal plane, distance between the posterior border of the mandible and mandibular foramen, and thickness of the mandibular ramus.ResultsThe mandibular foramen was vertically located above the occlusal plane at a distance of 2.6 ± 5.1 and 1.2 ± 5.1 mm in men and women, respectively. The distances between the mandibular ramus and foramen, measured with the posterior border line of the mandibular ramus as a criterion, were 15.9 ± 2.2 and 14.4 ± 2.1 mm in men and women, respectively. The thickest parts of the mandibular ramus were 6.8 ± 1.6 and 6.9 ± 0.9 mm in men and women, respectively.ConclusionKnowledge of the accurate position of the mandibular foramen is important for a safe IVRO. Mandibular ramus osteotomy line should be within 10 mm from the posterior border of the mandibular ramus, to avoid inferior alveolar nerve damage.

Mental Nerves in the Lower Lip: Anatomical Basis for the Recovery of Sensation following Inferior Alveolar Nerve Damage.

Inferior alveolar nerve damage is one of the most common complications of surgery on the lower third of the face. It can have a significant psychological and social impact, and its evolution varies in terms of the duration and degree of recovery. In the literature, few studies adequately explain this phenomenon. The author therefore aims to establish the anatomical basis of recovery and its variability. The author studied 60 mental nerves on 30 lips. A total of 25 lips were studied in situ, including five receiving an intraarterial injection of latex, whereas five lips were removed and dissected under transillumination. The author identified three types of intralabial distribution of the mental nerves: type I, absence of connections; type II, connections on the upper third of the lower lip; and type III, connections on the upper, middle, and lower thirds of the lower lip. Some cases also had a dominant side with more numerous fibers and a larger diameter than the contralateral side. Rapid or total recovery after inferior alveolar nerve damage is well known. The author's study showed the nerve map to repair nerve damage, and for the first time, to the author's knowledge, it highlighted the connections between the mental nerves in the lip. Types II and III allow the recovery of labiomental sensation.

Posterior ostectomy of a mandibular distal segment for nerve bundle traction to tensionless anastomosis of an inferior alveolar nerve

Tensionless adaptation of nerve ends is a challenging task in the repair of damaged inferior alveolar nerve (IAN). A new technique is introduced with posterior ostectomy of a mandibular distal segment after sagittal splitting for nerve bundle traction to tensionless anastomosis of nerve ends. We were able to create tensionless anastomosis of an IAN defect without autogenous or alloplastic graft using this method. This method is suitable for neurorrhaphy after neuroma removal in cases of IAN damage during dental procedures.

The Radiological Evaluation of Mandibular Canal Related Variables in Mandibular Third Molar Region: a Retrospective Multicenter Study.

The aim of this retrospective study was to investigate anatomical structure of mandibular canal and the factors those increase the possibility of inferior alveolar nerve damage in mandibular third molar region of Turkish population. Overall 320 participants with 436 mandibular third molars were included from four different study centers. Following variables were measured: type and depth of third molar impaction, position of mandibular canal in relation to third molars, morphology of mandibular canal, cortication status of mandibular canal, possible contact between the third molars and mandibular canal, thickness and density of superior, buccal, and lingual mandibular canal wall, bucco-lingual and apico-coronal mandibular canal diameters on cone-beam computed tomography scans. Lingual mandibular canal wall density and thickness were decreased significantly as the impaction depth of mandibular third molar was increased (P = 0.045, P = 0.001 respectively). Highest buccal mandibular canal wall density and thickness were observed in lingual position of mandibular canal in relation to mandibular third molar (P = 0.021, P = 0.034 respectively). Mandibular canal with oval/round morphology had higher apico-coronal diameter in comparison to tear drop and dumbbell morphologies (P = 0.018). Additionally, mandibular canals with observed cortication border and no contact with mandibular third molar had denser and thicker lingual mandibular canal wall (P = 0.003, P = 0.001 respectively). Buccal and lingual mandibular canal wall density, thickness and mandibular canal diameter may be related with high-risk indicators of inferior alveolar nerve injury.

Effect of vitamin B complex administration on pain and sensory problems related to inferior alveolar nerve damage following mandibular implant placement surgery.

Background Inferior alveolar nerve damage can lead to mild to severe paresthesia and even facial pain. One of the treatments considered today for the reconstruction and treatment of damaged peripheral nerves is the use of vitamin supplements. This study aimed to evaluate the effect of vitamin B complex supplementation on pain and sensory problems following mandibular implant placement surgery. Methods In this single-blind clinical trial, 46 patients applying for implant placement, who were eligible for the study, were evaluated. All the patients were examined for sensory facial injury and inferior alveolar nerve injury within 24 hours after implant placement. The nerve damage was recorded by AI (asymmetry index) in the initial examination. Patients who reported clinical and radiographic signs of nerve damage due to implant or drill impingement of the nerve canal were excluded from the study and promptly treated with anti-inflammatory protocols. Then the patients were randomly divided into control (n=23) and intervention (n=23) groups. Patients in the control group received routine treatment after implantation, and patients in the intervention group received vitamin B complex pills in addition to routine treatment. A placebo was used to eliminate the inductive effect of the drug in the control group. Follow-up of patients was performed at intervals of 14 days and 1, 2, and 3 months after treatment. Data analysis was performed using SPSS 24 and Kruskal-Wallis, Wilcoxon, and chi-squared tests. Results In both groups, a decreasing trend in pain intensity was observed for up to three months. There were no significant differences between the mean pain intensity in the intervention and control groups at all the follow-up intervals. In both groups, a decrease in the rate of paresthesia was observed during the 3-month follow-up. The mean of paresthesia in the two groups was not significantly different at any follow-up interval.Conclusion Vitamin B complex might not affect pain intensity and paresthesia after implant surgery.

Knowledge and Attitude Among the Saudi Dentists Towards Coronectomy of Impacted Mandibular Third Molars.

PurposeCompared to the complete extraction of impacted third molars that are in close proximity to the mandibular canal, the coronectomy procedure is used as an alternative, owing to its minimal risk of damaging the Inferior alveolar nerve. Despite clear coronectomy concepts mentioned in the literature, the procedure is debatable. This study aimed to assess the knowledge and attitude towards the coronectomy procedure among dentists in Saudi Arabia.Patients and MethodsThe 16 close-ended questionnaire was distributed electronically to 377 dentists over the country. It included the demographic data and the options given to their patients with complicated impacted third molars, and the number of coronectomy they have performed. The retrieved data were exported and transferred to the SPSS software program for analysis. The Chi-squared and Fisher’s exact tests were used as appropriate for comparisons. A P-value <0.05 was considered significant.ResultsOnly 54 (15%) participants performed coronectomy procedure, and only 28.3% of the participants advised their patients to do coronectomy. Nearly two-thirds of the participants (71.9%) were aware of coronectomy procedures, with no significant differences (P> 0.05) between the groups. About 68.9% of the participants agreed that coronectomy aims to protect inferior alveolar nerve damage. More than 60% of participants believed that coronectomy is a reliable technique, while 40.6% of participants claimed that they were capable of deciding whether to do coronectomy or extraction. No significant differences were found between the groups concerning most of the study variables (P> 0.05).ConclusionKnowledge of Saudi dentists towards coronectomy is good, while their attitude is still low. More learning strategies about coronectomy should be implemented.

Numb Chin Syndrome in Sickle Cell Disease: A Systematic Review

Introduction: Numb Chin Syndrome (NCS) is a rare sensory neuropathy characterized by inferior alveolar or mental nerve damage. It manifests as hypoesthesia, paraesthesia, or pain in the chin and lower lip. Few case reports have been published on NCS secondary to sickle cell disease (SCD). As a result, information about causes, disease course and treatment are lacking. Our objective was to synthesize all currently available relevant literature on this rare condition.Methods: A systematic review was performed following the PRISMA guidelines. The following databases were searched: Medline, EMBASE and CINAHL Complete. The search strategy was designed by a librarian and utilized text words and relevant indexing terms to identify studies about NCS in patients with SCD. Conference abstracts of relevant scientific meetings were manually searched. No language limits were applied. Reviews, notes, editorials or comments were excluded. Patient demographics (including age, sex, country, SCD genotype), clinical presentation, investigations, treatment and outcomes were extracted by two independent reviewers.Results: The systematic search revealed 73 publications (Figure). Only 11 publications from the databases and 3 from a manual search met the inclusion/exclusion criteria. Together, these case reports and series described 33 unique SCD patients. They originated from different regions (India, Turkey, Jamaica, USA, France, England). They were published between 1972 and 2021. Reports described between 1 and 13 patients each. Mean age was 28.3 years (standard deviation 11.7) and ranged from 11 to 60 years (Table). Sixteen were female. Genotype distribution was as follows: SS in 13 (39%), SC in 5 (15%), Sbeta-thalassemia in 3 (9%), not reported in 12 (36%). All but one case (97%) were associated with a vaso-occlusive crisis (VOC) and/or acute chest syndrome (ACS). One patient also developed multiorgan failure. One case occurred post dental surgery which led to a VOC. One case was associated with mandibular osteomyelitis and four others with infections. One patient presented with avascular osteonecrosis of the mandible. Comorbid medical conditions were reported as follows: rheumatoid arthritis treated with prednisone (1), pregnancy (1), type II diabetes (1) metastatic breast cancer treated by chemotherapy (1), membranoproliferative glomerulonephritis (1), asthma (1), retinal detachment (1) and splenectomy (1).X-Rays were the most utilized imaging modality (10 [30%]), followed by CT-scan (7 [21%]), magnetic resonance imaging (MRI) (6 [18%]) and bone scan (2 [6%]). Two X-Rays revealed subtle radiolucencies suggestive of bone infarction, 1 X-Ray changes consistent with avascular necrosis and 1 X-Ray lytic lesions typical of osteomyelitis. One patient had a normal X-ray, but a CT-scan showed loss of cortical condensation around the mental canal which corresponded on a bone scan to a region of slightly increased tracer uptake suggestive of infarction. The MRI for one patient with bilateral NCS showed increased T2 signal in both mandibular rami with associated small subperiosteal fluid collections. One patient had a lumbar puncture that was normal.Management of the neuropathy was mostly directed towards the underlying cause: treatment of VOC and SCD acute complications, antibiotics for infection, and tooth extraction for infectious control. Two patients received transfusions during their acute medical condition. The duration of symptoms ranged from a few hours to 14 years. Eleven patients (33%) were reported to have a complete resolution of NCS.Conclusion: We provide a systematic review of the clinical manifestations, investigations and management of NCS in patients with SCD. NCS occurred most often in the context of VOC/ACS. Radiological evidence of mandibular infarction was reported for some. Together, this suggests that vaso-occlusion and bone infarction could be pathophysiological mechanisms of NCS. Careful evaluation is warranted to rule out differential causes including local infection, avascular necrosis, primary neoplasm or metastatic disease. Publication bias, a small sample size, and author-dependant lexical variability used to describe NCS are some limitations to our review. Through this largest report of NCS in SCD, we draw attention to a rare and potentially underrecognized neurological complication that deserves further investigation to optimize management. [Display omitted] DisclosuresSoulieres: Novartis: Research Funding; BMS: Membership on an entity's Board of Directors or advisory committees. Forte: Novartis: Honoraria; Canadian Hematology Society: Research Funding; Pfizer: Research Funding.

A Prospective Observational Study on the Variables Affecting the Risk of Inferior Alveolar Nerve Damage During Lower Third Molar Surgery With Nerve/Root Proximity

The present study aimed to evaluate which factors were statistically associated with a greater probability of inferior alveolar nerve (IAN) damage during lower third molar surgery. A prospective observational study was performed at the Oral Surgery Unit of the Umberto I Hospital on 92 patients who underwent surgical extraction of a lower third molar that was radiographically overlapped with the mandibular canal. All surgeries were performed by the same expert surgeon. A principal component analysis and the exact 2-tailed Fisher exact test were used. Temporary IAN damage occurred in 10 cases (10.9%). Symptoms lasted from 18 to 180 days (73 ± 49.15). IAN damage was more frequent in difficult and long-lasting surgeries, in the presence of many risk factors and in patients with a reduced maximum mouth opening. Such factors should be accurately evaluated before surgery to assess and discuss the overall surgical risk of IAN damage with the patient especially when they are over the maximum limit of their significant variability range found in the present study, that is, >12 for difficulty index, >2 for number of orthopantomography risk markers and <3.7 cm for maximum mouth opening.

A New Concept of Safety Distance to Place Implants in the Area of the Inferior Alveolar Canal to Avoid Neurosensory Disturbance.

Inferior alveolar nerve (IAN) damage following implant placement is a severe complication that can compromise a patient's quality of life. Previous studies have suggested that a safety zone of 2 mm, if maintained, might avoid this problem. This retrospective study evaluates implants placed in closer proximity to the IAN without resulting in any postoperative neurologic complications and suggests a new concept of safety distance. A total of 60 consecutive patients receiving 101 mandibular implants < 2 mm from the IAN were included in this study. All enrolled patients had a CBCT scan done for radiologic assessment before implant placement and following final restoration. Measurements were obtained through cross-sectional views using Simplant software. In patients without neurologic disturbances, a mean distance of +0.75 mm was seen from the closest portion of the implant to the nerve bundle. In cases where a direct transection and/or compression of the nerve was not observed, the patients did not experience neurosensory disturbances.

Does the Coronectomy a Feasible and Safe Procedure to Avoid the Inferior Alveolar Nerve Injury during Third Molars Extractions? A Systematic Review.

This systematic review aimed to review the literature on the coronectomy technique and evaluate the incidence of success and complications as a surgical approach for inferior third molars. Online databases were searched for data on the frequency of inferior alveolar nerve damage, lingual nerve damage, root migration, pain, infection, dry socket, and extraction of the remaining root, and data on the necessity of reintervention were also extracted. Randomized clinical trials, controlled clinical trials, prospective cohort studies, and prospective and retrospective studies with or without the control group were intercepted. This systematic review was registered in PROSPERO (CDR 42020135485). Sixteen papers analyzed 2176 coronectomies in total, and only five of them were judged as appropriate according to methodological quality assessment. The incidence of inferior alveolar nerve injury was documented in 0.59% of the procedures, lingual nerve injury in 0.22%, infection 3.95%, dry socket 1.12%, extraction of the root 5.28%, and reintervention 1.13%. The pain was the most reported, in 22.04% of the population. This study provides an overview of the clinical success and complications of coronectomy, and their prevalence. A coronectomy may be considered a low-risk procedure and an option for treatment to avoid potential damage to nervous structures. However, patients should still undergo a full screening and evaluation of postsurgical procedures.

The NLRP3-related inflammasome modulates pain behavior in a rat model of trigeminal neuropathic pain

AimsNod-like receptor family pyrin domain containing 3 (NLRP3) may play an important role in neuropathic pain. Treatment for trigeminal neuropathic pain remains a challenge, as common drugs either do not demonstrate beneficial therapeutic effects or induce intolerance in patients. Main methodsIn a rat model of trigeminal neuropathic pain, pain caused by the malpositioning of dental implants is similar to that experienced by humans. We used masculine Sprague-Dawley rats with inferior alveolar nerve damage as a model to investigate the differential regulation of NLRP3. First, we confirmed the level of NLRP3 in the medullary dorsal horn and variation of pain response behavior after silencing the expression of NLRP3 inflammasome bodies in rats with trigeminal neuropathic pain. Second, under localized anesthesia, we extracted the lower left second molar, implanted a micro-dental implant, and deliberately injured the inferior alveolar nerve. Key findingsAfter nerve damage, the level of NLRP3-related inflammasomes was upregulated in microglia and the expression of a component of the inflammasome gradually increased during postoperative days 3–21. The suppression of adenovirus-shRNA-NLRP3 on postoperative day 1 markedly inhibited the expression of pro-inflammatory cytokines and the activation of the inflammasome and mechanical allodynia. Furthermore, it attenuated cell death in microglia, as evidenced by increased Bcl-2, Bcl-xL, Bax, and Bik expression. SignificanceThe level of NLRP3 in the dorsal horn is a pivotal factor in trigeminal neuropathic pain, and inhibition of the early expression of NLRP3 might serve as a potential therapeutic approach.

Mandibular third molar surgery: A review of common and uncommon complications

Background: Third molar surgical extraction is one of the commonest surgical procedures in oral surgery and it is associated with postoperative complications. However, some of these complications are commoner than others and they have variable impacts on the quality of life of the patients.Objective: To review the common and uncommon complications of third molar surgery as reported in the literature.Methods: PubMed, ScienceDirect databases, AJOL, and Google scholar literature search was done to identify related articles on complications of mandibular third molar surgical extractions. Other online materials were also reviewed. The search words used were mandibular, third molar, lower jaw, surgical extraction, common, uncommon, and complicationsResults: Common complications of third molar surgery identified include; postoperative pain, swelling, trismus, infection, dry socket, inferior alveolar and lingual nerve damage, injury to the adjacent tooth, with their attendant impact on the patient’s quality of life.Conclusion: Third molar surgical extractions are associated with certain complications and some of them are unavoidable. Therefore, adequate patients’ education and psychological preparation for the procedure and its sequelae are necessary.

Analysis of complications after the removal of 339 third molars.

Extractions of third molars constitute about 90% of the scheduled surgical procedures performed by oral surgeons. Wisdom tooth surgery is associated with complications, such as the lingual and inferior alveolar nerve damage, bleeding, tooth/jaw fractures, tooth displacement into the adjacent anatomical spaces, trismus, infections, and other. The aim of the study was to analyze complications after wisdom tooth extraction in patients treated at the Department of Oral Surgery of Jagiellonian University Medical College in Kraków, Poland, in the years 2016-2018. A retrospective analysis of the medical records of 339 patients treated in the outpatient setting was performed. The inclusion criterion comprised a single extraction of a third molar. The exclusion criteria were multiple extractions, comorbidities and pregnancy. No antibiotic prophylaxis was used. The incidence of post-extraction complications, such as oroantral communication, postoperative hematoma, acute inflammation of the surrounding tissues, trismus, and transient paresthesia in relation to patient gender and age, the developmental stage and location of the removed tooth as well as the type of surgery were studied. Perioperative complications occurred in 51 (15.0%) cases, and comprised the acute inflammation of the surrounding tissues in 31 patients, trismus after the removal of 13 lower third molars, oroantral communication after the extraction of 5 upper wisdom teeth, and hematoma as well as a transient sensory alteration of the lingual nerve in 1 case each. Complications were more common in patients who had a surgical extraction of a wisdom tooth with root separation and in cases of lower third molar extractions. No statistically significant correlation was found between the patients' age or gender, the developmental stage of the extracted tooth and the number of observed complications. Lower third molars and the necessity of surgical extraction with root separation are risk factors for postoperative complications in patients who require wisdom tooth removal. Complications after the removal of third molars are most often inflammatory.