To evaluate the torque required to perform sagittal split osteotomy using the angular osteotomy technique compared with the Posnick, Wolford, and Hunsuck/Epker techniques, and to assess associated fracture patterns and inferior alveolar nerve (IAN) visibility. A laboratory-based experimental study was conducted using 52 porcine mandibles. After dissection, sagittal osteotomies were performed in a blinded and randomized manner according to the assigned technique. The primary outcomes were the torque required to complete the osteotomy and the resulting fracture pattern. Secondary analysis included IAN visibility following osteotomy. Statistical analysis was performed using analysis of variance with Tukey post hoc testing for torque comparisons and Pearson χ2 or Fisher exact tests for categorical variables. Statistical significance was set at P<0.05. The angular osteotomy technique required significantly less torque (110±0.07N) compared with the Posnick, Wolford, and Hunsuck/Epker techniques (P<0.001). In addition, the angular technique demonstrated a higher frequency of favorable fracture patterns and reduced IAN visibility, suggesting a lower potential risk of nerve injury. The Hunsuck/Epker technique required the highest torque and was associated with less favorable fracture outcomes. Within the limitations of this ex vivo porcine model, the angular sagittal split osteotomy technique demonstrated greater mechanical efficiency, requiring lower torque and producing more homogeneous fracture patterns with reduced IAN exposure. These findings provide a comparative biomechanical assessment of different osteotomy designs and may contribute to understanding force distribution during sagittal splitting. However, direct clinical extrapolation should be made with caution, and further studies in human models are necessary to determine the implications for surgical outcomes and neurosensory recovery.

Pain management in children with molar-incisor hypomineralisation (MIH) presents a significant challenge, as affected teeth often respond poorly to local anaesthesia due to altered enamel and heightened pulp sensitivity. Overcoming these difficulties is crucial to achieving effective dental outcomes. To evaluate the effectiveness of pharmacological, desensitising and behavioural strategies for pain control in children and adolescents with MIH. Systematic search of multiple electronic databases identified studies published between 2001 and 2024. Eligible designs included randomised controlled trials, randomised crossover studies and clinical trials. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I V2 tools and certainty of evidence graded with GRADEpro. A random-effects meta-analysis was conducted to assess anaesthetic success with 4% articaine. Thirteen studies were selected, with six included in the meta-analysis. Pooled success rates for 4% articaine were 0.849 for inferior alveolar nerve block and 0.915 for intraosseous injection. Findings suggest improved anaesthetic success compared with 2% lidocaine. Pre-emptive ibuprofen, laser desensitisation and virtual reality distraction also showed benefits for reducing pain and anxiety. Current evidence suggests that an individualised, multimodal approach may improve pain management in children with MIH. However, further high-quality comparative studies are needed to guide clinical protocols. PROSPERO Registration: CRD42024474840.

Inferior alveolar nerve (IAN) sensory disturbance after mandibular third molar extraction can persist and affect speech, mastication, and quality of life. Photobiomodulation (PBM) has been used to promote peripheral nerve recovery, but the most suitable irradiation strategy remains unclear. Laser acupuncture (LA) delivers PBM to predefined acupoints and may provide both local and central neuromodulatory effects. To compare standardized LA with direct nerve-trajectory PBM for post-extraction IAN hypoesthesia in a randomized, double-blind, sham-controlled trial. Adults aged 18-60 years with unilateral IAN hypoesthesia lasting ≥7 days and ≤12 weeks were randomized (1:1:1) to LA, direct PBM along the external IAN projection, or sham treatment. All participants received mecobalamin (0.5 mg, three times daily) for 30 days. PBM was delivered using an 808-nm diode laser (continuous wave, 100 mW; beam area 1.0 cm2), 90 s/site (9 J; 9 J/cm2), every other day for 15 sessions. LA used a fixed 5 + 2 prescription: ST4, ST6, ST7, CV24, Jiachengjiang (EX-HN19), plus LI4 and PC6. Primary outcomes were two-point discrimination (TPD) and Semmes-Weinstein monofilament examination (SWME) at day 30. Secondary outcomes included Visual Analog Scale (VAS) numbness, additional sensory tests, and day-60 follow-up. Sixty participants completed the intervention. Both active groups improved more than sham for TPD and SWME (group × time p < 0.01). Mean TPD change at day 30 was -3.2 ± 1.8 mm (LA) and -2.6 ± 1.7 mm (direct PBM) versus -0.8 ± 1.1 mm (sham). SWME improved by ≥1 grade in 85%, 80%, and 25%, respectively. VAS numbness decreased by 60%, 48%, and 12%, respectively, and the improvement was largely maintained at day 60. No treatment-related adverse events occurred. Under matched PBM dosimetry, both irradiation strategies improved sensory recovery compared with sham. LA produced comparable results and was associated with greater improvement in patient-reported numbness.

The inferior alveolar nerve (IAN) is a sensory branch of the mandibular nerve that supplies sensation to teeth, the chin, and the lower lip. IAN injuries often result from trauma or iatrogenic causes, leading to the development of symptoms like difficulty in eating, smiling, pain, and paraesthesia. IAN regeneration is limited because of the confinement of the nerve within the mandibular canal. Current pharmacological and surgical interventions offer only partial recovery. Therefore, alternative approaches to enhance nerve repair and regeneration are required. To address this limitation, we developed a 3D-bioprinted scaffold composed of alginate, methylcellulose, and Schwann cell-derived acellular matrix (Alg/MC/ACM) for IAN regeneration. The Alg/MC hydrogel showed good mechanical stability and printability, and ACM provides biological cues for nerve regeneration. Proteomics analysis showed that there were 904 common proteins present when the Schwann cell lysate was compared with ACM. The rheological analysis demonstrated shear-thinning and viscoelastic properties of the Alg/MC/ACM hydrogel. In vitro cytocompatibility tests, such as MTT and Live/Dead assays using rat Schwann (RSC96) cells and neuronal (PC12) cells, demonstrated that Alg/MC/ACM2 significantly enhanced cell proliferation and viability when compared to Alg/MC and Alg/MC/ACM1 scaffolds. In vivo study in SD rat IAN crush injury model demonstrated that implantation of Alg/MC/ACM2 scaffolds improved the behavioral response when compared with injury control. Alg/MC/ACM2 scaffolds also promoted cellular infiltration, axonal organization, and remyelination, as observed in hematoxylin and eosin and Luxol fast blue staining. Overall, the incorporation of Schwann-cell-derived ACM within Alg/MC scaffolds provided a bioactive microenvironment that supported neural regeneration. This study presents the first evidence demonstrating the potential of Alg/MC/ACM bioprinted scaffolds as promising therapeutic strategies for IAN repair.

BackgroundDistraction is a safe and effective technique that diverts a child’s attention from anxiety‐provoking stimuli. This study aimed to evaluate the efficacy of thumb sleeves as a visual distraction and Pop‐It toys as therapeutic play in reducing dental anxiety and pain in children aged 4–6 years undergoing mandibular alveolar nerve block.Materials and MethodsThis double‐blind trial included 100 children aged 4–6 years, randomly allocated into four parallel groups: Group I (Control)—Tell–Show–Do (TSD) alone; Group II—TSD with visual distraction (thumb sleeve); Group III—TSD with sensory distraction (Pop‐It toy); Group IV—TSD with both visual and sensory distractions. Pulse rate was measured at baseline (T0), after behavior management (T1), and 2 min after local anesthesia (T3). Dental anxiety was assessed using the Facial Image Scale at T0 and T3, and pain was measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale at T2. Statistical significance was set at p < 0.05. Kolmogorov–Smirnov was used to test the normal distribution, and the Kruskal–Wallis test was used to compare the studied groups.ResultsAnxiety and pain scores varied among the groups. Based on pulse rate, Group III (TSD with sensory distraction) showed the lowest anxiety after behavior management, while Group I (TSD alone) showed the highest. After 2 min of anesthesia, Group IV (combined visual and sensory distraction) demonstrated the lowest anxiety, whereas Group II showed the highest. According to the Facial Image Scale, Group IV recorded the lowest anxiety and Group III the highest at T3. In terms of pain (FLACC), Group IV showed the lowest scores, while Group I recorded the highest during anesthesia administration. However, the Kruskal–Wallis test revealed no statistically significant differences between groups in pulse rate, Facial Image Scale, or FLACC scores (p > 0.05).ConclusionAlthough no statistically significant differences were found between the studied groups, the use of distraction techniques combined with TSD showed a trend toward greater reduction in dental anxiety and pain compared with TSD alone. These approaches may be considered as supportive behavior management tools during inferior alveolar nerve block (IANB) in young children.Trial Registration: ClinicalTrials.gov identifier: NCT06976047

First head-to-head comparison of allograft repair, direct neurorrhaphy and non-surgical management for iatrogenic trigeminal nerve injury: a prospective multicentre cohort study with doubly robust analysis.

A Single-Subject Finite Element Study on the Influence of Root Dislocation Direction on Inferior Alveolar Nerve Stress during Mesially Impacted Mandibular Third Molar Extraction.

The effect of metformin on inferior alveolar nerve regeneration following crush-type injury.

Impact of CBCT-assessed mandibular anatomy on neurosensory disturbance following sagittal split osteotomy.

Unilateral mandibular hyperplasia (UMH) frequently results in facial asymmetry and occlusal disturbances, with no unified diagnostic or therapeutic guidelines currently available. A retrospective analysis was conducted on 8 adult UMH patients, with digital technology as the core component. Preoperative virtual surgical planning (VSP) precisely determined the extent of osteotomy and condylectomy, while 3D-printed cutting guides and splints ensured accurate intraoperative execution. Single-photon emission computed tomography (SPECT) was used to assess growth activity but demonstrated limitations; therefore, a comprehensive evaluation integrating clinical history, patient age, and CT follow-up was emphasized to avoid false-positive results. All cases adhered to the one-stage surgery principle (simultaneous condylar management, orthognathic surgery, and contouring in a single procedure). Two modified surgical techniques were introduced: modified intraoral IVRO on the affected side, enabling synchronous condylectomy and joint reconstruction without facial scarring; modified SSRO on the affected side with the osteotomy line extended anterior to the mental foramen, allowing single-stage dissection and protection of the inferior alveolar nerve and facilitating contouring. Based on individual characteristics, 3 personalized protocols were proposed: condylectomy combined with orthodontics only; condylectomy combined with orthognathic surgery and contouring (for active condyles); and orthognathic surgery combined with contouring only (for inactive condyles). Postoperative follow-up of all 8 patients demonstrated stable occlusion, restored facial symmetry, and no evidence of recurrence. This study establishes a digital technology-supported personalized surgical system for UMH, enabling precise, safe, and effective restoration of facial aesthetics and function.

Dental implant placement in the posterior mandible can be challenging due to the presence of the inferior alveolar nerve (IAN). Biomechanical factors related to implant design and loading may also influence nerve compression. This study aimed to investigate the influence of implant geometry, diameter, length, and implant-canal distance on IAN pressure. Dental implants with two geometries (tapered and cylindrical), two lengths (8 and 12 mm), and two diameters (3.3 and 4.1 mm) were virtually positioned at three implant-canal distances (0.5, 1.0, and 1.5 mm). A total of 24 finite element models were generated. Functional occlusal loading was simulated using a 300 N vertical force and a 100 N oblique force applied at a 45° angle. The resulting IAN pressure values were determined. The implant diameter affected IAN pressure, with 3.3 mm implants yielding higher values than 4.1 mm implants. Longer implants exhibited lower pressure values than shorter implants. Cylindrical implants generated higher pressure than tapered implants. Increasing the implant-canal distance from 0.5 to 1.5 mm reduced nerve pressure. Vertical loading yielded higher pressure values than oblique loading. The implant-canal distance was the primary factor influencing IAN pressure. Implant diameter and geometry had secondary effects, whereas implant length had a limited influence. These findings highlight the importance of implant planning and design selection to reduce load transfer to the IAN.

BACKGROUND The Halstead inferior alveolar nerve block (IANB) is the standard local anesthetic method for mandibular dental procedures, but it can fail due to anatomic variations. A modified mylohyoid anesthesia (MMA) block can be used as a supplemental injection technique for the surrounding tissues. Therefore, this study included patients undergoing mandibular molar surgery and aimed to compare outcomes following a modified mylohyoid nerve block with 4% articaine with epinephrine and dexamethasone, 4% articaine with epinephrine, and 2% lidocaine with epinephrine. MATERIAL AND METHODS Sixty patients were equally allocated into 3 groups (n=20). Group 1 received 4% articaine with epinephrine plus dexamethasone via modified mylohyoid anesthesia (MMA). Group 2 received MMA with 4% articaine and epinephrine alone. Group 3 (control) received 2% lidocaine with epinephrine using Halstead's inferior alveolar nerve block. Pain intensity was assessed using a visual analog scale (VAS). Secondary outcomes included quality of anesthesia score (QAS) and duration of anesthesia (DOA). RESULTS Groups were comparable in age (P=0.958). Median VAS scores were 3.5, 5.5, and 8 mm for Groups 1, 2, and 3, respectively, with no significant differences (P=0.232). Median QAS was 2 in all groups (P=0.168). Mean DOA was 189.2, 216.5, and 219 min, respectively. CONCLUSIONS MMA demonstrated clinical outcomes comparable to the conventional inferior alveolar nerve block, although no statistically significant differences were observed among groups.

Accurate identification of the inferior alveolar nerve (IAN) is essential for preventing nerve injury during dental and maxillofacial procedures such as tooth extraction, implant placement, and orthognathic surgery. However, manual annotation of the IAN in cone-beam computed tomography (CBCT) is challenging because of image noise, anatomical variability, and the complex three-dimensional curvature of the nerve pathway. In this study, we propose an improved automatic segmentation framework for IAN identification in CBCTs using a hybrid CNN-attention architecture built upon the nnU-Net framework. The proposed framework introduces a task-specific CNN-attention hybrid architecture with stage-restricted Permuted Adaptive Instance Normalization (Permuted AdaIN) and decoder-stage contextual refinement to improve robustness to appearance variability while preserving anatomical continuity in thin tubular nerve segmentation. Permuted AdaIN is selectively applied to encoder stage 2 to encourage appearance-invariant feature representations while preserving boundary-sensitive anatomical structures. In addition, the decoder attention module refines contextual interactions between encoder and decoder features after skip fusion, improving segmentation consistency of the thin tubular nerve structure. A total of 130 CBCTs from two institutions were used for training and evaluation. The proposed method achieved Dice similarity coefficients of 0.63 ± 0.17 on the internal dataset (KUAH) and 0.62 ± 0.12 on the external dataset (KUGH), showing a modest numerical improvement compared with nnU-Net (0.60 ± 0.18 and 0.59 ± 0.11, respectively). In addition, the proposed method achieved lower boundary errors, with HD95 values of 2.96 ± 1.27mm and 3.72 ± 7.63mm, and ASSD values of 1.22 ± 0.49mm and 1.29 ± 2.10mm for the internal and external datasets, respectively. Qualitative analysis further demonstrated improved boundary alignment and continuity of the segmented nerve trajectory. These results suggest that the proposed framework may improve segmentation consistency and boundary agreement in automated IAN segmentation on CBCT images, although the magnitude of improvement over nnU-Net should be interpreted cautiously.

The impact of fracture fragment displacement on sensory function recovery of the inferior alveolar nerve in mandibular angle fractures.

Role of anesthetic techniques in trigeminocardiac reflex during oral surgery of the mandible under local anesthesia.

The mandibular lingula (spine of Spix) in contemporary research: A comprehensive critical review of global morphological variations and clinical implications.

Odontogenic myxoma of the mandible in a 5-year-old boy presenting with trismus: a case report

Background: Trigeminal neuralgia (TN), a facial pain disorder classically characterized by recurrent brief electric-shock-like paroxysms in one or more trigeminal divisions, frequently traverses dental pathways before specialist evaluation. Conversely, dental extraction, endodontic treatment, implant procedures, and third-molar surgery may injure the inferior alveolar, superior alveolar, mental, or lingual nerves and generate painful post-traumatic trigeminal neuropathy. We sought to define the diagnostic interface between classical TN and post-dental/alveolar nerve-related trigeminal pain in a tertiary referral cohort. Methods: We performed a retrospective single-center diagnostic-pathway study using a clinical dataset comprising 672 unique patients. A dental-interface trigeminal candidate cohort was assembled from aggregated patient-level source notes and adjudicated into five prespecified phenotypes: confirmed alveolar neuropathy, post-extraction neuropathic onset, odontogenic diagnostic misclassification, mixed/uncertain dental-interface pain, and clean classical TN. Extracted variables included demographics, trigeminal branch documentation, sensory deficit, dental procedure history, post-extraction onset, MRI and neurovascular conflict language, secondary structural disease, TN-directed medication exposure, invasive treatment exposure, documented outcomes, and time from first specialist documentation to first dated invasive treatment. Results: Among 201 dental-interface trigeminal candidates, 19 patients (9.5%) had confirmed alveolar neuropathy, 31 (15.4%) had post-extraction neuropathic onset, 20 (10.0%) represented odontogenic diagnostic misclassification, 115 (57.2%) remained mixed/uncertain, and 16 (8.0%) fulfilled a clean classical TN phenotype. Overall, 114 patients (56.7%) carried explicit TN terminology somewhere in the chart. Non-classical alveolar/post-dental syndromes comprised 70 patients (34.8%). Compared with clean classical TN, this non-classical group had higher rates of documented oral sensory deficit (38.6% vs. 0.0%, p = 0.002), post-extraction onset (52.9% vs. 0.0%, p < 0.001), extraction history (61.4% vs. 0.0%, p < 0.001), and secondary structural disease (22.9% vs. 0.0%, p = 0.035). Neurovascular conflict or vascular-loop language did not distinguish non-classical alveolar/post-dental syndromes from clean classical TN (38.6% vs. 37.5%, p = 1.000). Conclusions: A substantial minority of tertiary dental-interface trigeminal referrals represented alveolar/post-dental syndromes rather than clean classical TN, even while carrying TN labels and accumulating TN-directed treatment exposure. Post-extraction onset, lower-lip/chin or intraoral sensory change, and pain persisting despite extraction should prompt careful phenotyping before classical TN-directed escalation. The alveolar–trigeminal interface can be operationalized as a recognizable diagnostic pathway with direct implications for multidisciplinary facial-pain evaluation.

Neurosensory Disturbances Related to the Inferior Alveolar Nerve Amongst Patients With Mandibular Medication-Related Osteonecrosis of the Jaw (MRONJ): A Clinical and Radiological Overview

To evaluate the diagnostic capability of artificial intelligence (AI) compared to human radiographic interpretation in assessing the relationship between the inferior alveolar nerve (IAN) and the third molar. The search was conducted in nine electronic databases (PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, Computers & Applied Sciences, ACM Digital Library, and Compendex) and gray literature (Google Scholar and ProQuest) for studies published up to December 2024. Fifteen diagnostic studies were included, encompassing approximately 19,049 third molars and 14,455 imaging exams. Nine studies used 2D images (panoramic radiographs) to assess the IAN-third molar relationship, two used CBCT, and four used both panoramic radiographs and CBCT. Significant heterogeneity was observed across studies regarding AI models, imaging techniques, and classification methods, along with inconsistencies in the presentation of diagnostic metrics. AI tools have demonstrated high accuracy in diagnosing the relationship between the IAN and third molars, offering time savings and reliable diagnostic support for radiologists, oral and maxillofacial surgeons, and general practitioners. While CBCT-based AI models showed promising diagnostic accuracy, the available data were limited, and the certainty of evidence was low.