Inferior Alveolar Nerve Injury Research Articles

Frequency of Inferior Alveolar Nerve Injury During Third Molar Extraction.

To determine the frequency of inferior alveolar nerve injury during third molar extraction and the associated factors. Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan, from July to December 2021. A total of 163 patients with third molar surgery were included. Patients were followed up after one week, one month, and three months of duration. The frequency of inferior alveolar nerve injury was determined as well as its relationship with other surgical variables like age, gender, type of impaction, buccal flap retraction, bone cutting, tooth splitting, and duration of surgery via Chi-square test. The frequency of inferior alveolar nerve injury was found to be 1.2% (n = 02). None of the surgical variables had a statistically significant association with it (p >0.05). The frequency of nerve injury of the inferior alveolar nerve during extraction of the third molar was 1.2%. Proper treatment planning, using advanced radiography, experienced surgeon, and proper technique can help in lowering nerve injury risk. Inferior alveolar nerve injuries, Molar, Tooth extraction, Paraesthesia.

Risk Factors Associated With Inferior Alveolar Nerve Injury After Extraction of Impacted Lower Mandibular Third Molars: A Prospective Cohort Study

BackgroundInferior alveolar nerve (IAN) injury is one of the complications of impacted lower mandibular third molar (LM3) extraction. Given the unknown prognosis of IAN injuries and limited treatment options, it is critical to understand the risk factors of IAN injury before LM3 extraction. PurposeThe study purpose was to identify risk factors associated with IAN injury after LM3 extraction. Study design, setting, sampleThis was a prospective cohort study including patients who underwent LM3 extraction from May to December in 2021 at authors’ institution. Patients with systemic diseases, previous maxillofacial surgeries or sensory abnormalities were excluded. Predictor variable(s)The predictor variable is composed of several risk factors. The variables were grouped into four categories: demographic, radiographic, procedure-related, and surgeon experience. Main outcome variable(s)The outcome variable was postoperative neurosensory disturbance coded as present or absent and was measured as one-month (transient) and one-year (permanent). CovariatesNot applicable. AnalysesThe measurement data were represented by mean and standard deviation (SD). The association of each variable with the presence of IAN injury was tested by the chi-square test. Statistical significance was accepted at p < 0.05. ResultsThe study sample was consisted of 705 patients (37.0% male) with an average age of 28.51 ± 6.51 years. A total of 17/705 (2.4%) and 4/705 (0.57%) patients developed transient and permanent IAN injury. The results demonstrated that the following factors were associated with higher rates of transient injury: use of chisels during surgeries (6.4%; 95% CI: 2.7-12.3; p=0.02; RR=11.4), LM3s located below the IAN canal (8.7%; 95% CI: 4.3-15.7; p<0.01; RR=7.3), compressed contact between LM3s and the IAN canal (36.4%; 95% CI: 12.3-78.2; p<0.001; RR=25.4), and not using corticosteroids after surgeries (3.8%; 95% CI: 1.9-6.5; p=0.03; RR=3.1). The only factor associated with permanent injury was compressed contact between LM3s and the IAN canal (18.2%; 95% CI: 2.2-62.3; p<0.001; RR=48.2). Conclusions and RelevanceClose proximity between LM3s and IAN canal, and the use of chisels, increase the risk of transient IAN injury. Corticosteroid treatment may promote nerve recovery. Compressed contact between LM3s and IAN canal is the only risk factor for permanent injury.

Inferior alveolar nerve injury resulting from different implant rotary instruments: An ex vivo comparative study in human cadaveric mandibles

The present study aimed to evaluate the degree of nerve injury on inferior alveolar nerve (IAN) by different implant drills resulting from direct canal intrusion into inferior alveolar canal (IAC). A cadaveric study involving 7 human mandibles was performed to evaluate mechanical injury of canal enclosed IAN resulting from different drills. In group 1, osteotomies were created using different drills with 1 mm of intracanal intrusion, simulating accidental drill intrusion into canal. In group 2, drilling was stopped when the tip has breached into IAC, limited by tactile feedback of operator. The depth and width of nerve defects were assessed using optical coherence tomography. A significant difference in defect depth was found (p < 0.001) in group 1. A sinus lift reamer inflicted the least damage (0.068 ± 0.022 mm). It was also found that the mean defect depth was significantly different when a twist drill was used (p = 0.016). Sinus lift reamer can be used safely for osteotomy preparation in mandible when bone height is limited or when radiographic visualization of canal is poor. Bone corticalization around IAC does not provide adequate protection for IAN in the event of accidental intracanal intrusion.

Endoscopically-assisted extraction of broken roots or fragments within the mandibular canal: a retrospective case series study

PurposeTo assess the impact of endoscope-assisted fractured roots or fragments extraction within the mandibular canal, along with quantitative sensory testing (QST) alterations in the inferior alveolar nerve (IAN).MethodsSix patients with lower lip numbness following mandibular third molar extraction were selected. All patients had broken roots or fragments within the mandibular canal that were extracted under real-time endoscopic assistance. Follow-up assessments were conducted on postoperative days 1, 7, and 35, including a standardized QST of the lower lip skin.ResultsThe average surgical duration was 32.5 min, with the IAN exposed in all cases. Two of the patient exhibited complete recovery of lower lip numbness, three experienced symptom improvement, and one patient remained unaffected 35 days after the surgery. Preoperative QST results showed that the mechanical detection and pain thresholds on the affected side were significantly higher than those on the healthy side, but improved significantly by postoperative day 7 in five patients, and returned to baseline in two patients on day 35. There were no significant differences in the remaining QST parameters.ConclusionsAll endoscopic surgical procedures were successfully completed without any additional postoperative complications. There were no cases of deterioration of IAN injury, and lower lip numbness recovered in the majority of cases. Endoscopy allowed direct visualization and examination of the affected nerve, facilitating a comprehensive analysis of the IAN.

Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve.

Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN). To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction. Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed. All IMM3s were extracted easily without symptoms of IAN injury after extraction. Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

TREATMENT OF YATROGENIC POST-TRAUMATIC NEUROPATHY ASSOCIATED WITH ENDODONTIC THERAPY USING 3D TECHNOLOGIES

Post-traumatic neuropathy is one of the complications of endodontic treatment, represents a serious problem, manifested by sensory disturbances and has a significant negative impact on the quality of life of patients. Mechanical pressure on the filler causes swelling and hematoma and, due to the chemical action of the substance, neurotoxicity. The decision to treat a patient with trigeminal neuropathy requires complex treatment. Early surgical removal of excess endodontic material resulting from endodontic treatment provides the best prognosis for recovery. With the development of modern digital technologies, advances have been made in the endodontic treatment process. The presented clinical case describes original method for the treatment of endodontic inferior alveolar nerve injuries associated with endodontic therapy using surgical template obtained by three-dimensional software modeling. Using computed tomography software, a template was developed for drilling the bone in the projection of the localization of the material. The surgical template is printed with a 3D printer, after installation in the oral cavity, osteotomies are made under X-ray and excess material is removed, after which the patient is prescribed complex treatment. Results: After 2 weeks, the patient&amp;#39;s complaints disappeared. Sensory impairments were restored and had a positive impact on the patient’s quality of life. A control X-ray examination revealed regeneration of young bone tissue at the osteotomy site. Conclusion: The introduction of digital planning software and the use of 3D printed surgical guides in endodontic microsurgery have significantly improved treatment planning as well as operative and psychological comfort for patients.

Repair of Inferior Alveolar Nerve in Orthognathic Surgery Simulator (RIANOS): A Novel, Open-Source, Combined 3D Printed, and Ex-Vivo Chicken Sciatic Nerve Training Model

Study Design Face and content validation of a surgical simulation model. Objective Accidental transection of the inferior alveolar nerve (IAN) during bilateral sagittal split osteotomies (BSSO) has a reported incidence of up to 7%, determining important sensory disturbances in patients. Proper repair demands the need of microsurgical anastomosis skills. No previous training models have been described to simulate this. Therefore, we present a validated simulation model for intraoral repair of transected IAN. Methods A CT scan of an orthognathic surgery patient was modified and a 3D model of a mandible with BSSO was printed. Chicken thigh anatomy was reviewed, and 2.5 mm sciatic nerves were dissected and mounted in the model. In order to simulate intraoral work depth, it was put inside a dental phantom or medical glove box. The model was tested by a group of experts (n = 12), simulating a transected IAN repair inside the mouth with both loupes and a double visor surgical training microscope. A survey was conducted to assess Face and Content validity. Results The model was named RIANOS after Repair of Inferior Alveolar Nerve in Orthognathic Surgery Simulator. The printing cost of each model was approximately US$3 and the design file is open-source and available for download. All experts “Strongly Agreed” that the model was useful for training inferior alveolar nerve microsurgical repair and would consider implementing it with their residents. Conclusions We developed a low cost, reproducible, open-source simulator for IAN injury repair training during BSSO. Face and Content validity was achieved through evaluation by a group of experts.

Immediate implant placement in the posterior mandibular region was assisted by dynamic real-time navigation: a retrospective study

BackgroundEfficient utilization of residual bone volume and the prevention of inferior alveolar nerve injury are critical considerations in immediate implant placement (IIP) within the posterior mandibular region. Addressing these challenges, this study focuses on the clinical efficacy and implant accuracy of dynamic real-time navigation, an emerging technology designed to enhance precision in implantation procedures.MethodsThis study included 84 patients with 130 implants undergoing immediate placement in the posterior mandibular region. Stratified into dynamic navigation, static guide plate, and freehand implant groups, clinical indicators, including initial stability, distance to the inferior alveolar nerve canal, depth of implant placement, and various deviations, were systematically recorded. Statistical analysis, employing 1- or 2-way ANOVA and Student’s t-test, allowed for a comprehensive evaluation of the efficacy of each technique.ResultsAll 130 implants were successfully placed with an average torque of 22.53 ± 5.93 N.cm. In the navigation group, the distance to the inferior alveolar nerve and the depth of implant placement were significantly greater compared to the guide plate and freehand groups (P < 0.05). Implant deviation was significantly smaller in both the navigation and guide plate groups compared to the freehand group(P < 0.05). Additionally, the navigation group exhibited significantly reduced root and angle deviations compared to the guide plate group(P < 0.05), highlighting the superior precision of navigation-assisted immediate implant placement.ConclusionsIt is more advantageous to use dynamic navigation rather than a static guide plate and free-hand implant insertion for immediate posterior mandibular implant implantation.

System for automatically assessing the likelihood of inferior alveolar nerve injury

Inferior alveolar nerve (IAN) injury is a severe complication associated with mandibular third molar (MM3) extraction. Consequently, the likelihood of IAN injury must be assessed before performing such an extraction. However, existing deep learning methods for classifying the likelihood of IAN injury that rely on mask images often suffer from limited accuracy and lack of interpretability. In this paper, we propose an automated system based on panoramic radiographs, featuring a novel segmentation model SS-TransUnet and classification algorithm CD-IAN injury class. Our objective was to enhance the precision of segmentation of MM3 and mandibular canal (MC) and classification accuracy of the likelihood of IAN injury, ultimately reducing the occurrence of IAN injuries and providing a certain degree of interpretable foundation for diagnosis. The proposed segmentation model demonstrated a 0.9 % and 2.6 % enhancement in dice coefficient for MM3 and MC, accompanied by a reduction in 95 % Hausdorff distance, reaching 1.619 and 1.886, respectively. Additionally, our classification algorithm achieved an accuracy of 0.846, surpassing deep learning-based models by 3.8 %, confirming the effectiveness of our system.

Risk determination of inferior alveolar nerve injury after mandibular third molar extraction

Introduction. Extraction of impacted molars may be accompanied by complications, including inferior alveolar nerve (IAN) injury, with an incidence of up to 8.4% [3]. Among the risk factors for IAN trauma is the relationship between the molar and the mandibular canal (MC). The aim of the study is to evaluate the difficulty of extraction of impacted M3M and the risk of NAI injury based on radiological clichés. Materials and methods. A retrospective descriptive study was performed, including 25 molars. OPGs, and CBCTs of the patients were evaluated. Age, sex of patients; degree of inclusion according to Pell &amp; Gregory; angulation of molars; Rood &amp; Shehab signs were studied. Results. According to the degree of difficulty of the intervention, we obtained: low difficulty — 2 cases; medium — 21 cases; high — 2 cases. 84% of cases showed an association between more than one signs proposed by Rood &amp; Shehab. The most common were loss of white line (33%), followed by MC narrowing and root darkening (22% each). The incidence of NAI injury was 8.3%. Conclusions. Risk prediction is useful in planning and facilitates decision making regarding the extraction technique of the impacted M3M.

Coronectomy of impacted mandibular third molars: a clinical and radiological retrospective case series study with 2-9 years of follow-up.

Impacted mandibular third molars occasionally are in intimate relation to the inferior alveolar nerve (IAN). Coronectomy has been proposed as a good alternative to prevent injury of the IAN. The present study evaluates the clinical and radiological outcomes of impacted mandibular third molars presenting radiographic signs associated with a high risk of IAN injury, and which were treated with the coronectomy technique. A retrospective case series evaluated the outcomes of coronectomies of impacted mandibular third molars. The inclusion criteria were: available preoperative, immediate postoperative and two-year panoramic radiographs, preoperative cone-beam computed tomography (CBCT), and a complete case history. The clinical evaluation comprised intraoperative complications (mobilized fragments of root and damage to adjacent structures), short-term complications (sensory alterations and postoperative infection), and long-term complications (infection or oral exposure). The IAN position with respect to the roots, root shape, eruption status, third molar position, radicular-complex migration and bone above roots were radiographically evaluated as well. Approximately a total of 2000 mandibular third molars were removed from 2011 to 2022. Of these, 39 molars in 34 patients were partially extracted using the coronectomy technique. The mean age was 36 years (range 22-77), and the mean follow-up was 28 months (range 24-84). There were two short-term postoperative infections. One of them was resolved through reintervention to remove the roots after antibiotic treatment, while the other required hospital admission and removal of the roots. One case of short-term transient lingual paresthesia was also recorded. Two long-term oral exposures were detected, and the root fragments had to be extracted. There were no permanent sensory alterations. In our case series of 39 impacted mandibular molars in intimate contact with the IAN and treated with the coronectomy technique, the number of complications was low (two infections and a single case of transient lingual paresthesia), and no permanent sensory alterations were observed. Prospective studies, especially randomized clinical trials, are needed to compare this technique with conventional extraction.

High- Risk Factors Associated with Inferior Alveolar Nerve Injury Following Removal of the Third Molars: A Preliminary Study

PURPOSE: This study aims to determine the incidence of inferior alveolar nerve (IAN) injury following the extraction of the lower third molars (LTMs) and to identify the demographic, radiographic, and intra-operative risk factors associated with this complication. MATERIALS &amp;amp; METHODS: Fifty LTMs from 47 patients were included in this prospective clinical study. Demographic data and intra-operative parameters including operation time, bone removal and duration, excessive bleeding and IAN exposure were recorded. Bone retention, anatomical position of LTMs (Pell&amp;amp;Gregory and Winter classification) and 5 radiographic criteria proposed by Rood and Shehab were evaluated on panoramic images, whereas the distance between roots and the inferior alveolar canal (IAC), the cortication status of IAC, and the buccolingual position of IAC were examined on CBCT images. Chi-square test was used to compare the presence of IAN injury with variables. A p-value &amp;lt; 0.05 was considered as statistically significant. RESULTS: The incidence of temporary IAN injury was 6% among study population. No permanent IAN injury was observed. Excessive bleeding (p=0.007), IAN exposure (p=0.007), the lingual position of IAC (p=0.035) and dumbbell-shaped IAC (p=0.002) were found to be associated with increased risk of temporary IAN injury. CONCLUSION: Identification of high-risk factors is essential for predicting the risk of IAN injury, and determining the most convenient treatment plan for each case. Further studies with larger study samples are needed both to confirm the risk factors that are proposed in the present study and to identify the other potential ones.

The effect of root orientation on inferior alveolar nerve injury after extraction of impacted mandibular third molars based on propensity score-matched analysis: a retrospective cohort study

BackgroundThe injury of the inferior alveolar nerve (IAN) is one of the most serious complications of impacted mandibular third molars (IMTMs) extraction. The influence of the root orientation of IMTMs on IAN injury is still controversial. A deeper understanding of the risk factors of IAN injury conduces to better prevention of IAN injury. This study aims to explore whether root orientation is an independent risk factor of IAN injury during IMTMs extraction using the statistical strategy of propensity score matching (PSM).MethodsThis retrospective cohort study included 379 patients with 539 cases of high-risk IMTMs screened by panoramic radiography and cone beam computed tomography. The IAN injury incidence after extraction of different groups of IMTMs was analyzed using the chi-square test or Fisher’s exact test. The correlation between third molar root orientation and impaction depth/contact degree with IAN was evaluated by the Lambda coefficient. Based on PSM for balancing confounding factors including age, sex, impaction depth, and contact degree, the effect of root orientation on the incidence of IAN injury was further analyzed using Fisher’s exact test.ResultsThere were significant group differences in IAN injury incidence in impaction depth, root orientation, and contact degree of root-IAC before PSM. Root orientation was correlated with impaction depth and contact degree of root-IAC. After PSM, there were 9 cases with IAN injury and 257 cases without IAN injury. There were significant group differences between the buccal and non-buccal groups after PSM, and the risk of IAN injury was higher when the root was located on the buccal side of IAC (OR = 8.448, RR = 8).ConclusionsRoot orientation is an independent risk factor of IAN injury, and the risk is higher when the root is located on the buccal side of IAC. These findings could help better evaluate the risk of inferior alveolar nerve injury before the extraction of IMTMs.

Relationship of the Degree of Nerve Exposure and Surgical Manipulation and Short-Term Neurosensory Disturbance Following Sagittal Split Ramus Osteotomy: A Prospective Study

BackgroundNeurosensory disturbance (NSD) is a common complication after sagittal split ramus osteotomy (SSRO) due to inferior alveolar nerve (IAN) injury. The impact of intraoperative nerve manipulation on NSD remains debated. PurposeThe purpose of this study was to evaluate the influence of IAN exposure and manipulation during SSRO on functional sensory recovery (FSR). Study designThis was a single-center, prospective cohort study of 40 patients undergoing SSRO at Mahidol University, from December 2020 to December 2021. The inclusion criteria were patients aged 20-34, ASA Class I-II. The exclusion criteria were patients with systemic bone disease, history of head and neck or neurological pathology, previous SSRO or incomplete data collection. Predictor variableDegree of intraoperative nerve manipulation was divided by the attending surgeon as follows; 1) Nerve fully encased in distal segment and not visible (NS); 2) Nerve encased in distal segment but partially visible (DS) ; 3) Nerve partially encased in proximal segment and fully dissected free (PS). Outcome variablesThe area of interest was divided into the lip and chin. The primary outcome was time to FSR. The secondary outcome was subjective patient report, using a visual analogue scale, compared to FSR. CovariatesThe covariates were sex, age, skeletal diagnosis, degree of movement, and concomitant genioplasty/subapical procedure. AnalysesKaplan-Meier survival analysis, Cox proportional hazards regression, and Mcnemar test were utilized. P-value < 0.05 was significant. ResultsIn the lip, the median times to FSR were; NS, 2 days; DS, 45 days; PS, 102 days. (Interquartile range: 77,127, 114, respectively) In the chin, the median times to FSR were; NS, 23 days; DS, 92 days; PS, 87 days. (Interquartile range: 77, 161, 101, respectively.) Nerve manipulation significantly affected FSR in the lip and chin (p= 0.001, <0.001, respectively. Cox hazard ratios for DS and PS were lower compared to NS. Patients consistently reported more NSD compared to FSR as per Mcnemar test. Conclusion and RelevanceAfter SSRO, FSR in the lip is prolonged when the IAN is partially encased in the proximal segment and released. This raises the question of the efficacy of surgically releasing a partially encased IAN.

Evaluation of Implant Placement Risk Levels in Partially Edentulous Patients Using Cone Beam Computed Tomography.

This study aimed to evaluate the implant placement risk levels in partially edentulous patients using cone beam computed tomography (CBCT) and implant planning software. A total of 101 CBCT scans of partially edentulous patients were included. Evaluations of jawbone anatomy, vital structures' proximity, and the risk of inferior alveolar nerve injury with esthetic considerations were done on CBCT images using implant surgery software (BlueSkyPlan4;BlueSkyBio, Grayslake, IL). A total of 101 patients with 106 edentulous sites were examined. The mean ridge height of the non-esthetic zone was 10 mm and 14.4 mm in the maxilla and mandible, respectively. The period of edentulousness significantly affected the risk of placing implants in the non-esthetic zone (P<.05). The relation between gender and mandibular canal identification was significant (P<.01). A higher risk of implant placement is associated with a more extended period of edentulousness. The preoperative assessment revealed that the mandibular canal could be identified more easily in females than males; thus, nerve injury could be avoided. However, age hadno associated effect. Age has no associated effect on the implant placement risk levels for partially edentulous patients during dental implant planning. A higher risk of implant placement is associated with a more extended period of edentulousness. Mandibular canal identification during virtual preoperative assessment was higher in females.

Risk assessment of inferior alveolar nerve injury after wisdom tooth removal using 3D AI-driven models: A within-patient study

ObjectiveTo compare a three-dimensional (3D) artificial intelligence (AI)- driven model with panoramic radiography (PANO) and cone-beam computed tomography (CBCT) in assessing the risk of inferior alveolar nerve (IAN) injury after mandibular wisdom tooth (M3M) removal through a within-patient controlled trial. MethodsFrom a database of 6,010 patients undergoing M3M surgery, 25 patients met the inclusion criteria of bilateral M3M removal with postoperative unilateral IAN injury. In this within-patient controlled trial, preoperative PANO and CBCT images were available, while 3D-AI models of the mandibular canal and teeth were generated from the CBCT images using the Virtual Patient Creator AI platform (Relu BV, Leuven, Belgium). Five examiners, who were blinded to surgical outcomes, assessed the imaging modalities and assigned scores indicating the risk level of IAN injury (high, medium, or low risk). Sensitivity, specificity, and area under receiver operating curve (AUC) for IAN risk assessment were calculated for each imaging modality. ResultsFor IAN injury risk assessment after M3M removal, sensitivity was 0.87 for 3D-AI, 0.89 for CBCT versus 0.73 for PANO. Furthermore, the AUC and specificity values were 0.63 and 0.39 for 3D-AI, 0.58 and 0.28 for CBCT, and 0.57 and 0.41 for PANO, respectively. There was no statistically significant difference (p>0.05) among the imaging modalities for any diagnostic parameters. ConclusionThis within-patient controlled trial study revealed that risk assessment for IAN injury after M3M removal was rather similar for 3D-AI, PANO, and CBCT, with a sensitivity for injury prediction reaching up to 0.87 for 3D-AI and 0.89 for CBCT. Clinical significanceThis within-patient trial is pioneering in exploring the application of 3D AI-driven models for assessing IAN injury risk after M3M removal. The present results indicate that AI-powered 3D models based on CBCT might facilitate IAN risk assessment of M3M removal.

The effectiveness of photobiomodulation therapy on inferior alveolar nerve injury: A systematic review and META-analysis.

The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to orthognathic surgeries, extraction of impacted third molars and mandibular fractures. A electric search was conducted by a combination of manual search and four electric databases including Pubmed, Embase, Cochrane library and Web of Science, with no limitation on language and publication date. Gray literature was searched in ClinicalTrials.gov and googlescholar. All retrieved articles were imported into ENDNOTE software (version X9) and screened by two independent reviewers. All analysis was performed using the REVMAN software (version 5.3). Finally, 15 randomized controlled trials met the inclusion criteria for qualitative analysis and 14 for META-analysis from 219 articles. The results showed that PBM therapy had no effect on nerve injury in a short period of time (0-48h, 14 days), but had significant effect over 30 days. However, the effect of photobiomodulation therapy on thermal discrimination was still controversial, most authors supported no significant improvement. By calculating the effective rate of PBM, it was found that there was no significant difference in the onset time of treatment, whether within or over 6 months. The results of this META-analysis show that PBM therapy is effective in the treatment of IAN injures no matter it begins early or later. However, due to the limited number of well-designed RCTs and small number of patients in each study, it would be necessary to conduct randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.

INCIDENCE OF COMPLICATIONS AFTER THIRD MANDIBULAR MOLAR CORONECTOMY

Coronectomy is a technique that involves the removal of the crown of the third molar, leaving the root in place. It is recommended when the risks of complete extraction outweigh the benefits, especially in cases where there is a high risk of inferior alveolar nerve (IAN) injury. The success of coronectomy depends on adherence to the operating protocol, which is controlled by the oral sur­geon. The aim of this systematic review is to assess the incidence and nature of complications associated with the coronectomy of mandibular third molars. The systematic literature search was conducted according to PRISMA guidelines in MEDLINE (PubMed), and EMBASE (Sci­enceDirect) databases. A total of 287 titles were identi­fied. 9 studies met the final inclusion criteria. The results showed that coronectomy had a low incidence of IAN sensory disturbance, with 1.6% to 4.3% of cases expe­riencing such complications, while other studies recor­ded no cases of sensitivity loss. Infection and dry socket occurred in a small percentage of cases. Coronectomy is a safe and useful technique for treating impacted mandi­bular third molars. Similar or lower incidence of com­plications compared to those from extraction were seen. Further prospective homogenous randomized controlled clinical trials are necessary to evaluate the effectiveness of coronectomy in third mandibular molars.

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.

Incidence neurosensory deficit in mandibular fractures.

Sensory disturbances in the inferior alveolar nerve (IAN) prior to treatment can be attributed to various factors, including the site, type of fracture, and fracture displacement. Therefore, it is of interest to assess the incidence of inferior alveolar nerve injuries associated with mandibular fractures before and after surgical treatment. Group A consisted of patients with inferior alveolar nerve paresthesia before treatment, while Group B consisted of patients with inferior alveolar nerve paresthesia after treatment. A significant difference was observed between the two groups, with a p-value of 0.031 (p <0.05) with the overall incidence of IAN deficit was 57.33% before treatment and 61.33% after treatment. These findings highlight the importance of promptly identifying and managing IAN injuries to minimize long-term consequences.