inferior alveolar nerve

The final phase of root canal therapy involves the obturation of the root canal system to prevent bacterial leakage and ensure successful outcomes. However, during this process, there is a risk of sealer extrusion into vital structures such as the mandibular canal, which can lead to sensory changes like paresthesia.

This report discussed a 40-year-old female case who presented with a crown fracture and a periapical lesion on her endodontically treated mandibular left second molar. During the retreatment, bioceramic sealer was extruded into the mandibular canal. Immediate radiographic evaluation and cone beam computed tomography confirmed the sealer’s presence within the sub-branches of the mandibular canal, though the main canal was unaffected. Conservative treatment with ibuprofen and dexamethasone resulted in pain relief and the patient did not experience any neurological deficits such as paresthesia. A 36-month follow-up revealed successful healing of the periapical lesion and absorption of the extruded sealer.

This case highlighted the importance of precise endodontic techniques to prevent sealer extrusion and demonstrated the potential of conservative management in cases of sealer extrusion into sub-branches of inferior alveolar nerve.

This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine.

The current randomized controlled clinical trial was conducted on 100 patients in two groups (n = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi‑square test, and P < 0.05 was set as statistically significant.

The patients’ pain severities during the three stages were significantly different (P = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine.

The success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.

 The inferior alveolar nerve (IAN) block is the most commonly used mandibular injection method for local anesthesia in restorative and surgical procedures. Ultrasound images can provide more accurate information about the location of the inferior alveolar neurovascular bundle.

 This study aimed to evaluate the ultrasound images of patients to determine the location of the mandibular foramen (MF) relative to the adjacent landmarks.

 In this cross-sectional analytical study, 50 patients were subjected to intra-oral ultrasonography of the right and left sides of the mandible. An Alpinion ultrasound system (Seoul, South Korea) was used for detecting the MF, as well as its distance from different landmarks.

 In all patients, the MF was found using color Doppler ultrasonography. The probability of detecting MF in conventional ultrasonography was estimated at 36% and 18% for the right and left sides of the mandible without using the Doppler technique, respectively. The mean MF distance from the anterior border of the ramus was 14.6 ± 2.1 and 16.1 ± 2.1 mm on the right and left sides, respectively. Also, the vertical distance of MF from the occlusal plane was 7.5 ± 1.1 mm on the right side and 8.7 ± 1.2 mm on the left side of the mandible. In all studied patients, the MF was above the occlusal plane.

 The results of this study showed that ultrasonography is not only a suitable option for intra-oral imaging due to its non-ionizing beams, but is also appropriate for localization of the MF and its related landmarks.

Inferior alveolar nerve (IAN) injury is a serious complication during intraoral surgeries. We aimed to evaluate the outcome of photobiomodulation (PBM) therapy in patients with IAN injury associated with third molar or implant procedures.

Eight patients with an alteration of sensory function of the IAN after third molar or implant surgeries were enrolled in this case series study. The patients received 10 sessions of PBM therapy (810 nm diode laser, 200 mW, 10 J/cm2 per point, three times a week). Pinprick (PP) and visual analogue scale (VAS) neurosensory tests were recorded at each treatment session and 14 days after the last treatment. The association between explanatory variables and the outcome of interest was analyzed using generalized estimating equations.

The median percentage change of outcomes from the first to the last visit was as follows: VAS score: +125.00% (range: 50.00 to 166.67); PP score: +350% (range: 150 to 800). The duration of paresthesia was inversely correlated with changes in VAS and PP scores. No significant association was found between patients’ gender or age and changes in VAS and PP scores.

Considering the limitations of this study, PBM with the parameters used in this study presented positive effects on neurosensory recovery in patients suffering from IAN injury associated with routine intraoral procedures. Patients with shorter duration of paresthesia tended to respond more favorably to PBM therapy.

Phentolamine mesylate (OraVerse) is mostly used to reverse soft tissue anesthesia after dental procedures. The aim of the present study was to evaluate the effect of the injection of OraVerse on postoperative pain after root canal treatment in patients with symptomatic irreversible pulpitis. Methods and Materials: In this randomized single-blind clinical trial study, 100 patients (50 per group) with symptomatic irreversible pulpitis in the first or second mandibular molars, randomly received either OraVerse or sham treatment after a single-visit root canal therapy. Each patient recorded their pain score, using a Heft Parker visual analogue scale, before and after 6, 12, 24, 36, 48, and 72 h of the treatment. They also monitored their soft-tissue anesthesia every 15 min for 5 h. Data were analyzed by t-test and repeated measured ANOVA statistical tests. The level of significance was set at 0.05.

Patients who received phentolamine had significantly higher pain scores at 6- and 12-h postoperative intervals compared with those receiving sham treatment (P=0.01 and P=0.00 respectively). Consumption of analgesics in OraVerse group was significantly higher than that of the sham group (P=0.48).

Although phentolamine accelerated the reversal of normal soft tissue sensation after the dental visit, it increased postoperative pain in patients suffering from symptomatic irreversible pulpitis, which may limit phentolamine administration in this group.

Widespread use of dental implants in the past 15 years has resulted in an increase in complications associated with implant surgeries. The aim of the present study was to determine the frequency of lower lip paresthesia in patients receiving implant-supported mandibular overdentures.

In this descriptive, cross-sectional study, 63 patients receiving implant-supported mandibular overdentures were evaluated. For clinical examination, the two-point discrimination test (2DP) was used before surgery and at 1-, 3- and 6-month postoperative intervals. Data was analyzed using descriptive statistical tests and chi-square test.

The results showed frequency rates of 19%, 4.8% and 4.8% for lower lip paresthesia at 1-, 3- and 6-month postoperative intervals. At 1-month postoperative interval, female patients exhibited a significantly higher rate of paresthesia compared to male patients (P = 0.035).

Lower lip paresthesia was highly prevalent (19%) one-month after implant surgery; however, its frequency decreased over time. After 3 months, the frequency of paresthesia decreased by about 3 quarters (4.8%) and remained constant until 6 months after surgery. During the 1-month period after surgery, female patients had a high rate of paresthesia compared to male patients.

Administration of local anesthetic agents is a safe procedure. However, various localized, distant and systemic complications have been reported. Posterior superior alveolar nerve block (PSAB) and inferior alveolar nerve block (IANB) are the two most common nerve blocks in the jaws. In this mini review, we tend to describe rare complications of these two methods. Rare complications of IANB includenecrosis of the chin skin of, neuritis of the facial nerve, trismus, ischemia and blanching of skin, anemia in the face, numbness of the ear, diplopia , taste disturbance, infra condylar abscess, burning sensation in eye, reduction in visual acuity and atrophy of the optic nerve. Some Rare complications of PSA are diplopia, amaurosis, epiphoria, paralysis, esotropia, hematoma, pupillary dilation and ptosis, paresis of the lateral pterygoid muscle and trismus. Since complications of dental anesthesia are inevitable, their prevention and management are essential. Management of complications requires comprehensive knowledge regarding the management of complications and injection techniques to prevent these complications.