Decellularized allografts as an alternative for reconstruction of large inferior alveolar nerve defects: a systematic review

Abstract

Background Inferior alveolar nerve (IAN) injuries are a clinical problem with devastating consequences, causing temporary or permanent paresthesia, significantly affecting the patient's quality of life. Despite morbidity, side effects and controversy regarding its results, autologous nerve grafting is still the main treatment for these type of lesions. However, due to advances in knowledge about nerve damage and with the aim of preventing the described problems of autografts, new treatment alternatives based on decellularized allografts have emerged. The aim of this systematic review was to evaluate the reported efficacy of decellularized allografts for the treatment of IAN damage. Material and Methods We performed a systematic search in Pubmed, Scopus and Web of Science databases following the PRISMA guidelines. Cohort studies, randomized or non-randomized clinical studies, prospective or retrospective studies, without age limits and language restriction that included human subjects who received decellularized allograft as treatment for IAN damage were included. Results Six articles met the inclusion criteria and were included for data analysis. In all 6 articles, resolution of IAN damage was observed in more than 85% of patients after a 12-month follow-up period, and in 2 of them, complete resolution was observed in 100% of their patients at longer follow-ups. Conclusions Decellularized allograft appears to be a promising alternative to resolve IAN lesions, without requiring a nerve autograft procedure. However, more randomized clinical trials are needed to validate adequate treatment modalities with decellularized allografts. Key words: Decellularized allograft, alveolar inferior nerve, allograft, injury.

Clinical insights into traumatic injury of the inferior alveolar and lingual nerves: a comprehensive approach from diagnosis to therapeutic interventions

“…This choice is driven by the optimal compatibility between the two nerves, enhancing the likelihood of successful graft integration and functional recovery [ 60 ]. The literature consistently reports a noteworthy nerve restoration rate, ranging from 87 to 100%, when employing autologous nerve grafts [ 51 , 61 ]. While all autologous techniques entail some degree of donor-side morbidity, requiring a secondary procedure for tissue removal [ 60 ], studies indicate that sural nerve harvest is well-tolerated.…”

“…To mitigate donor-side morbidity, there is ongoing research on processed-decellularized allografts [ 47 ]. These allografts demonstrate high success rates, exceeding 85%, in achieving sensory restoration for both smaller and larger defects (documented in the literature for defects up to 7 cm [ 61 ]), albeit in limited patient numbers thus far [ 48 , 61 , 64 ]. In addition to autologous and allogeneic grafts, various alloplastic or xenogeneic scaffolds are available, which can be either resorbable or non-resorbable.…”

Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases

“…It runs inside the mandibular canal and innervates the mandibular teeth, chin, lower lip, mucosa, and gingiva up to the lower second premolar ( 2 ). Lesions in the IAN are a clinical problem that have been documented in surgical procedures such as extraction of the lower third molars, mandibular fractures, orthognathic surgery, placement of dental implants, and mandibular resections due to benign and malignant tumors ( 1 , 3 ).…”

“…One of the most important complications derived from this technique is permanent hypoesthesia of the IAN ( 4 ). This condition significantly affects the quality of life of patients who experience it, producing alterations in speech, taste, mastication, oral hygiene, and lip competence, the latter of which is involved in the retention and swallowing of food ( 3 ). In addition, injury to this nerve can cause chronic neuropathic pain ( 5 ), adverse psychological effects, and decreased quality of life in patients ( 2 ).…”