Infection Related Inferior Alveolar Nerve Paresthesia in the Lower Premolar Teeth

Abstract

Introduction. The aim of this paper was to describe two cases of IAN infection-induced paresthesia and to discuss the most appropriate treatment solutions. Methods. For two patients, periapical lesions that induced IAN paresthesia were revealed. In the first case, the tooth was previously endodontically treated, whereas in the second case the lesion was due to pulp necrosis. Results. For the first patient, a progressive healing was observed only after the tooth extraction. In the second patient, the paresthesia had resolved after endodontic treatment. Conclusions. The endodontic-related paresthesia is a rare complication that can be the result of a combination of etiopathogenic mechanisms such as mechanical pressure on the nerve fibers due to the expanding infectious process and the production of microbial toxins. Paresthesia resulting from periapical lesions usually subsides through elimination of infection by root canal treatment. However, if there are no signs of enhancement, the immediate extraction of the tooth is the treatment of choice in order to prevent irreversible paresthesia because it was demonstrated that there is a correlation between the duration of mechanical or chemical irritation and the risk of permanent paresthesia.

Inferior alveolar nerve paresthesia caused by periapical infection: A case report

“…Through CBCT images it was perceptible that the bone barrier between the apex of the affected tooth, already weakened by the presence of perirradicular infection, caused the mandible canal to become more vulnerable to the mechanical and microbial aggression from the root canal to the nerve endings. The risk of a permanent nerve injury [9] and the patient's concern led to a more aggressive approach, aiming to remove the cause as early as possible, in order to reach a better prognosis [5]. Most of the dental paresthesia cases have implicated lower PMs [1] and a few lower or superior molars [2,4,6].…”

“…Once the cause is determined and removed, paresthesia is usually resolved within days [5,10]. The chosen treatment depends on the cause and extent of injury [2].…”

“…Endodontic-related paresthesia is a rare complication in endodontics and can be related to periapical pathology (infection) or endodontic iatrogenic causes, as a consequence of incorrect treatment of the root canals (over-instrumentation or overfilling), resulting in mechanical pressure and/or chemical injury [2]. In the first situation most of the cases have been reported in lower pre-molars or molars, with large periradicular lesions [1,[4][5][6]. The symptoms generally subside trough elimination of infection by root canal treatment or immediate extraction of the affected tooth.…”

Odontologia: uma visão contemporânea - Volume 15

“…Podem estar relacionadas às lesões periapicais, extravasamento de material usado para obturação de canais e uso inadequado de soluções irrigadoras, como hipoclorito de sódio. O nervo mais afetado é o nervo alveolar inferior e os seus ramos, podendo apresentar os sintomas por tempo indeterminado (ALVES et al, 2014;CENSI et al, 2016).…”

“…A incidência de parestesias causadas pelo tratamento endodôntico ou presença de lesões periapicais na população é atualmente desconhecida. Na literatura a maioria dos trabalhos sobre o tema são relatos de casos (SEN et al, 2015;ANDRABI et al, 2014;SHAD-MEHR et al, 2015;CENSI et al, 2016;KÖSEOGLU et al, 2006;TILOTTA-YASUKAWA et al, 2006;NGEOW, 2010) que permitem uma análise muito pequena da apresentação clínica, fatores de risco e estratégias de tratamento (RICUCCI et al, 2017). Desta forma, este capítulo tem o objetivo de demonstrar clinicamente a parestesia relacionada ao tratamento endodôntico e a presença de lesões periapicais.…”