Inferior Alveolar Nerve Paresthesia Relieved by Microscopic Endodontic Treatment

Abstract

We experienced two cases of inferior alveolar nerve paresthesia caused by root canal medicaments, which were successfully relieved by microscopic endodontic treatment. In the first case, the paresthesia might have been attributable to infiltration of calcium hydroxide into the mandibular canal through the root canals of the mandibular left second molar tooth. In the second case, the paresthesia might have been attributable to infiltration of paraformaldehyde through the root canals of the mandibular right second molar tooth. The paresthesia was relieved in both cases by repetitive microscopic endodontic irrigation using physiological saline solution in combination with oral vitamin B 12 and adenosine triphosphate.

The diagnosis and management of nerve injury during endodontic treatment

“…However, when this severe complication occurs, an accurate and timely mannered diagnosis is important for enabling efficient management, and for improving the prospects for recovery (Grotz et al, 1998;Rosen, 2014;Garisto et al, 2010;Yatsuhashi et al, 2003;Gallas-Torreira et al, 2003;Pogrel, 2007;Givol et al, 2010;Givol et al, 2002;Chaushu et al, 2002;Scolozzi et al, 2004;Seddon et al, 1943).…”

“…If a nerve injury is suspected, a timely mannered management approach is advised in order to define the exact sensory disturbance; quantify the sensory disturbance; determine management needs; and monitor recovery (Grotz et al, 1998;Rosen, 2014;Yatsuhashi et al, 2003;Pogrel, 2007;Juodzbalys et al, 2011;Seddon, 1942;Scolozzi et al, 2004;Seddon et al, 1943).…”

“…However, the fundamental marker of a sensory malfunction is the patient's own subjective complaints (Yatsuhashi et al, 2003;Pogrel, 2007;Juodzbalys et al, 2011;Bennett et al, 1987;Bennett & Jannetta, 1980). Presently, there is no agreement as to the ideal techniques to assess nerve injury following endodontic treatment.…”

“…Practically all endodontic procedures, such as local anesthesia administration (Garisto et al, 2010), root canal preparation and irrigation (Guivarc'h et al, 2017), root canal filling (Rosen et al, 2016), and surgical endodontic treatments (Kim & Kratchman, 2006;Moiseiwitsch, 1995;Alves et al, 2014), that are performed in the vicinity of trigeminal nerve branches may trigger nerve injury (Rosen et al, 2016;Yatsuhashi et al, 2003). Many non-endodonticrelated entities such as infectious diseases, trauma, tumors, or idiopathic diseases have also been suggested as possible origins of altered sensation of trigeminal nerve branches (Divya et al, 2010), and should be regarded as a differential diagnosis for endodontic treatment related nerve injury (Rosen, 2014;Gallas-Torreira et al, 2003;Givol et al, 2011;Pogrel, 2007;Tilotta-Yasukawa et al, 2006).…”

Estimation of inferior alveolar nerve proximitytothe root api-ces : A CBVI analysis

“…Various procedures in endodontics may lead to inferior alveolar nerve injury, a rare but serious treatment complication (Grötz 1998, Escoda-Francoli 2007) [5], [6]. It can result from the pressure phenomenon within the nerve canal (root canal medicaments), mechanical trauma (overzealous instrumentation), extru-sion of chemical agents (over filling by root canal obturation materials) and periapical surgery (Yatsuhashi T et al2003) [7]. Hence it is important to know the exact location of the inferior alveolar nerve with respect to the surrounding structures to avoid any potential injury to the nerve.…”