Abstract
To the best of our knowledge there are no guidelines regarding the surgical management
of dental implant-related injuries to the mandibular nerve. This review aims to investigate
the success of different surgical interventions. Neurosensory injury to the mandibular
branch of the trigeminal nerve can occur during administration of local anaesthetic,
elevation of the flap, preparation for osteotomy, and placement of the implant. Surgical
interventions include extraction of the implant, external decompression, internal
neurolysis, excision of a neuroma, neurorrhaphy, nerve grafting, and low-level laser
therapy. The following electronic databases were searched: MEDLINE, EMBASE, and the
Cochrane Library. Primary outcome measures included patient-reported outcomes such
as pain and altered sensation. A total of 185 publications were obtained, of which
21 were included in the qualitative synthesis (2 randomised controlled trials (RCT),
9 controlled cohort studies, and 10 case reports/series). They were all screened in
consideration of the exclusion criteria and appraised using the Cochrane risk of bias
tool, the Newcastle Ottawa scale, and the modified Newcastle Ottawa scale. Results
were triangulated to evaluate their level of agreement. The extraction of dental implants
less than 36 hours after injury to the mandibular nerve results in the most successful resolution
of neurosensory dysfunction. Various microsurgical techniques have shown less success
in obtaining neurosensory recovery than extraction of the implant. However, microsurgery
is worthwhile, as it improves neurosensory dysfunction and reduces dysaesthesia in
the majority of patients. Direct suturing and external decompression can result in
good neurosensory recovery, and nerve grafts are also successful whenever tension-free
direct suturing is not possible. Low-level laser therapy has been shown to achieve
some neurosensory improvement.
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Article info
Publication history
Published online: May 11, 2020
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© 2020 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.
