Research Article| Volume 58, ISSUE 7, P795-800, September 2020

Success of surgical interventions for direct dental implant-related injuries to the mandibular nerve: a review

  • L.M. Fee
    Address: 22 The Crescent, Clontarf, Dublin 3
    BA BDS, MSc in Dental Implants(Bristol University), Diploma in Pimary Care Oral Surgery, RCS(Eng), Diploma in Conscious Sedation (Newcastle University), Cert in Clinical Education (Edinburgh University)
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      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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