inferior alveolar nerve (IAN),

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  • #12330
    Anonymous
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    An inherent risk of mandibular third molar odontectomy
    is damage to the inferior alveolar nerve (IAN), which
    generally lies in a position buccal and inferior to the
    tooth roots. The major risk factors associated with IAN
    injury during extraction of mandibular third molars
    include advanced patient age, depth of impaction, tooth
    angulation, need for tooth sectioning and bone removal,
    surgeon experience, and radiographic predictors. Owing
    to variations in degree and depth of the impacted tooth
    and its relationship to the inferior alveolar canal (IAC),
    some patients may have an increased risk of damage
    to the adjacent IAN. Although several studies have
    assessed the radiographic predictors of potential nerve
    injury,no study has attempted to correlate impaction
    type with tooth proximity to the IAC based on
    panoramic findings. Several studies have indicated that
    of radiographic findings may indicate the proximity of
    the IAN to the tooth root, including root darkening, root
    deflection, root narrowing, the presence of a bifid root
    apex, interruption of the white line(s) of the IAC,
    diversion of the IAC, and narrowing of the IAC. Rood
    and Shebab and others have suggested that 3 of the
    7 signs were more significantly associated with IAN
    injury: root darkening, interruption of the white line(s)
    of the IAC, and diversion of the IAC.

    #17566
    sushantpatel_doc
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    #17567
    drmittal
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    Background. Endodontic treatment of mandibular molar teeth has the potential to damage the inferior alveolar nerve via direct trauma, pressure or neurotoxicity.

    Methods. The author reviewed all cases of involvement of the inferior alveolar nerve resulting from root canal therapy in patients seen in a tertiary referral center during an eight-year period (1998 through 2005). The author had encouraged practitioners to refer patients immediately to a university clinic.

    Results. The author saw 61 patients during the eight-year period. Eight patients were asymptomatic and received no treatment. Forty-two patients exhibited only mild symptoms or were seen more than three months after undergoing root canal therapy, and they received no surgical treatment. Only 10 percent of these patients experienced any resolution of symptoms. Eleven patients underwent surgical exploration. Five of these patients underwent exploration and received treatment within 48 hours, and all recovered completely. The remaining six patients underwent surgical exploration and received treatment between 10 days and three months after receiving endodontic therapy. Of these patients, four experienced partial recovery and two experienced no recovery at all.

    Conclusions. Early surgical exploration and débridement may reverse the side effects of endodontic treatment on the inferior alveolar nerve.

    Clinical Implications. If the radiograph obtained after endodontic therapy shows sealant in the inferior alveolar canal, then immediate referral to an oral and maxillofacial surgeon is indicated if the patient has continued symptoms of paresthesia or pain once the local anesthetic should have worn off. Immediate surgical exploration and débridement may provide satisfactory results.

    #17568
    drmittal
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    Registered On: 06/11/2011
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