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Aims Periapical lesions have been implicated in mandibular trigeminal sensory neuropathy. This study aimed to report on a case series of consecutive patients presenting with mandibular division trigeminal nerve injuries (TNI) caused by periapical lesions. Common presenting characteristics and possible strategies for management were also investigated.Materials and methods A retrospective study of 22 patients with TNI caused by periapical lesions. Data were extracted from patient records and analysed using Microsoft Excel and SPSS. Factors associated with TNI resolution were assessed using Student's t-Tests and one-way Analysis of Variance (ANOVA), where P <0.05 indicated statistical significance.Results Twenty-one patients had inferior alveolar nerve injuries (IANI) and one had a lingual nerve injury (LNI). The most commonly affected teeth were the first molars (11 patients; 50%). TNI symptoms included numbness, pain and/or paraesthesia. IANI resolved completely among five patients within a mean time of 4.7 months (range 1.5-12 months). Patients who showed complete resolution had the affected teeth extracted or primary endodontic treatment with antibiotics.Conclusions Patients with TNI caused by periapical lesions can suffer significantly from combined numbness, pain and paraesthesia. Resolution of these injuries may be maximised upon early diagnosis and treatment of the periapical lesion by tooth extraction or primary endodontic treatment.

This article reports a brief overview of the risks associated with lower third molar extractions, and the claims that coronectomy may be useful as a treatment modality in managing some aspects of those risks. It discusses the position in terms of consent, and reports that some cases suggest that clinicians who do not offer coronectomy in appropriate circumstances may be vulnerable to litigation.

Aim: The risk factors associated with inferior alveolar nerve damage during third molar surgery were investigated., Material and Methods: Surgeries performed during a period of 50 months by a single expert surgeon were reviewed. Only those surgeries that met the selected inclusion criteria were considered for this study. The following tests were applied for the statistical analysis: the Kolmogorov-Smirnov test, the principal components analysis, the Mann-Whitney U test, the two-tailed exact Fisher test and the Bonferroni sequential correction., Results: The surgical difficulty index, multi-rooted third molars and changes in the inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage., Conclusions: Computed tomography is mandatory when the nerve is superimposed on the tooth root on the ortopantomography. SCIENTIFIC RATIONALE FOR STUDY: Lower third molar extraction is one of the most common procedures in oral and maxillofacial surgery, and it is burdened by the risk of inferior alveolar nerve damage. Understanding which factors are able to predict this complication is therefore essential in correctly programming surgery., Principal Findings: Surgical difficulty index, multi-rooted third molars and changes in inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage., Practical Implications: If, on the orthopantomography, the nerve is superimposed on the tooth root, a computed tomography is mandatory to define all of these variables.

Many post-operative complications can be avoided with good patient selection, training and surgical planning. Obtaining explicit patient consent is also an essential component of treatment. The most significant complications from oral surgical interventions are iatrogenic trigeminal nerve injuries, which can result in permanent altered sensation and pain, causing considerable functional and psychological disability. This paper provides some useful suggestions on minimising the risks of these injuries. By understanding the risk factors and modifying the resulting intervention, more of these injuries may be prevented.

Background: The incidence of implant-related inferior alveolar nerve injuries (IANI) is steadily increasing within the UK population., Aims: This study prospectively reviewed thirty cases (35% male; 65% female) of implant-related IANI seen in a specialist nerve injury clinic.Methods Neurosensory examinations were carried out to ascertain a quantifiable rating of the perception, pain profiling and functional difficulties. Data were analysed using SPSS software., Results: Patients were aware of signing consent forms for the surgery in 11 cases and 8 of those felt they were not explicitly warned about nerve injury. Over 70% of patients were referred after six months post injury. Implant surgery planning involved intra-oral films only (30%), CBCT (10%), dental pantomograph (50%) and long cone peri-apical radiographs (48%). However, no radiographic evidence pre- or postoperatively was provided by the referring practitioner in 15% of cases. Intra-operative problems included bleeding and neurological symptoms. Proximity of the implant bed or implant to the inferior alveolar canal was evident radiographically. This showed contact with roof inferior alveolar nerve canal in 44% of cases, protrusion into the canal in 20% of cases, crossing of the canal in 20% cases and distance in one case, presumed to be due to local anaesthetic injury. All patients presented with a demonstrable neuropathy, which included neuropathic pain (50%) that interfered with speaking, kissing and socialising., Conclusions: Consent, preoperative planning and appropriate referral were inadequate in provision of mandibular implants in this patient group. Recommendations have been proposed to improve practice and possible novel strategies are suggested for the prevention and improved management of these complications.