ASSESSMENT OF NEUROSENSORY DISTURBANCES AND RECOVERY FOLLOWING SURGICAL REMOVAL OF IMPACTED MANDIBULAR THIRD MOLAR – A PROSPECTIVE STUDY

Aim: This prospective study aim to determine the incidence and pattern of recovery of IAN and LN decits after surgery while comparing which nerve, site, side, age group and type of impaction was most likely to suffer from neurosensory disturbances and to evaluate the risk factors such as duration of surgery, proximity to inferior alveolar canal, excessive hemorrhage, clinical observation of neurovascular bundle, contributing to these postoperative neurosensory decits. Materials&Methods: This study was conducted on 30 patients who underwent surgical removal of impacted mandibular third molar between 2017-2019 in the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere. Clinically, all the patients underwent objective evaluation by using pin prick test, two-point discrimination and blunt test. Sensory function was evaluated 1 week, 1, 3 and 6 months post-operatively. The areas that were evaluated are those supplied by IAN and LN. Result: The incidence of NSD in our study was 10%, the IAN 6.7% and LN decit 3.3%. No permanent NSD was observed in this study. Statistically signicant association was found between excessive hemorrhage from the socket and NSD (p=0.009). No signicant association was found between gender, age, side, type, difculty score and duration, observation of neurovascular bundle during surgery and proximity of roots to the inferior alveolar canal with NSD.

Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances

Background The purpose of this study was to analyze medium-to-long-term implant success and survival rates, and lower lip sensory disturbance after placement of dental implants with simultaneous inferior alveolar nerve (IAN) repositioning. Methods Fifteen patients (3 men, 12 women) treated in two centers were included in this retrospective study. The ages of the participants ranged from 19 to 68. A total of 48 dental implants were placed in 23 posterior mandibular segments simultaneously with IAN transposition or lateralization. The residual bone above the IAN ranged from 0.5 to 7.0 mm. Crestal bone changes were measured using cone beam computed tomography (CBCT) images. Disturbance of the IAN was evaluated subjectively using a modified questionnaire. Results The healing process was uneventful in fourteen patients. In one patient, spontaneous fracture of the operated mandible occurred on tenth day after the surgery. The implant in the fracture line was removed at the time of open reduction and fixation. One more implant was lost after 5 years of loading. Therefore, the overall dental implant survival rate was 95.8%, whereas all implants in function were judged as successful after a follow-up period of 1 to 10 years. Transient neurosensory disturbances (ND) were observed in all patients who underwent IAN lateralization and IAN transposition. At follow-up times of 3 years, 5 years, and 10 years, weak hypoesthesia remained in two subjects treated with IAN transposition. None of the patients developed neuropathic pain after the procedure. Conclusions Within the limitations of this study, we conclude that reconstruction of severely resorbed mandibles with dental implants in conjunction with IAN repositioning is an effective and reliable technique. Although neurosensory disturbances are the most common complication after surgery, they tend to resolve over time. Advanced surgical skills are required to perform this technique.