Mahmood Hanya, Stern Melanie, Atkins Simon
Department of Oral Surgery, School of Clinical Dentistry, Sheffield, UK.
Department of Orthodontics, School of Clinical Dentistry, Sheffield, UK.
J Orthod. 2019 Dec;46(4):374-377. doi: 10.1177/1465312519879703. Epub 2019 Oct 9.
Inferior alveolar nerve (IAN) damage is a rare but recognised complication of dental procedures including third molar surgery, implant surgery, endodontic treatment and local anaesthetic injections. However, it is rarely caused by orthodontic tooth movement. This report highlights a case of temporary IAN anaesthesia to the right mental region, which was likely to have occurred secondary to the orthodontic uprighting of a lingually tilted molar using a high strength arch wire. Immediate deactivation of the appliance and an acute reducing dose of systemic steroids resulted in complete resolution of symptoms. To the best of the author's knowledge, there have been seven previously described cases of IAN paraesthesia but no cases reporting IAN anaesthesia secondary to orthodontic fixed-appliance treatment. This case highlights the importance of dentists practising orthodontics to have an awareness of the clinical and radiographic signs that may indicate a high-risk case requiring appropriate referral for cone beam imaging and careful orthodontic planning. Furthermore, this case emphasises the need to warn high-risk patients of the symptoms of this rare complication and how it may be managed. This will ultimately help to minimise the risk of litigation and optimise patient experience and care.
下牙槽神经(IAN)损伤是一种罕见但已被认识到的牙科手术并发症,包括第三磨牙手术、种植手术、牙髓治疗和局部麻醉注射。然而,它很少由正畸牙齿移动引起。本报告重点介绍了一例右侧颏部区域IAN暂时麻醉的病例,这可能是由于使用高强度弓丝对舌倾磨牙进行正畸直立继发所致。立即停用矫治器并急性减少全身类固醇剂量后症状完全缓解。据作者所知,此前已有7例IAN感觉异常的病例报道,但尚无正畸固定矫治器治疗继发IAN麻醉的病例。该病例突出了正畸牙医了解可能表明需要适当转诊进行锥形束成像和仔细正畸规划的高风险病例的临床和影像学体征的重要性。此外,该病例强调需要向高风险患者警告这种罕见并发症的症状以及如何处理。这最终将有助于将诉讼风险降至最低,并优化患者体验和护理。