title: Surgical management of damaged inferior alveolar nerve caused by endodontic overfilling of calcium hydroxide paste.
abstract: OBJECTIVE
  To evaluate the neurosensory outcome of management of damaged inferior alveolar nerves caused by endodontic overfilling and to assess the efficacy of delayed surgical intervention.
  
  
  METHODS
  Nine patients who underwent surgical removal of extruded endodontic material were included. All patients were evaluated for neurosensory function using a set of standardized tests. The outcome of surgical intervention was evaluated through patient interview and quantitative statistical analysis.
  
  
  RESULTS
  Surgical procedures included foreign body removal, microsurgical external/internal decompression, excision of neuroma followed by nerve repair, and excision of damaged nerve segment with interpositional nerve graft. Seven of the nine patients had significant improvement according to the follow-up neurosensory assessment. Four patients reported significant improvement, three patients reported mild improvement and two patients reported no appreciable improvement in the Visual Analog Scale (VAS). Two patients who reported no appreciable improvement in VAS also did not achieve FSR. In these patients, calcium hydroxide was spread widely along the IAN and a surgical approach was obtained via sagittal spit osteotomy. The mean time to reach FSR was 222.7 (±41.8) days with a range of 106-397 days. In the early repair group who received surgery within 60 days, three out of five patients achieved FSR in a mean time of 198.0 (±76.2) days. The mean time to FSR in all four subjects who received surgical attention over 60 days after injury was 241.3 (±139.8) days with a range of 106-397 days. As all four cases in the late repair group with limited amount of nerve injury achieved FSR, only 3 of 5 early repair cases with wide-spread injury achieved a similar outcome.
  
  
  CONCLUSIONS
  The results of this case series confirmed the notion that surgical management of the inferior alveolar nerve is effective in the treatment of nerve injuries caused by endodontic extrusion of calcium hydroxide paste. Delayed surgical repair of the inferior alveolar nerve can be indicated and helpful for the neurosensory recovery of damaged IAN, however, the surgical management was less effective in case of widespread nerve injuries.
authors.affiliation: Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.|Department of Oral and Maxillofacial Surgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Kyonggi-do, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Byun
authors.affiliation: Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.
authors.forename: S-S
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Department of Occupation and Environment, Konkuk Postgraduate Medical School, Choong-Ju, Korea.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Chung
authors.affiliation: Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.
authors.forename: H-K
authors.initials: HK
authors.lastname: Lim
authors.affiliation: Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.
authors.forename: W-H
authors.initials: WH
authors.lastname: Hei
authors.affiliation: Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.
authors.forename: J-M
authors.initials: JM
authors.lastname: Woo
authors.affiliation: Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.|Oral Cancer Center & Clinical Trial Center, Seoul National University Dental Hospital, Seoul, Korea.
authors.forename: S-M
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea. leejongh@snu.ac.kr.|Dental Research Institute, Seoul National University, Seoul, Korea. leejongh@snu.ac.kr.
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D002126:Calcium Hydroxide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008340:Mandibular Nerve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology / Q000601:surgery; D011861:Radiography, Dental; D012387:Root Canal Filling Materials / Q000009:adverse effects*; D012389:Root Canal Obturation / Q000009:adverse effects*; D012684:Sensory Thresholds; D019553:Tooth, Nonvital / Q000473:pathology; D061221:Trigeminal Nerve Injuries / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D012387:Root Canal Filling Materials; D002126:Calcium Hydroxide
keywords: calcium hydroxide; decompression; endodontic complication; inferior alveolar nerve damage; nerve repair; sensory recovery