Use of cone-beam computed tomography in the diagnosis of sensory nerve paresthesia secondary to orthodontic tooth movement: A clinical report

Inferior alveolar nerve damage secondary to orthodontic treatment: A systematic scoping review

BACKGROUND

Neurosensory impairment is a common complication following inferior alveolar nerve (IAN) damage.

OBJECTIVE

To document and report the various causes, diagnosis, and management of IAN damage secondary to orthodontic treatment.

METHODS

An electronic search for studies that reported IAN damage in patients undergoing orthodontic treatment was performed up to July 15, 2020 using MEDLINE, Embase, and PubMed databases. Descriptive analyses and linear regression model were performed.

RESULTS

A total of 15 case reports were identified including 16 patients with an overall mean age of 23.3. All the included studies reported temporary sensory alterations which manifested as anesthesia (19%, n = 3), paresthesia (75%, n = 12), or combined (6%, n = 1). The majority of cases managed by stopping the orthodontic force (75%, n = 12), followed by appliance adjustments (19%, n = 3), providing a bite plate (13%, n = 2), and/or providing pharmacological management (38%, n = 6). Full recovery median duration reported in all cases following the aforementioned managements was 17.5 days.

CONCLUSIONS

IAN damage secondary to orthodontic treatment is emerging in the literature in recent years. Identifying high risk patients with close proximity to the IAN canal is a must to formulate a proper treatment plan to avoid such complications.

Orthodontic-related nerve injuries: a review and case series

Trigeminal neuropathy secondary to orthodontic tooth movement is reported as a rare occurrence. Risk assessment is possible to prevent or immediately treat these injuries and clinicians should be aware of the risk factors. Increasingly, orthodontics is provided by non-specialists and orthodontic therapists. This paper presents cases and a review of orthodontic-related nerve injuries, where early diagnosis of orthodontic nerve injuries was misdiagnosed, preventing early or immediate treatment that would have likely optimised neural recovery and prevented permanent sensory neuropathic pain in these patients. We present two cases of trigeminal neuropathy following orthodontic tooth movement that highlight some key issues relating to improving pre-orthodontic risk assessment during treatment planning and early identification of developing neuropathy requiring urgent cessation/reversal of orthodontic treatment. The cases presented demonstrate the importance of thorough pre-orthodontic assessment before treatment planning. Traditionally, two-dimensional imaging such as panoramic and periapical radiographs have been the gold standard for predicting the relationship of the dentition to the mandibular canal. However, cone beam computed tomography imaging is now accepted as providing a more accurate image of the position of the teeth in relation to vital structures, such as neurovascular supply.

Inferior alveolar nerve anaesthesia: A rare complication of orthodontic tooth movement

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.

CBCT imaging - A boon to orthodontics

The application of innovative technologies in dentistry and orthodontics has been very interesting to observe. The development of cone-beam computed tomography (CBCT) as a preferred imaging procedure for comprehensive orthodontic treatment is of particular interest. The information obtained from CBCT imaging provides several substantial advantages. For example, CBCT imaging provides accurate measurements, improves localization of impacted teeth, provides visualization of airway abnormalities, it identifies and quantifies asymmetry, it can be used to assess periodontal structures, to identify endodontic problems, to plan placement sites for temporary skeletal anchorage devices, and to view condylar positions and temporomandibular joint (TMJ) bony structures according to the practitioner’s knowledge at the time of orthodontic diagnosis. Moreover, CBCT imaging involves only a minimal increase in radiation dose relative to combined diagnostic modern digital panoramic and cephalometric imaging. The aim of this article is to provide a comprehensive overview of CBCT imaging, including its technique, advantages, and applications in orthodontics.