Journal of Dental Rehabilitation and Applied Science (구강회복응용과학지)

Korean Academy of Stomatognathic Function and Occlusion (대한턱관절교합학회)
권호 표지

Analysis of Patients with Mandibular Nerve Damage after Root Canal Therapy

근관치료 후 발생한 하악신경 손상 환자에 대한 분석

  • Lee, Ji-Soo (Department of Orofacial pain and Oral medicine, College of Dentistry, Yonsei University) ;
  • Song, Ji-Hee (Department of Orofacial pain and Oral medicine, College of Dentistry, Yonsei University) ;
  • Kim, Young-Gun (Department of Orofacial pain and Oral medicine, College of Dentistry, Yonsei University) ;
  • Kim, Seong-Taek (Department of Orofacial pain and Oral medicine, College of Dentistry, Yonsei University)
  • 이지수 (연세대학교 치과대학 구강내과학교실) ;
  • 송지희 (연세대학교 치과대학 구강내과학교실) ;
  • 김영건 (연세대학교 치과대학 구강내과학교실) ;
  • 김성택 (연세대학교 치과대학 구강내과학교실)
  • Received : 2011.07.16
  • Accepted : 2011.09.25
  • Published : 2011.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Reported causes of mandibular nerve injury in relation to neuropathic pain in dentistry include extraction, dental implant surgery, oral and maxillofacial surgery, periodontal treatment, and root-canal therapy. This study analyzed the characteristics of pharmacologic management of neuropathy after root-canal therapy. 32 patients who complain of abnormal sensation or pain after root-canal therapy and were referred to Department of Oral Medicine and the Temporomandibular Joint and Orofacial Pain Clinic at the Dental Hospital of Yonsei University, Seoul, Korea from 2004 to 2011 enrolled in this analysis and improvement of symptom was evaluated after pharmacologic management. Thirty-two patients who had hypoesthesia or dysesthesia at the initial visit were analyzed(9 men, 23 women; mean age: 44 years). The causes of neuropathy were local anesthesia(46.9%), chemical trauma from the sealant in root-canal(25%), endodontic surgery(15.6%), and unknown causes(12.5%). Medications such as steroids, anticonvulsants, antidepressants, and analgesics were took for improvement of symptoms and titrated for a variety of period from 1 week to 11 months. It was found that neuropathy of the inferior alveolar nerve and the lingual nerve was in 25 and 7 patients. The improvement of neurosensory disturbance and no improvement after pharmacotherapy was in 21(66%) and 11(34%) patients respectively. The hypoesthesia and dysesthesia was improved 67% and 65% respectively. These results suggest that symptomatic improvement by pharmacologic management can be possible in patients with neuropathy after root-canal therapy. But improvement of symptoms was influenced by the causes and degree of nerve injury, the periods of pharmacotherapy, and the choice of treatment methods. So, further investigation is needed by quantitative measurement of more variables in more individuals.

치과에서 임상적으로 신경병성 통증이 발생하는 경우는 주로 하악신경이 손상 받은 경우이며 그 원인으로는 발치, 인공치아매식, 악안면 수술, 치주치료 및 근관치료 등이 있다. 본 연구는 근관치료 후 발생한 하악신경 손상 환자의 신경병증의 원인과 증상에 따라 약물치료를 통해 개선된 정도를 분석해 보고자 하였다. 근관치료 후 발생한 이상감각 또는 통증을 주 증상으로 2004년부터 2011년까지 연세대학교 치과대학병원 구강내과에 내원한 환자 중 32명의 의료기록을 분석하였고, 약물치료를 시행한 경우 환자의 증상이 개선된 정도를 평가하였다. 초진시 감각저하 또는 감각부전의 증상을 호소한 총 32명의 환자 (남자 9명, 여자 23명, 평균나이 44세)를 분석하였다. 신경병증의 발생 원인은 근관치료 시 마취 (46.9%), 근관 내 적용한 약재에 의한 화학적 손상 (25%), 근관수술 (15.6%), 기타 원인이 불분명한 경우 (12.5%) 순으로 많았다. 처방된 약물은 스테로이드, 항경련제, 항우울제, 진통제 등이었고, 환자의 증상이 개선될 때까지 약물 용량은 조절되었으며, 약물 복용 기간은 1주일에서 11개월까지 다양하였다. 증상이 나타난 부위에 따라 하치조신경 손상으로 인한 증상을 나타내는 환자가 25명, 설신경 손상으로 인한 증상을 나타내는 환자가 7명이었으며, 약물치료 후 증상이 개선된 경우가 21명 (66%), 증상 개선이 미미하거나 없는 경우가 11명 (34%)이었다. 그 증상은 감각저하와 감각부전으로 분류하였고, 감각저하는 67%, 감각부전은 65% 개선을 보였다. 근관치료와 연관된 하악신경 손상으로 인해 신경병증이 발생된 경우 약물치료를 통한 증상 개선을 도모해 볼 수 있다. 다만, 신경병증의 종류와 회복 수준은 신경 손상의 원인, 정도와 손상 발생 후 치료 시기, 처치 방법 등에 의해 영향을 받으며, 각각의 변수에 따라 통증 강도나 회복 정도에 차이가 있을 것으로 예상되므로 향후 더 많은 개체 수에서 다양한 변수에 대한 정량적인 연구가 필요할 것으로 생각된다.

Keywords

References

  1. Baron, R., Peripheral neuropathic pain: from mechanisms to symptoms. The Clinical journal of pain, 2000. 16(2 Suppl): p. S12-20. https://doi.org/10.1097/00002508-200006001-00004
  2. Woolf, C.J. and R.J. Mannion, Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet, 1999. 353(9168): p. 1959-64. https://doi.org/10.1016/S0140-6736(99)01307-0
  3. Hillerup, S., Iatrogenic injury to the inferior alveolar nerve: etiology, signs and symptoms, and observations on recovery. International journal of oral and maxillofacial surgery, 2008. 37(8): p. 704-9. https://doi.org/10.1016/j.ijom.2008.04.002
  4. Sandstedt, P. and S. Sorensen, Neurosensory disturbances of the trigeminal nerve: a long-term follow-up of traumatic injuries. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 1995. 53(5): p. 498-505. https://doi.org/10.1016/0278-2391(95)90055-1
  5. Choi, Y., et al., Analysis of neurosensory dysfunction after dental implant surgery. Korean Journal of Oral Medicine, 2009. 34(4): p. 379-385.
  6. Lynch, M.E. and A.K. Elgeneidy, The role of sympathetic activity in neuropathic orofacial pain. Journal of orofacial pain, 1996. 10(4): p. 297-305.
  7. Marbach, J.J., et al., Incidence of phantom tooth pain: an atypical facial neuralgia. Oral surgery, oral medicine, and oral pathology, 1982. 53(2): p. 190-3. https://doi.org/10.1016/0030-4220(82)90285-7
  8. Campbell, R.L., K.W. Parks, and R.N. Dodds, Chronic facial pain associated with endodontic therapy. Oral surgery, oral medicine, and oral pathology, 1990. 69(3): p. 287-90. https://doi.org/10.1016/0030-4220(90)90288-4
  9. Polycarpou, N., et al., Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. International endodontic journal, 2005. 38(3): p. 169-78. https://doi.org/10.1111/j.1365-2591.2004.00923.x
  10. Pogrel, M.A., Damage to the inferior alveolar nerve as the result of root canal therapy. Journal of the American Dental Association, 2007. 138(1): p. 65-9. https://doi.org/10.14219/jada.archive.2007.0022
  11. Meyer, R.A. and S.L. Ruggiero, Guidelines for diagnosis and treatment of peripheral trigeminal nerve injuries. Oral and maxillofacial surgery clinics of North America, 2001. 13(2): p. 383-392.
  12. Ryu, J. and J. Kwon, Dysesthesia after Tooth Extraction and Implant Surgery Reported by Dentists Korean Journal of Oral Medicine, 2007. 32(3): p. 263-272.
  13. Vickers, E.R. and M.J. Cousins, Neuropathic orofacial pain part 1--prevalence and pathophysiology. Australian endodontic journal : the journal of the Australian Society of Endodontology Inc, 2000. 26(1): p. 19-26. https://doi.org/10.1111/j.1747-4477.2000.tb00146.x
  14. Battrum, D.E. and J.L. Gutmann, Phantom tooth pain: a diagnosis of exclusion. International endodontic journal, 1996. 29(3): p. 190-4. https://doi.org/10.1111/j.1365-2591.1996.tb01368.x
  15. Lilly, J.P. and A.S. Law, Atypical odontalgia misdiagnosed as odontogenic pain: a case report and discussion of treatment. Journal of endodontics, 1997. 23(5): p. 337-9. https://doi.org/10.1016/S0099-2399(97)80419-0
  16. Matwychuk, M.J., Diagnostic challenges of neuropathic tooth pain. Journal, 2004. 70(8): p. 542-6.
  17. Giuliani, M., et al., Inferior alveolar nerve paresthesia caused by endodontic pathosis: a case report and review of the literature. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 2001. 92(6): p. 670-4. https://doi.org/10.1067/moe.2001.117269
  18. Morse, D.R., Endodontic-related inferior alveolar nerve and mental foramen paresthesia. Compendium of continuing education in dentistry, 1997. 18(10): p. 963-8, 970-3, 976-8 passim; quiz 98.
  19. Knowles, K.I., M.A. Jergenson, and J.H. Howard, Paresthesia associated with endodontic treatment of mandibular premolars. Journal of endodontics, 2003. 29(11): p. 768-70. https://doi.org/10.1097/00004770-200311000-00019
  20. Conrad, S.M., Neurosensory disturbances as a result of chemical injury to the inferior alveolar nerve. Oral and maxillofacial surgery clinics of North America, 2001. 13(2): p. 255-263.
  21. Nitzan, D.W., A. Stabholz, and B. Azaz, Concepts of accidental overfilling and overinstrumentation in the mandibular canal during root canal treatment. Journal of endodontics, 1983. 9(2): p. 81-5. https://doi.org/10.1016/S0099-2399(83)80081-8
  22. Fanibunda, K., J. Whitworth, and J. Steele, The management of thermomechanically compacted gutta percha extrusion in the inferior dental canal. British dental journal, 1998. 184(7): p. 330-2. https://doi.org/10.1038/sj.bdj.4809618
  23. Krafft, T.C. and R. Hickel, Clinical investigation into the incidence of direct damage to the lingual nerve caused by local anaesthesia. Journal of cranio-maxillo -facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 1994. 22(5): p. 294-6. https://doi.org/10.1016/S1010-5182(05)80079-4
  24. Pogrel, M.A., Trigeminal nerve chemical neurotrauma from injectable materials. Oral and maxillofacial surgery clinics of North America, 2001. 13(2): p. 247-253.
  25. Renton, T., et al., Trigeminal nerve injuries in relation to the local anaesthesia in mandibular injections. British dental journal, 2010. 209(9): p. E15. https://doi.org/10.1038/sj.bdj.2010.978
  26. Hosoya, N., et al., Effects of calcium hydroxide on physical and sealing properties of canal sealers. International endodontic journal, 2004. 37(3): p. 178-84. https://doi.org/10.1111/j.0143-2885.2004.00781.x
  27. Yatsuhashi, T., et al., Inferior alveolar nerve paresthesia relieved by microscopic endodontic treatment. The Bulletin of Tokyo Dental College, 2003. 44(4): p. 209-12. https://doi.org/10.2209/tdcpublication.44.209
  28. Kawakami, T., C. Nakamura, and S. Eda, Effects of the penetration of a root canal filling material into the mandibular canal. 2. Changes in the alveolar nerve tissue. Endodontics & dental traumatology, 1991. 7(1): p. 42-7. https://doi.org/10.1111/j.1600-9657.1991.tb00181.x
  29. Neaverth, E.J., Disabling complications following inadvertent overextension of a root canal filling material. Journal of endodontics, 1989. 15(3): p. 135-9. https://doi.org/10.1016/S0099-2399(89)80136-0
  30. Orstavik, D., Paraesthesia following endodontic treatment: survey of the literature and report of a case. International endodontic journal, 1983. 16(4): p. 167-172. https://doi.org/10.1111/j.1365-2591.1983.tb01320.x
  31. Gatot, A. and F. Tovi, Prednisone treatment for injury and compression of inferior alveolar nerve: report of a case of anesthesia following endodontic overfilling. Oral surgery, oral medicine, and oral pathology, 1986. 62(6): p. 704-6. https://doi.org/10.1016/0030-4220(86)90267-7
  32. Scarano, A., et al., Injury of the inferior alveolar nerve after overfilling of the root canal with endodontic cement: a case report. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 2007. 104(1): p. e56-9. https://doi.org/10.1016/j.tripleo.2007.01.036
  33. Gregg, J.M., Neuropathic complications of mandibular implant surgery: review and case presentations. Annals of the Royal Australasian College of Dental Surgeons, 2000. 15: p. 176-80.
  34. Park, J.H., S.H. Lee, and S.T. Kim, Pharmacologic management of trigeminal nerve injury pain after dental implant surgery. The International journal of prosthodontics, 2010. 23(4): p. 342-6.
  35. Lynch, M.E., Antidepressants as analgesics: a review of randomized controlled trials. Journal of psychiatry & neuroscience : JPN, 2001. 26(1): p. 30-6.
  36. Oshima, K., et al., Clinical investigation of patients who develop neuropathic tooth pain after endodontic procedures. Journal of endodontics, 2009. 35(7): p. 958-61. https://doi.org/10.1016/j.joen.2009.04.017
  37. Lewis, M.A., et al., Management of neuropathic orofacial pain. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 2007. 103 Suppl: p. S32 e1-24. https://doi.org/10.1016/j.tripleo.2006.06.057
  38. Smith, M.T., et al., Sleep quality and presleep arousal in chronic pain. Journal of behavioral medicine, 2000. 23(1): p. 1-13. https://doi.org/10.1023/A:1005444719169