• Restorative Dentistry and Endodontics
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• v.25 no.2
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• pp.225-234
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• 2000

The purpose of this study was to investigate the distribution and fluorescene intensity of vasoactive intestinal polypeptide(VIP) immunoreactive cells in rat trigeminal ganglion after inferior alveolar nerve axotomy. The animals were divided into normal and two experimental groups. The experimental animals were sacrificed at 14th and 28th day after inferior alveolar nerve axotomy. The trigeminal ganglion was removed and immersed in the 4% paraformaldehyde-0.2% picric acid in 0.1M phosphate buffer. Serial frozon sections about $16{\mu}m$ in thickness were cut with a cryostat. The immunofluorescence staining was performed. The rabbit anti-VIP(1 : 8,000) was used as primary antibody and fluorescene isothiocynate(FITC)-conjugated anti-rabbit IgG(1 : 80) as secondary antibody. The slides were observed under confocal laser scanning microscope. Three-dimensional images were constructed from 9 serial images(each $1{\mu}m$ in thickness) made by automatic optical sectioning. Unprocessed optical sections were obtained and stored on a optical disk. Color picture were printed by a video copy processor. The results were as follows; 1. The appearance of VIP immunoreactive cells in the mandibular part of trigeminal ganglion was 8.79${\pm}$1.99% in normal group and 39.16${\pm}$5.62% in 14 days, 16.25${\pm}$2.39% in 28 days after inferior alveolar nerve axotomy groups. 2. The relative fluorescence intensity of VIP immunoreactive cell bodies in the mandibular part of trigeminal ganglion was 134.40${\pm}$10.39 in normal group and 192.88${\pm}$14.06 in 14 days, 143.10${\pm}$5.02 in 28 days after nerve axotomy groups. Therefore, the relative fluorescence intensity of 14 days after nerve axotomy group was 43.3% higher than intensity of normal group. 3. In optical single section analysis of VIP immunoreactive cell bodies, white cell bodies(moderate fluorescence intensity) were the most abundant in normal and 28 days after nerve axotomy groups. Whereas, in 14 days after nerve axotomy group, red cell bodies(high fluorescence intensity) were the most abundant. 4. In optical serial section analysis of VIP immunoreactive cell bodies, red cell bodies(high fluorescence intensity) were observed in a part of the 9 sections of normal and 24 days after nerve axotomy groups. Whereas, red cell bodies were observed in all of the 9 sections of 14 days after nerve axotomy group. 5. The results indicates that number and fluorescence intensity of VIP immunoreactive cells were increased in the mandibular part of trigeminal ganglion following inferior alveolar nerve axotomy.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.5
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• pp.341-350
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• 2024

Background: Achieving successful pain control and adequate anesthesia through an inferior alveolar nerve block for endodontic treatment in cases with symptomatic irreversible pulpitis (SIP) is difficult, especially in mandibular molars. This study was designed to compare the effect of oral medication with ibuprofen and soft laser therapy on inferior alveolar nerve block during endodontic treatment. Methods: The trial comprised 180 patients (45 each group) with SIP. Four groups of patients were created: group 1 received 400 mg of ibuprofen; group 2 received soft laser irradiation; group 3 received a combination of soft laser and ibuprofen 400 mg; and group 4 received a placebo 1 h prior to local anesthesia. Patients recorded their pain scores on the Heft-Parker visual analog scale (VAS) before the start of intervention, 15 min after anesthesia, during access cavity preparation, and ultimately during root canal instrumentation. Each patient also rated their level of discomfort on a VAS. Every stage with no or minimal discomfort was deemed successful. The chi-square, Kruskal-Wallis, and one-way analysis of variance tests were used to evaluate the data. Results: The best success rate was achieved for soft laser ibuprofen combination, ibuprofen and soft laser groups reported similar success results, and control group recorded the least pain scores. The mean pain scores were lowest for group 3 and highest for group 4 (P < 0.001). Ibuprofen and soft laser combination was significantly better than control group (P < 0.001). There was no significant difference between ibuprofen and laser groups (P = 0.24). Conclusions: For teeth with irreversible pulpitis, preoperative ibuprofen treatment combined with soft laser irradiation greatly improved the success rates of inferior alveolar nerve block anesthesia.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.6
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• pp.347-353
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• 2023

This case report presents inferior alveolar nerve (IAN) repositioning as a viable approach for implant placement in the mandibular molar region, where challenges of severe alveolar bone width and height deficiencies can exist. Two patients requiring implant placement in the right mandibular molar region underwent nerve transposition and lateralization. In both cases, inadequate alveolar bone height above the IAN precluded the use of short implants. The first patient exhibited an overall low alveolar ridge from the anterior to posterior regions, with a complex relationship with adjacent implant bone level and the mental nerve, complicating vertical augmentation. In the second case, although vertical bone resorption was not severe, the high positioning of the IAN within the alveolar bone due to orthognathic surgery raised concerns regarding adequate height of the implant prosthesis. Therefore, instead of onlay bone grafting, nerve transposition and lateralization were employed for implant placement. In both cases, the follow-up results demonstrated successful osseointegration of all implants and complete recovery of postoperative numbness in the lower lip and mentum area. IAN repositioning is a valuable surgical technique that allows implant placement in severely compromised posterior mandibular regions, promoting patient comfort and successful implant placement without permanent IAN damage.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.1
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• pp.39-43
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• 2012

One of the most common procedures in dentistry is the inferior alveolar nerve block anesthesia but visual problem can occur during this procedure. Transient visual acuity decrease after inferior alveolar nerve block anesthesia can result from unintended intravascular injection. In this case report, we present ocular complication that has rarely been reported. The understanding of anatomy related to this case is discussed with suggestions for proper management of the patients. The dental management for ocular complications includes a correct diagnosis, management by understanding of patient's anatomic variations. This will prevent intravascular injection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.3
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• pp.158-166
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• 2019

Objectives: Inferior alveolar nerve block (IANB) is the most frequently used treatment for mandibular molars. Successful IANB requires insertion of the dental needle near the mandibular foramen. In this study, we aimed to analyze the anatomic location of the mandibular lingula and evaluate the effects of internal oblique ridge (IOR)-guided IANB. Materials and Methods: The location of the mandibular lingula was measured using cone-beam computed tomography images of the mandibles obtained from 125 patients. We measured the distances from the occlusal plane to the lingula and from the IOR to the lingula in 250 mandibular rami. Based on the mean of these distances, alternative anesthesia was carried out on 300 patients, and the success rate of the technique was evaluated. Results: The mean vertical distance was $8.85{\pm}2.59mm$, and the mean horizontal distance was $14.68{\pm}1.44mm$. The vertical (P<0.001) and the horizontal (P<0.05) distances showed significant differences between the sex groups. The success rate of the IOR-guided technique was 97.3%. Conclusion: IANB-based location of mandibular lingula showed a high success rate. From this study, we concluded that analysis of the anatomic locations for mandibular lingula and IOR-guided IANB are useful for restorative and surgical dental procedures of the mandibular molars.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.3
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• pp.266-269
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• 1999

This article discusses the vascular change of dorsal surface of tongue following inferior alveolar nerve block of 2% lidocaine HCl with 1:100,000 epinephrine. Twenty-two rats were randomly allocated to three groups: control group; without mandibular nerve block, experimental group 1; 2% lidocaine HCl, experimental group 2; 2% lidocaine HCl plus 1:100,000 epinephrine. The assessments were performed at 1-, 5-, 30-, 60-, 120-minute after inferior alveolar nerve block. Vessel diameters using the micrometer were measured and compared. Results showed that the increase in vascular constriction in group 3 was greater than those in groups 1 and 2. In conclusion, local anesthesia combined with epinephrine assures safer anesthesia for hemostasis.

• The Journal of the Korean dental association
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• v.54 no.11
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• pp.874-879
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• 2016

Damage to the inferior alveolar nerve(IAN) is a relatively infrequent complication in endodontic treatment. However, endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve resulting in sensory disturbances such as pain, dysesthesia, paresthesia or anesthesia. Two mechanism(chemical neurotoxicity and mechanical compression) are responsible for the IAN injury. When absorbent materials overfilled, it can be treated as a non-surgical procedure. But early surgical intervention required when mechanical, chemical nerve damage expected. We report surgical removal of overfilled gutta-percha and IAN decompression through sagittal split osteotomy in case of dysesthesia after overfilling of endodontic material into the mandibular canal. Dysesthesia recovered 3 months after surgical treatment.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.225-229
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• 2017

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.3
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• pp.250-257
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• 2001

Sensory dysfunction following the injury of the inferior alveolar nerve requires objective examination to get a reproducible data and to provide necessary treatment. This study was designed to evaluate if the SEP(somatosensory evoked potentials) of the mental nerve can be used as an objective method for the diagnosis of nerve injury and sensory disturbances. The subjects were nineteen patients ($37.4{\pm}11.3$ years old) who had been suffered from sensory disturbance of the unilateral lower lip and mental region for over 6 months after the inferior alveolar nerve injuries confirmed by the microsurgical explorations. The clinical neurosensory tests as SLTD(static light touch discrimination), MDD(moving direction discrimination), 2PD(two point discrimination), PPN(pin prick nociception) and accompanied pain were preceded to electro-physiologic examinations as SEP. The score of sensory dysfunction (sum score of all sensory tests) ranged from 0 to 8 were compared to the latency differences of the mental nerve SEPs. The correlation between clinical sensory scores and SEPs were tested by Spearman nonparametric rank correlation analysis, the differences in SEP latency by Kruskal-Wallis test and the latency differences according to PPN and accompanied pain by Mann-Whitney U test. This study resulted that the difference of the latencies between normal side and affected side was $2.22{\pm}2.46$ msec and correlated significantly with the neurosensory dysfunction scores (p=0.0001). Conclusively, the somatosensory evoked potentials of the mental nerve can be a useful diagnostic method to evaluate the inferior alveolar nerve injuries and the change of sensory dysfunction to be reproduced as an objective assessment.

• Imaging Science in Dentistry
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• v.49 no.2
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• pp.79-86
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• 2019

Purpose: This study reviewed the common conditions associated with displacement of inferior alveolar nerve canal. Materials and Methods: General search engines and specialized databases including Google Scholar, Pub Med, Pub Med Central, Science Direct, and Scopus were used to find relevant studies by using keywords such as "mandibular canal", "alveolar canal", "inferior alveolar nerve canal", "inferior dental canal", "inferior mandibular canal" and "displacement". Results: About 120 articles were found, of which approximately 70 were broadly relevant to the topic. We ultimately included 37 articles that were closely related to the topic of interest. When the data were compiled, the following 8 lesions were found to have a relationship with displacement of mandibular canal: radicular/residual cysts, dentigerous cyst, odontogenic keratocyst, aneurysmal bone cyst, ameloblastoma, central giant cell granuloma, fibrous dysplasis, and cementossifying fibroma. Conclusion: When clinicians encounter a lesion associated with displaced mandibular canal, they should first consider these entities in the differential diagnosis. This review would help dentists make more accurate diagnoses and develop better treatment plans according to patients' radiographs.