Treatment of injuries to the inferior alveolar nerve after endodontic procedures

Overextension of filling material into the mandibular canal after root treatment in the lower jaw is a rare but serious complication. Mechanical compression, chemical neurotoxicity and local infection may cause irreversible nerve damage. A report on 11 patients with neurological complaints of the inferior alveolar nerve after endodontic treatment is summarised. The neurological findings are dominated by hypaesthesia and dysaesthesia. Half of the patients reported pain. Hyperaesthesia is found much more rarely. Nearly all the patients had a combination of one or more symptoms. Initial X-rays showed root filling material in the area of the mandibular canal. Nine cases were treated with apicectomy and decompression of the nerve; in two cases, extraction of the tooth was necessary. Only one patient reported persistent pain after surgery. If neurological complaints appear after root filling in the lower jaw, a nerve injury due to root filling material should be ruled out. In cases of overfilling, immediate apicectomy and decompression of the nerve with conservation of the tooth is often the treatment of choice; the tooth may be preserved and the best chance of avoiding permanent nerve damage is provided.