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Permanent nerve involvement has been reported following inferior alveolar nerve blocks. This study provides an update on cases reported to one unit in the preceding six years. Lidocaine was associated with 25 percent of cases, articaine with 33 percent of cases, and prilocaine with 34 percent of cases. It does appear that inferior alveolar nerve blocks can cause permanent nerve damage with any local anesthetic, but the incidences may vary.

The success rate of dental implants placed in female patients taking oral bisphosphonates, before the risks became known in 2003, were compared with a control group of females receiving implants and not taking bisphosphonates. The bisphosphonate group had an overall success rate of 86 percent versus a success rate of 95 percent in the control group. This suggests that the failure rate of implants placed in patients taking oral bisphosphonates may be higher unless suggested safeguards are taken.

Permanent nerve involvement following inferior alveolar nerve block may occur from 1 in 20,000 to 850,000 patients with little information on local anesthetic used. Patients with permanent nerve damage from blocks were recorded. Lidocaine was associated with 35 percent, with articaine causing approximately 30 percent of the cases. Nerve blocks can cause permanent damage to the nerves, independent of the local anesthetic used. Articaine is associated with this phenomenon in proportion to its usage.

The practice of dentistry is most often perceived as the treatment of the hard tissues of the oral region, specifically the teeth and jaws. However, there are many disorders and conditions involving surgical treatment of the soft tissues that extend to the adjacent and associated structures of the oral and maxillofacial surgery region.

In a review of 163 consecutive patients referred with trigeminal nerve (inferior alveolar or lingual nerve) involvement following dental treatment, the most common etiology was third-molar removal (87 patients). The second most common cause was an inferior alveolar nerve block injection (34 patients), with a smaller number of endodontic and periodontal complications. Female patients outnumbered male 3.3 to 1. Twenty-seven patients were offered surgical exploration and possible nerve repair surgery; of them, 14 underwent surgery. Forty percent of the patients admitted to being involved in litigation during the time they were undergoing treatment.

The mandible and maxilla suffer from a number of lesions that, though benign, have a high recurrence rate (10 percent to 80 percent) after simple enucleation. These include the ameloblastoma, keratocyst, odontogenic myxoma, central giant cell granuloma and ossifying fibroma. The appropriate treatment of these lesions is controversial, eliciting accusations of both undertreatment and overtreatment. Liquid nitrogen cryotherapy may be a valuable treatment modality to prevent recurrences of these lesions without causing cosmetic deformity.

Both the inferior alveolar and the lingual nerve are at risk for damage following various surgical procedures. Sensory nerve function following potential damage should be tested and evaluated for treatment, with microneurosurgery considered under certain conditions. Repair between three and six months following injury has the best results. A study of 43 patients who underwent microneurosurgery for various types of injuries, and have been followed for at least one year, found four (9.3 percent) with essentially complete return of sensation; five (11.6 percent) with good return; 19 (44.2 percent) with some return; 13 (30.2 percent) with no return; and two (4.6 percent) with a decrease in sensation.