J Dent Rehabil Appl Sci.  2024 Nov;40(4):305-312. 10.14368/jdras.2024.40.4.305.

Treatment of paresthesia induced by periapical lesions: a case report

• Jo HJ
• Ha JH

• KMID: 2562774
• DOI: http://doi.org/10.14368/jdras.2024.40.4.305

Abstract

Paresthesia, which may occur in the absence of stimulation or as a result of stimulation, are recognized as a characteristic symp-tom of neuropathic pain, but paresthesia that occur in the dental area are mainly caused by local causes. Depending on the time of occurrence, paresthesia caused by periapical lesions and root canal treatment requires removal of the cause or pharmacological treatment, and a surgical approach may be required if the symptoms persist for a long time. This case report presents the results of endodontic treatment of paresthesia associated with periapical lesions.

Keyword

paresthesia; pharmacology; root canal treatment

Figure

• 

  Fig. 1 Preoperative radiograph of right mandibular first molar showing large apical lesion (Case 1). (A) Preoperative radiograph. (B, C) Cone-beam Computed Tomography (CBCT) images. The lesions invaded the upper boundary of mandibular canal.

• 

  Fig. 2 Changes in paresthesia areas (Case 1). (A) On the first visit, (B) On the second visit, (C) On the third visit. There was a significant reduction in paresthesia areas and root canal treatment could be completed.

• 

  Fig. 3 Serial periapical radiographs of right mandibular first molar (Case 1). (A) Working length determination, (B) At 1 week follow-up, (C) 4-month follow up, (D) At 1-year follow-up. Periapical lesion is in healing status.

• 

  Fig. 4 Follow-up panoramic radiographs (Case 1). (A) Initial panoramic radiograph, (B) At 1-year follow-up panoramic radiograph. Periapical lesion is in healing status.

• 

  Fig. 5 Serial periapical radiographs of right mandibular first and second molars (Case 2). (A) Preoperative radiograph of left mandibular first, second molar, (B) After intentional replantation procedure of left mandibular second molar, (C) Working length determination of left mandibular first molar, (D) After canal filling and core restoration.

• 

  Fig. 6 Long term follow-up periapical radiograph (Case 2). (A) Radiograph at first visit, (B) 3-month follow up radiograph, (C) 1-year follow up radiograph. Complete healing of second molar lesions is observed. Delayed healing of the mandibular first molar lesion is being monitored regularly.

• 

  Fig. 7 Changes in paresthesia areas (Case 2). (A) Area of paresthesia on the first visit, (B) Area of paresthesia after left mandibular first molar root canal re-treatment; no significant paresthesia area reduction was shown, (C) Area of paresthesia right after intentional replantation procedure. After #36 root canal treatment, all the symptoms of paresthesia had disappeared, and no additional extraoral photographs were taken.

• 

  Fig. 8 Instrument for 2-point discrimination test method.

Reference

References

1. Merskey HE. 1986; Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 3:S1–226.

2. López‐López J, Estrugo‐Devesa A, Jané‐Salas E, Segura‐Egea JJ. 2012; Inferior alveolar nerve injury resulting from overextension of an endodontic sealer: non‐surgical management using the GABA analogue pregabalin. Int Endod J. 45:98–104. DOI: 10.1111/j.1365-2591.2011.01939.x. PMID: 21883296.

3. Andrabi SMUN, Alam S, Zia A, Khan MH, Kumar A. 2014; Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report. Restor Dent Endod. 39:215–9. DOI: 10.5395/rde.2014.39.3.215. PMID: 25110646. PMCID: PMC4125586.

4. Knowles KI, Jergenson MA, Howard JH. 2003; Paresthesia associated with endodontic treatment of mandibular premolars. J Endod. 29:768–70. DOI: 10.1097/00004770-200311000-00019. PMID: 14651287.

5. Morse DR. 1997; Infection-related mental and inferior alveolar nerve paresthesia: literature review and presentation of two cases. J Endod. 23:457–60. DOI: 10.1016/S0099-2399(97)80303-2. PMID: 9587302.

6. Giuliani M, Lajolo C, Deli G, Silveri C. 2001; Inferior alveolar nerve paresthesia caused by endodontic pathosis: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 92:670–4. DOI: 10.1067/moe.2001.117269. PMID: 11740484.

7. Buchanan GD, Smit C, Gamieldien MY, El Sheshtawy AS. 2023; Resolution of Apical Periodontitis-induced Mental Nerve Paresthesia Through Nonsurgical Endodontic Retreatment: A Case Report. J Endod. 49:920–4. DOI: 10.1016/j.joen.2023.05.004. PMID: 37182791.

8. Serra J. 1999; Overview of neuropathic pain syndromes. Acta Neurol Scand Suppl. 173:7–11. DOI: 10.1111/j.1600-0404.1999.tb07385.x. PMID: 10819087.

9. von Ohle C, EIAyouti A. 2010; Neurosensory impairment of the mental nerve as a sequel of periapical periodontitis: Case report and review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 110:e84–9. DOI: 10.1016/j.tripleo.2010.03.033. PMID: 20580288.

10. Ozkan BT, Celik S, Durmus E. 2008; Paresthesia of the mental nerve stem from periapical infection of mandibular canine tooth: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 105:e28–31. DOI: 10.1016/j.tripleo.2008.01.023. PMID: 18442732.

11. Ahonen M, Tjäderhane L. 2011; Endodontic-related paresthesia: a case report and literature review. J Endod. 37:1460–4. DOI: 10.1016/j.joen.2011.06.016. PMID: 21924203.

12. Mohammadi Z. 2010; Endodontics-related paresthesia of the mental and inferior alveolar nerves: an updated review. J Can Dent Assoc. 76:a117.

13. Andersson L, Kahnberg KE, Pogrel MA. Oral and maxillofacial surgery. New Jersey: Wiley-Blackwell;2010.

14. Ghali GE, Epker BN. 1989; Clinical neurosensory testing: practical applications. J Oral Maxillofac Surg. 47:1074–8. DOI: 10.1016/0278-2391(89)90184-5. PMID: 2677276.

15. de Beukelaer JG, Smeele LE, van Ginkel FC. 1998; Is short-term neurosensory testing after removal of mandibular third molars efficacious? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 85:366–70. DOI: 10.1016/S1079-2104(98)90058-0. PMID: 9574942.

16. Basirat M, Kia SJ, Motevasseli S, Dadvar Z. 2018; Corticosteroids Indications in Oral and Maxillofacial Diseases: Side Effects, Dosage, and Administration. J Dentomaxillofac Radiol Pathol Surg. 7:51–6.