Hillerup S, Jensen R H, Ersbøll B K . Trigeminal nerve injury associated with injection of local anesthetics: needle lesion or neurotoxicity? J Am Dent Assoc 2011; 142: 531–539. Elian N, Mitsias M, Eskow R, Jalbout Z N, Cho S C, Froum S, Tarnow D P . Unexpected return of sensation following 4.5 years of paresthesia: case report. Implant Dent 2005; 14: 364–367. Robinson P P, Loescher A R, Smith K G . The effect of surgical technique on lingual nerve damage during lower 3rd molar removal by dental students. Eur J Dent Educ 1999; 3: 52–55.

If neuropathy occurs – recall patient immediately, confirm whether the neuropathy is in the IAN distribution and, if so, remove implant. The conclusion drawn is that articaine is a safe and effective local anaesthetic for use in clinical dentistry but that there are no significant benefits of using articaine 4% compared with lidocaine 2% for IDBs. 24 Yes, your doctor will likely charge more for their time and effort based on how many years of experience they have within the field and with Invisalign specifically. But Invisalign as a company offers bonuses to these doctors to offset these costs.Hegedus F, Diecidue R J . Trigeminal nerve injuries after mandibular implant placement - practical knowledge for clinicians. Int J Oral Maxillofac Implants 2006: 21: 111–116. Renton T, Yilmaz Z . Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain. 2011 Fall; 25: 333–344.

Does the addition of cone-beam CT to panoral imaging reduce inferior dental nerve injuries resulting from third molar surgery? A systematic review The management will depend upon the mechanism,the duration of the nerve injury and the patients' symptoms. 28 The patient's ability to cope with the neuropathy and pain, functional problems and their psychological status will drive the need for intervention. Considering that 70% of these patients present with neuropathic pain, most are managed with reassurance and medication. Cognitive behavioural techniques are also being developed for these patients. Many injuries have limited benefit from surgical intervention and should be managed symptomatically using medication or counselling. Immediate intervention is required for endodontic, implant and third molar related nerve injuries and immediate referral is suggested for all cases.Conversely there are rare reports of resolution of implant related IAN neuropathies at over four years 19 but these do not comply with normal reports of peripheral sensory nerve injuries. 14 Some authors recommend referral of injuries after six months 20 but this may be too late for many peripheral sensory nerve injuries to effect a recovery. We now understand that, after three months, permanent central and peripheral changes occur within the nervous system subsequent to injury that are unlikely to respond to surgical intervention. 21 Zuniga J R, Pate J D, Hegtvedt A K . Regenerative organization of the trigeminal ganglion following mental nerve section and repair in the adult rat. J Comp Neurol 1990: 22: 295: 548–558.