Advance in Functional Restoration of Injured Nerve with Low Level Laser and its Utilization in the Dental and Maxillofacial Region.

The inferior alveolar nerve and facial nerve are the two most important nerves in the dental and maxillofacial region. The injury to them is one of the major postoperative complications after alveolar surgery and orthognathic surgery. However, recovering the nerve function after injury takes a long time and the recovery effect tends to be unsatisfactory. In recent years, an intensively investigated technique, low level laser which has been applying in assisting the recovery of nerve function, has been gradually proved to be effective in clinically treating postoperative nerve injury. In this article we review in terms of the mechanisms involved in low level laser-assisted functional restoration of nerve injury and its clinical application in the recovery of nerve function in the dental and maxillofacial area as well.

A Systematic Review of the Cervical Plexus Accessory Innervation and Its Role in Dental Anesthesia.

INTRODUCTION: Accessory innervation (AI) may account for the persistent sensation perceived after successful mandibular anesthesia in the adult patient. The purpose of this systematic review was to record the quality of evidence pertaining to the cervical plexus (CP) AI in dental anesthesia. MATERIALS AND METHODS: Electronic and manual searches were conducted using Ovid and Medline of articles published from 1922 to March of 2015. Studies written in any language were included as long as they involved: (i) humans, animals, and/or cadavers AND (ii) anatomical and/or research anesthetic-technique approaches and/or clinical approaches. Exclusion criteria were (i) maxillary buccal infiltration, (ii) no abstract/paper available, (iii) studies that do not comprise the description of the branches of the CP branches in dentistry and (iv) duplicated articles. The articles were reviewed and graded by levels of evidence (LOE) through a methodological scoring index (MSI). RESULTS: Forty-four out of 185 papers fulfilled the inclusion criteria. One randomized control trial, 3 comprehensive reviews, 1 cohort study, 5 case series/reports, 16 poor-quality cohort and case series/reports and 18 reviews/case, reports/expert opinions were found. Of the 44 publications, there were 4 LOE 1, 1 LOE 2, 5 LOE 3, 20 LOE 4 and 14 LOE 5 studies. CONCLUSIONS: The MSI helped to classify papers LOE in a standardized and objective approach. The objective evidence quality occurrence recorded was found to be LOE 4 (n = 20) > LOE 5 (n = 14) > LOE 3 (n = 5) > LOE 1 (n = 4) > LOE 2 (n = 1). The anatomy of the CP needs to be reexamined and understood in the anatomical literature.

Identification and adjustment of experimental occlusal interference using functional magnetic resonance imaging.

BACKGROUND: The purpose of this study was to use functional magnetic resonance imaging (fMRI) to quantify changes in brain activity during experimental occlusal interference. METHODS: Fourteen healthy volunteers performed a rhythmical tapping occlusion task with experimental occlusal interference of the right molar tooth at 0 mm (no occlusion), 0.5 mm, and 0.75 mm. The blood-oxygen-level dependent (BOLD) signal was quantified using statistical parametric mapping and compared between rest periods and task periods. RESULTS: In tapping tasks with experimental occlusal interference of 0.75 mm or 0.5 mm, there was clear activation of the contralateral teeth-related primary sensory cortex and Brodmann's area 46. At 0 and 30 minutes after removal of the experimental occlusal interference, the activation clearly appeared in the bilateral teeth-related primary sensory cortices and Brodmann's area 46. At 60 minutes after the removal of the experimental occlusal interference, the activation of Brodmann's area 46 had disappeared, and only the bilateral teeth-related primary sensory cortices were active. CONCLUSIONS: The present results suggest that adjustments for experimental occlusal interference can be objectively evaluated using fMRI. We expect that this method of evaluating adjustments in occlusal interference, combined with fMRI and the tapping task, could be applied clinically in the future.

Transverse cervical nerve: implications for dental anesthesia.

The inferior alveolar nerve block (IANB) has the highest failure incidence of any dental anesthetic technique. Many authors have outlined potential reasons for these failures in permanent lower molars, including accessory innervations from the mylohyoid and mental foramen. However, the potential accessory innervation of posterior mandibular teeth from the transverse cervical nerve (TCN), a branch of ventral rami from the C2-C3 spinal nerves from the cervical plexus (CP), has been difficult to assess as a result of the small size and thickness of the mandibular accessory foramina and nerve branches, as well as due to the dissection technique performed. The goal of this study was to identify and trace the CP branches from fresh human cadaver tissue samples using the Sihler's technique. Two fresh human cadaver samples were used. Samples were fixed in neutralized formalin, macerated in potassium hydroxide, decalcified in acetic acid, stained in Ehrlich's hematoxylin, destained in acetic acid, and cleared in glycerin. Both specimens skin was dissected. The Sihler's technique delineated all nerves three dimensionally and helped to disclose structures of small size and thickness. The TCN from the CP, stained in blue, innervated the posterior mandible in one of the two samples. These results confirmed that the CP may supply accessory innervation to the inferior border of the posterior mandible through the TCN. These findings illustrate variations of anatomy that may account for IANB failures in posterior mandibular teeth and allows for clinical decisions for implementing supplemental anesthetic techniques.

Trigeminal nerve injuries in relation to the local anaesthesia in mandibular injections.

OBJECTIVE: This study reports the signs and symptoms that are the features of trigeminal nerve injuries caused by local anaesthesia (LA). METHODS: Thirty-three patients with nerve injury following LA were assessed. All data were analysed using the SPSS statistical programme and Microsoft Excel. RESULTS: Lingual nerve injury (LNI; n = 16) and inferior alveolar nerve injury (IANI; n = 17) patients were studied. LNI were more likely to be permanent. Neuropathy was demonstrable in all patients with varying degrees of paraesthesia, dysaesthesia (in the form of burning pain) allodynia and hyperalgesia. All injuries were unilateral. A significantly greater proportion of LNI patients (75%) had received multiple injections, in comparison to IANI patients (41%) (p <0.05). Fifty percent of patients with LNI reported pain on injection. The presenting signs and symptoms of both LNI and IANI included pain. These symptoms of neuropathy were constant in 88% of the IANI group and in 44% of LNI patients. Functional difficulties were different between the LNI and IANI groups, a key difference being the presence of severely altered taste perception in nine patients with LA-induced LNI. CONCLUSIONS: Chronic pain is often a symptom after local anaesthetic-induced nerve injury. Patients in the study population with lingual nerve injury were significantly more likely to have received multiple injections compared to those with IANI.

Local differences in the position of the mental foramen.

The mental foramen has been reported to vary in position in different ethnic groups. Repeated failures during injections and operative procedures involving the mental foramen suggest the presence of local differences in a given population. The aim of the present study was to investigate possible local differences of the mental foramen in Eastern Anatolian individuals in the Turkish population. The present investigation is based on the examination of 70 adult mandibles. The study consisted of three measurements, to include the relations of the mental foramen to the following: 1) the lower teeth; 2) the body of mandible; 3) the mandibular symphysis and posterior border of the ramus of the mandible. The most common position of the foramen was in line with the longitudinal axis of the second premolar tooth (relation IV), at the midpoint of the mandibular body height and at 1/3.5 of the distance from the mandibular symphysis to the posterior border of the ramus. Local differences of the mental foramen may occur in a population. Prior to surgery knowledge of the most common location of the foramen peculiar to a local population may enable effective mental block anaesthesia to be provided.

Sensory innervation of mandibular teeth by the nerve to the mylohyoid: implications in local anesthesia.

Traditionally, the nerve to the mylohyoid has been considered a motor nerve. However, dissection and clinical studies have challenged this dogma implicating the nerve to the mylohyoid as a nerve of accessory sensory innervation to mandibular teeth. Within the infratemporal fossa, the nerve to the mylohyoid branches from the inferior alveolar nerve and may be anesthetized with an inferior alveolar nerve block. However, because of the variability in location of branching and the potential barriers formed by both the pterygomandibular fascia and the sphenomandibular ligament, the nerve to the mylohyoid may escape anesthesia in an inferior alveolar nerve block. This may prevent profound local anesthesia of the mandibular teeth and may account, at least in part, for the high failure rate of the inferior alveolar nerve block. Alternative local anesthesia procedures may be employed to ensure adequate anesthesia of the nerve to the mylohyoid is achieved. This review provides a background of anatomical and clinical research of the nerve to the mylohyoid and outlines techniques suggested for providing a neural blockade of the nerve to the mylohyoid.

[Neurophysiological background of pain in the orofacial area: review of the literature]. / Az orofaciális terület fájdalmainak neurofiziológiai háttere. Osszefoglaló referátum.

The article presents an overview on the peripheral and central neural mechanisms underlying pain in the orofacial area. First a definition of pain and a description of general aspects of orofacial pain are presented. Characteristics of acute and chronic pain are also described. The study highlights the sense organs, the molecular mechanisms and categories of primary afferents involved in peripheral events of orofacial pain. After describing the brain-stem nuclei participating in trigeminal pain and their functional role, primary afferents involved in nociceptive sensation from the tooth pulp, explanations of dentinal sensitivity and differences between the brain-stem endings of primary afferents among different species are discussed in details. The role of higher brain centres, with a special emphasis on the thalamus and somatosensory cortex in the development of orofacial pain sensation is considered. The last section provides a review about how the activities of nociceptive neurons are controlled by higher brain centres and neurochemicals involved in pain transmission.

Dental pulp cells provide neurotrophic support for dopaminergic neurons and differentiate into neurons in vitro; implications for tissue engineering and repair in the nervous system.

Glial cell line-derived neurotrophic factor (GDNF) mRNA is highly expressed by dental pulp cells (DPCs) prior to the initiation of dental pulp innervation. We show that radioactively labelled exogenous GDNF is retrogradely transported from neonatal teeth and vibrissae to the trigeminal neurons, indicating that GDNF acts as a classical neurotrophic factor in the trigeminal system. We also show that DPCs from both rats and humans produce nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and GDNF mRNAs in vitro, promote the survival and phenotypic characteristics of embryonic dopaminergic (DA) neurons and protect DA neurons against the neurotoxin 6-hydroxy-dopamine (6-OHDA) in vitro. By using inhibitory antibodies to NGF, BDNF and GDNF, we show that the promotion of DA neuron survival relates to the production and release of neurotrophic proteins by DPCs in vitro. We suggest that in vivo production of neurotrophic factors by DPCs play roles in tooth innervation. However, continued production of neurotrophic factors by the DPCs might have wider implications. We propose that the dental pulp is a viable source of easily attainable cells with possible potential for development of autologous cell transplantation therapies. We also show that a population of neural crest-derived dental pulp cells acquire clear neuronal morphology and protein expression profile in vitro, indicating the presence of a cell population in the dental pulp with neuronal differentiation capacity that might provide additional benefits when grafted into the CNS.

The key to profound local anesthesia: neuroanatomy.

BACKGROUND: To achieve profound dental local anesthesia, it is necessary for the dentist to have a thorough knowledge of the details of sensory innervation to the maxilla and mandible. Since the early 1970s, dentistry has experienced a resurgence of interest in the neuroanatomical basis of local anesthesia, resulting in numerous scientific reports on the subject. OVERVIEW: Current studies afford a more detailed knowledge of the branching of various divisions of the trigeminal nerve, the great sensory nerve of the head region. In this article, the authors provide an update of the peripheral distribution of the trigeminal nerve to enhance induction of safe and effective dental local anesthesia. CONCLUSIONS AND PRACTICAL IMPLICATIONS: An understanding of the potential variations in innervation should help the dentist improve his or her ability to induce profound local anesthesia.

[Electroanalgesia: operating principles]. / Electroanalgesie: principes de fonctionnement.

We are faced every day with the problem of dental pain arising from the concomitant action of the nerve fibres, the odontoblasts and the dentinal fluid. Its propagation is due to the triggering of the action potential from the resting potential. It can be reduced thanks to a reversible process of anelectrotonus in electro-analgesia.

Four common mandibular nerve anomalies that lead to local anesthesia failures.

Local anesthesia is essential in treating many dental and oral disorders. However, many types of anatomical anomalies are seen in the nervous system of the mandible that interfere with achieving local anesthesia. The authors describe four such anomalies and offer ways to overcome them when trying to properly anesthetize affected patients.

Convergence of afferents from superior sagittal sinus and tooth pulp on cells in the thalamus of the cat.

We have previously shown convergence of craniovascular and tooth pulp afferents in the cervical spinal cord of cats. This study looked for similar convergence in the thalamus. Fifty-four thalamic cells with input from tooth pulp, superior sagittal sinus, or both, were identified. Twenty-nine cells with tooth pulp and superior sagittal sinus input were located in the ventrobasal complex of the intralaminar nuclei. Most of these 29 cells were also excited by cooling the contralateral tooth pulp, and 21 had receptive fields on the contralateral face or forelimb. Twenty cells excited by stimulation of superior sagittal sinus, and not tooth pulp, were found in several nuclei. The 5 cells excited by stimulation of tooth pulp, but not sagittal sinus, were restricted to the ventrobasal complex. The data confirm convergence from sagittal sinus, tooth pulp, and skin in the thalamus of anaesthetized cats.

Qualitative evaluation of the masseteric poststimulus EMG complex following mechanical or acoustic stimulation of osseointegrated oral implants.

To qualify the contribution of the periodontal-ligament receptors to trigeminal inhibitory reflex responses, 20 subjects with maxillary implant-supported fixed prostheses opposing mandibular teeth or implants were compared to 10 subjects with removable dentures in the maxilla opposing implant-supported prostheses and 10 subjects with natural teeth in both jaws. Standardized mechanical taps were delivered to an implant, a denture tooth, or a natural tooth in the central incisor region of the maxilla. Bilateral surface electromyographic recordings of the masseter muscles were obtained while subjects maintained a constant myoelectric activity by clenching. Stimulation of an implant in partially edentulous subjects elicited a reflex response in 7 of 10 subjects. Likewise, stimulation of a tooth of a maxillary removable denture resulted in a clear reflex response in 5 of 10 totally edentulous subjects. On the other hand, a reflex response did only occur in 1 of 10 totally edentulous subjects with implant-supported prostheses in both jaws. It was concluded that the presence of some natural teeth in either the maxilla or mandible allowed the occurrence of a reflex response. In totally edentulous subjects, mucosal or periosteal mechanoreceptors, triggered by stimulation of the denture bearing area or by transmission of vibrations through the jaw bone, could be responsible for the remaining reflex responses.

Convergence of afferents from superior sagittal sinus and tooth pulp on cells in the upper cervical spinal cord of the cat.

Units in the dorsolateral area of the upper cervical cord respond to craniovascular stimulation. This study examined tooth pulp responses in this area in cats. Eleven of 21 units tested in the dorsolateral area had convergent inputs from superior sagittal sinus and tooth pulp; while 10 units had sagittal sinus, but not tooth pulp, input. Mean response latency to tooth pulp stimulation (25.8 ms) was significantly longer than to superior sagittal sinus stimulation (9.8 ms). Half of the units had cutaneous receptive fields; and in five units, action potentials could be evoked by electrical stimulation in the posterior complex of the thalamus.

Multiple effects of an identified proprioceptor upon gastric pattern generation in spiny lobsters.

1. Using deafferented preparations of the stomatogastric nervous system of spiny lobsters (Panulirus interruptus), we stimulated the central soma of the Anterior Gastric Receptor neuron (AGR) and analyzed sensorimotor integration in the gastric central pattern generator during rhythm production. 2. Driving AGR to spike tonically at lower frequencies (10-20/s) accelerated the gastric rhythm, while higher frequencies (> or = 30/s) suppressed it. 3. Shorter spike trains in AGR evoked phase-dependent resetting of the gastric rhythm. Repetitive trains could entrain rhythms to both longer and shorter cycle periods. Some pattern-generating effects are consistent with effects upon the lateral gastric neuron, an influential member of the gastric mill network. 4. AGR affected the burst intensity of many of the gastric neurons in specific, complex ways. Some power-stroke motor neurons were excited because AGR activated excitatory, premotor interneurons (E cells). However, AGR also activated parallel, seemingly inhibitory inputs, whose mechanism remains unclear. Still other effects on motor neurons may be mediated partly by synaptic interactions within the network.

Neuronal and neurochemical mechanisms of hypothalamic inhibition of the nociceptive reflex.

Using cats anesthetized with chloralose-Nembutal we have studied the effect of high frequency stimulation of the medial and lateral structures of the posterior, tuberal, and anterior hypothalamus, and also of the central gray matter of the midbrain on the nociceptive jaw-opening reflex induced by tooth pulp stimulation. We recorded the EMG response of the digastric muscle as the index of the nociceptive reflex. We have shown that the EMG response of the nociceptive reflex is effectively suppressed on stimulation of all hypothalamic structures and the central gray matter, the threshold of the suppressive action being lower on stimulation of the central gray matter. The effects of the hypothalamic suppression of the nociceptive reflex were eliminated almost completely after naloxone administration, with the exception of the central gray matter, which is slightly more resistant to the action of this agent. After bilateral electrolytic destruction of the central gray matter the antinociceptive effect of the hypothalamus was retained, decreasing only insignificantly, The effect of complete suppression of the amplitude of the EMG response, similar to the effect of stimulation of the hypothalamus and the central gray matter, was also observed after intravenous administration of phenapidine, an opiate agonist with a marked central analgesic action. The neuronal and neurochemical mechanisms of hypothalamic suppression of the nociceptive jaw-opening reflex are discussed.

[Supplementary innervation of lower teeth. Review of the literature]. / Contribuição ao estudo da inervação suplementar dos dentes inferiores - uma revisão bibliográfica.

When pain persists after a successful injection of the inferior alveolar nerve, the professional must think on the possibility of supplementary nerve supply of the region. This review updates the current knowledge of this supplementary innervation. Not every patient will require this kind of anesthesia, however, the dentist must be aware of its existence.

Topographic representation of lower and upper teeth within the trigeminal sensory nuclei of adult cat as demonstrated by the transganglionic transport of horseradish peroxidase.

Transganglionic transport of horseradish peroxidase-wheat germ agglutinin conjugate (HRP-WGA) entrapped in hypoallergenic polyacrylamide gel was used to study the patterns of termination of primary afferents that innervate the lower and upper tooth pulps within the trigeminal sensory nuclear complex (TSNC). HRP injections were made into the inferior and superior alveolar nerves in order to compare the central projections of the whole nerve with those from tooth pulps. In addition, the relationship between the distribution of the trigeminothalamic tract cells and the projection sites of the tooth pulp afferents was investigated by injecting HRP into the posterior ventral thalamus. HRP-labeled tooth pulp afferent fibers innervating the lower and upper teeth projected to the subnucleus dorsalis (Vpd) of pars principalis, the rostrodorsomedial part (Vo.r) and nucleus dorsomedialis (Vo.dm) of pars oralis, the medial regions of pars interpolaris, and laminae I, II, and V of pars caudalis. Terminal fields of the lower tooth pulp afferents formed a rostrocaudally running, uninterrupted column from the midlevel of Vpd to the caudal tip of caudalis. In contrast, the column of termination of upper tooth pulp afferents was discontinuous at the Vpd/Vo.r transition, and ended at the more rostral level of the caudalis than that of the lower tooth pulp afferents. The representation of the lower and upper teeth in the TSNC was organized in a somatotopic fashion which varied from one subdivision to the next, although terminal zones of the inferior and superior alveolar nerves overlapped within the Vo.r, Vo.dm, and dorsomedial part of rostral pars interpolaris. The lower and upper teeth were represented in the Vpd, Vo.r, Vo.dm, medial region of pars interpolaris, and laminae I, II, and V, in a ventrodorsal or caudorostral, dorsoventral, lateromedial, dorsoventral, and mediolateral or dorsomedial-ventrolateral sequence, respectively. The smaller, more focal terminal areas of the teeth contrasted sharply with more extensive terminal fields of the alveolar nerves. The HRP injections within the thalamus indicated that neurons in Vpd, the caudal pars interpolaris, and laminae I/V of caudalis, which are subdivisions of TSNC that receive pulpal projections, sent their axons to the ipsilateral and contralateral posterior ventral thalamus.(ABSTRACT TRUNCATED AT 400 WORDS)