Orthodontic-related nerve injuries: a review and case series

Trigeminal neuropathy secondary to orthodontic tooth movement is reported as a rare occurrence. Risk assessment is possible to prevent or immediately treat these injuries and clinicians should be aware of the risk factors. Increasingly, orthodontics is provided by non-specialists and orthodontic therapists. This paper presents cases and a review of orthodontic-related nerve injuries, where early diagnosis of orthodontic nerve injuries was misdiagnosed, preventing early or immediate treatment that would have likely optimised neural recovery and prevented permanent sensory neuropathic pain in these patients. We present two cases of trigeminal neuropathy following orthodontic tooth movement that highlight some key issues relating to improving pre-orthodontic risk assessment during treatment planning and early identification of developing neuropathy requiring urgent cessation/reversal of orthodontic treatment. The cases presented demonstrate the importance of thorough pre-orthodontic assessment before treatment planning. Traditionally, two-dimensional imaging such as panoramic and periapical radiographs have been the gold standard for predicting the relationship of the dentition to the mandibular canal. However, cone beam computed tomography imaging is now accepted as providing a more accurate image of the position of the teeth in relation to vital structures, such as neurovascular supply.