Needle breakage during dental anesthesia: Management strategies and its associated preventive measures

Dental anesthesia is useful and important for the procedures of tooth extraction, oral tissue biopsy, periapical and periodontal surgery and more others. However, needle breakage during dental anesthesia, presents a considerable challenge in its clinical management. Retained fragments can lead to pain, trismus, dysphagia, and infections, and may migrate into deeper spaces, increasing the complexity and risk upon its retrieval. To avoid such consequences, prompt removal of the broken fragment is often advocated. However, no standard guidelines were developed. This review provides a comprehensive analysis of the current imaging modalities and surgical techniques used in fragment localization and retrieval. The surgical approaches may vary depending on the location of broken fragment. In addition, the use of C-arm fluoroscopy, endoscopes, dynamic navigation systems and static surgical guides can facilitate the surgery. Conversely, magnets and metal detectors have shown to be ineffective. Factors such as needle location, patient cooperation, systemic health, maximum mouth opening, and surgical risks must be carefully considered. Additionally, this article emphasizes the importance of prevention. Proper injection techniques, use of long and thicker needles, adequate patient preparation, and avoiding prebending are critical to reduce the risk of breakage.