Stephan Acham1, Astrid Truschnegg2, Petra Rugani1, Barbara Kirnbauer1, Knut Ernst Reinbacher3, Wolfgang Zemann4, Lumnije Kqiku5, Norbert Jakse1,4. 1. Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University Graz, Billrothgasse 4, 8010, Graz, Austria. 2. Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University Graz, Billrothgasse 4, 8010, Graz, Austria. astrid.truschnegg@medunigraz.at. 3. Office for Maxillofacial Surgery and Dental Medicine, Ringweg 98530, 8530, Deutschlandsberg, Austria. 4. Division of Oral and Cranio-Maxillofacial Surgery, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria. 5. Division of Preventive and Operative Dentistry, Endodontics, Periodontology, Prosthodontics, Restorative Dentistry and Implantology, Department of Dental Medicine and Oral Health, Medical University Graz, Billrothgasse 4, 8010, Graz, Austria.
Abstract
OBJECTIVES: The aim of this publication is to provide a concept for prevention and a standardized step-by-step clinical approach to this rare but serious and potentially preventable complication of dental local anesthesia. MATERIALS AND METHODS: We collected data with a PUBMED search using the key words "local anesthesia," "dental anesthesia/anesthesia" OR "mandibular block anesthesia," "complication," "hypodermic needle," "needle breakage" OR "needle fracture," and "foreign body AND removal" OR "retrieval." The existing literature was systematically evaluated from 1980 to date using Microsoft Excel 2007 (Microsoft Corporation). RESULTS: After analysis of the literature, we included 36 reports documenting 59 needle breakage events and defined possible risk factors and preventive measures. All relevant reported parameters were listed in tabular form. The main result of this article is a treatment algorithm for this complication. CONCLUSIONS: Prevention of a needle fracture should be the main goal during local dental anesthesia. Use of longer hypodermic needle can obviate complex retrieval surgery. If immediate removal of the fragment fails, localization, planning, and the necessary surgical procedure should be arranged promptly. CLINICAL RELEVANCE: Following a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.
OBJECTIVES: The aim of this publication is to provide a concept for prevention and a standardized step-by-step clinical approach to this rare but serious and potentially preventable complication of dental local anesthesia. MATERIALS AND METHODS: We collected data with a PUBMED search using the key words "local anesthesia," "dental anesthesia/anesthesia" OR "mandibular block anesthesia," "complication," "hypodermic needle," "needle breakage" OR "needle fracture," and "foreign body AND removal" OR "retrieval." The existing literature was systematically evaluated from 1980 to date using Microsoft Excel 2007 (Microsoft Corporation). RESULTS: After analysis of the literature, we included 36 reports documenting 59 needle breakage events and defined possible risk factors and preventive measures. All relevant reported parameters were listed in tabular form. The main result of this article is a treatment algorithm for this complication. CONCLUSIONS: Prevention of a needle fracture should be the main goal during local dental anesthesia. Use of longer hypodermic needle can obviate complex retrieval surgery. If immediate removal of the fragment fails, localization, planning, and the necessary surgical procedure should be arranged promptly. CLINICAL RELEVANCE: Following a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.
Entities:
Keywords:
Complication; Dental anesthesia; Foreign body removal; Hypodermic needle; Local anesthesia; Needle breakage
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