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The incidence of lingual nerve injury related to third molar surgery, one day after surgery (excluding the use of lingual flap elevation) varies from 0.4% to 1.5%. 10 The incidence of persistent involvement (still present at six months) varies from 0.5% (with the use of a lingual flap) to a low of 0.0%. 14 The author uses a minimal access buccal approach (see Chapter 4 of the associated BDJ Clinical Guide) for M3Ms as lingual flap access surgery is associated with increased temporary lingual nerve injury (LNI). Causes of lingual nerve injury include dental local anaesthetic injections, intubation, ablative surgery and submandibular gland surgery. The most common cause of LNIs is third molar surgery, with a reported incidence of 1-20% temporary and 0-2% permanent. 9 Persistence of any peripheral sensory nerve injury depends on the severity of the injury, increased age of the patient, the time elapsed since the injury and the proximity of the injury to the cell body (the more proximal lesions having a poorer prognosis). Identification of 'high risk teeth' by recognising radiographic risk factors for IAN injury such as:

Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Korea Note: It is recommended that you wash the InvisiLift™ after each use. Wash it in warm water and allow it to air dry. Once dry, the self-adhesive properties will be restored. Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Korea

Lago-Méndez L, Diniz-Freitas M, Senra-Rivera C, Gude-Sampedro F, Gándara Rey J M, García-García A. Relationships between surgical difficulty and postoperative pain in lower third molar extractions. J Oral Maxillofac Surg 2007; 65: 979–983. However, to determine the clinical prognosis of tooth-implant injury, reports of orthodontic miniscrew on the effect of tooth-screw injury can be cited. Orthodontic miniscrews have been used extensively based on the concept of absolute anchorage by the user-friendly easy placement of small-sized screw 10. However, because they are blindly placed in the inter-radicular space, trauma to natural teeth can be a major cause of failure. Thus, some clinical studies on the prognosis of natural tooth roots invaded by miniscrews have been published. Clinical studies of root injuries showed positive results. A 5-year retrospective study Borah and Ashmead 11 showed a very low incidence of root impingement (0.47%) by 2340 transfixation screws in 387 patients with facial fractures. The impinged teeth remained intact and did not require extraction. Another retrospective study reported 1.5% iatrogenic injury to roots during intermaxillary fixation for mandibular fractures. All scratched roots remained vital and root canal perforated teeth were treated endodontically later 12. In a prospective study of patients with mandibular fractures, the incidence of clinically significant damage appeared to be low, although approximately 27.1 % of the 232 screws had damaged the roots 13. Once IAN neuropathy develops this may be a sign of spreading bone infection related to a bone sequestrum or tooth fragments remaining in situ. Implant nerve injuries

The patients complained only of a few clinical symptoms, even when the implant injured the adjacent natural teeth. Four patients complained of symptoms, and three of them were belonging to group I (directly invasion by the implant). Immediately after surgery, one patient with the implant in the maxillary right first premolar area complained of tenderness on percussion of the maxillary right canine, which had already been endodontically treated. However, the symptom disappeared after several days. Another patient in group II complained of tooth discomfort after surgery and underwent RCT with signs of pulp necrosis. Yet another patient complained of minute tooth discomfort after surgery, and intentional replantation was performed five years later. The last patient reported intermittent inconvenience during mastication with the tooth which had undergone RCT one month after loading. Eventually, the tooth was extracted three years and three months later with discomfort. Neurosensory Deficits of Inferior Alveolar Nerve Following Impacted Mandibular Third Molar Extraction: Comparison of One-Stage Complete Extraction with Two-Stage Partial Coronectomy Surgical Technique Kim, S. G. Implant-related damage to an adjacent tooth: a case report. Implant Dent. 9(3), 278–280 (2000). Articaine is an amide analgesic that was introduced to dentistry in 1998; however, lidocaine (also an amide analgesic) remains the gold standard in the UK. Articaine is the most widely used local anaesthesia in many countries for over 20 years 10 and is said to have a number of advantages. These include low toxicity subsequent to inadvertent intravascular injection which may be due to the rapid breakdown to an inactive metabolite (articainic acid), rapid onset of surgical analgesia (around 2.5 minutes) and, compared with lidocaine, better diffusion through soft and hard tissues. 25

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Ribas, B. R. et al. Positioning errors of dental implants and their associations with adjacent structures and anatomical variations: a CBCT-based study. Imaging Sci. Dent. 50, 281–290 (2020). Kang, Y. G., Kim, J. Y., Lee, Y. J., Chung, K. R. & Park, Y. G. The stability of miniscrews invading the dental roots and the effect on the periodontal tissues in beagle dogs. Angle Orthod. 79(2), 248–255 (2009).