Resolution of Apical Periodontitis-induced Mental Nerve Paresthesia Through Nonsurgical Endodontic Retreatment: A Case Report

Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by cone-beam computed tomography imaging. Nonsurgical root canal retreatment was performed over 2 visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. Nonsurgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention. (J Endod 2023;49:920-924.)

Automated summary

Paresthesia can occur as a consequence of unsuccessful root canal treatment, especially when it leads to apical periodontitis involving the mental neurovascular bundle. This case report presents a patient who experienced discomfort on mastication and persistent numbness of the lower left lip due to incomplete primary endodontic treatment. Cone-beam computed tomography imaging confirmed the involvement of the mental neurovascular bundle. Non-surgical root canal retreatment was performed and resolved the paresthesia after a 3-year follow-up. This suggests that nonsurgical endodontic retreatment may be effective in healing large periapical lesions and resolving complications like paresthesia. (J Endod 2023;49:920-924)