Multimodal regenerative peptides show promise for inferior alveolar nerve injury recovery in three case reports

Iatrogenic inferior alveolar nerve (IAN) injury is a significant complication of oral and maxillofacial surgeries, often leading to persistent neurosensory dysfunction like anesthesia, dysesthesia, or paresthesia. These symptoms severely impact quality of life, affecting facial expression, mastication, and speech. Current treatments are often limited, and recovery can be prolonged or incomplete due to anatomical constraints within the mandibular canal, including edema, inflammation, and fibrosis that impede axonal regrowth. Understanding the intricate biological processes of peripheral nerve injury, such as Wallerian degeneration, Schwann cell (SC) stimulation, and extracellular matrix remodeling, is crucial for developing effective regenerative strategies.

This study presents a narrative review alongside three clinical cases of patients experiencing inferior alveolar nerve injury. Each patient was managed with a multimodal peptide-based regenerative protocol. The intervention aimed to support the complex biological reactions involved in peripheral nerve healing, including debris removal, vascularization, and axonal regeneration. The primary objective was to assess the clinical outcomes and neurosensory recovery in these individuals. The study design is a case-series with a hypothesis-generating approach, documenting the response to the regenerative peptide intervention.

All three patients with persistent neurosensory dysfunction due to inferior alveolar nerve injury demonstrated clinical improvement following the multimodal peptide-based regenerative protocol. The protocol appeared to facilitate the re-establishment of a permissive niche for neural healing, overcoming anatomical limitations often encountered in mandibular canal injuries. This approach supported the intricate biological processes of nerve repair, including Wallerian degeneration, Schwann cell activation, and macrophage-dependent debris removal, which are critical for successful axonal regeneration. The observed recovery suggests a positive modulation of the inflammatory response and extracellular matrix remodeling. Patients experienced resolution or significant reduction of symptoms such as anesthesia, dysesthesia, hypoesthesia, or paresthesia, which had previously been resistant to conventional management. This qualitative improvement highlights the potential for regenerative peptides to support the inherent regenerative capability of peripheral nerves.

The multimodal peptide-based regenerative protocol led to clinical recovery of neurosensory function in all three patients with inferior alveolar nerve injury.