Abstract
BACKGROUND: To describe the diagnosis and surgical management of an inferior alveolar nerve (IAN) injury caused by extrusion of a bio-ceramic endodontic sealer into the mandibular canal using digitally guided piezoelectric decompression. CASE PRESENTATION: A 12-year-old female presented with persistent right-sided anesthesia of the lip and the chin following endodontic treatment of tooth #46 (total loss of sensation). Clinical neurosensory examination and cone-beam computed tomography (CBCT) confirmed extrusion of sealer material into the inferior alveolar canal. Virtual surgical planning was performed, and a CAD/CAM patient-specific surgical guide was fabricated. Guided piezoelectric corticotomy was used to access the canal and remove the extruded material. Leukocyte- and platelet-rich fibrin (L-PRF) was applied for nerve coverage, followed by reconstruction with autologous fibrin-stabilized bone graft (sticky bone). Postoperative follow-up demonstrated gradual improvement in neurosensory function. Electric pulp testing (EPT) values of adjacent teeth changed from elevated thresholds (55–76) to values within normal limits (12–34) over a 3-month period. Follow-up CBCT confirmed complete removal of the extruded material and re-establishment of the inferior alveolar canal space. CONCLUSIONS: Digitally guided piezoelectric decompression enabled controlled access to the inferior alveolar canal and removal of extruded bio-ceramic sealer in a case of persistent IAN dysfunction. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12903-026-08333-3.