Needle fracture as a complication of dental local anesthesia: recommendations for prevention and a comprehensive treatment algorithm based on literature from the past four decades.

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.