Individual Risk Factors Associated with Post-traumatic Trigeminal Neuropathy Following Endodontic Procedures: A Systematic Review.

Abstract

Introduction: To identify patient-specific phenotypic, anatomical, psychological, and clinical risk factors associated with the development of post-traumatic trigeminal neuropathy (PTTN) following endodontic procedures.

Methods: This systematic review was conducted following PRISMA 2020 guidelines, with the protocol prospectively registered in PROSPERO (CRD420251071354). Searches were performed in PubMed/MEDLINE and LILACS (via BVS) up to June 2025. Studies were eligible if they reported patient-level phenotypic, anatomical, psychological, or clinical features linked to PTTN following endodontic therapy. Three reviewers independently conducted data extraction and quality assessment. An exploratory meta-analysis was performed to estimate the pooled prevalence of PTTN by sex.

Results: Nine studies were included. A predominance of female patients among those with PTTN was observed, with a pooled proportion of 67% (95% CI: 63.3%-70.5%). Psychological comorbidities such as anxiety and depression, previous chronic pain conditions, and endodontic procedures in anatomically high-risk areas particularly mandibular molars were also identified as potential risk factors. Some studies proposed predictive frameworks integrating sensory testing and patient history. However, heterogeneity in study designs and limited quantitative data prevented subgroup analyses.

Conclusions: This review suggests that female sex, psychological vulnerability, and altered sensory modulation may be individual level-risk factors for PTTN following endodontic treatment. These findings reinforce the importance of risk-based clinical decision-making and underscore the need for prospective studies with standardized diagnostic criteria to develop validated predictive models in endodontics.