Case Report: Regenerative peptides for Inferior alveolar nerve injury: a narrative review with hypothesis-generating three clinical cases

Inferior alveolar nerve (IAN) injury represents a substantial complication in oral and maxillofacial surgery, often leading to persistent neurosensory dysregulation with limited effective treatment options. This narrative review analyzes the biological rationale for regenerative peptides as potential adjuncts in peripheral nerve repair and presents three hypothesis-generating clinical cases managed using a multimodal approach. Experimental evidence suggests that peptides, such as BPC-157, thymosin β 4 derivatives (TB-500), and ARA-290, may affect biological pathways implicated in peripheral nerve repair, such as inflammation regulation, cytoprotection, angiogenic signaling, extracellular matrix remodeling, Schwann cell biology, and axonal regeneration. Nonetheless, these processes have been demonstrated mainly in preclinical models and have not been directly established in patients with IAN injury. Three illustrative clinical cases treated with a multimodal method incorporating peptide agents, dexamethasone, and local anesthetic showed neurosensory recovery during follow-up. Nonetheless, owing to the uncontrolled nature of these observations, spontaneous recovery and other confounding factors cannot be excluded, and causality cannot be established. Consequently, a phase-based intervention framework is proposed, emphasizing a biologically informed phase-mediated management system. Despite promising biological rationale, peptide-based interventions remain investigational, with unresolved questions concerning safety, delivery, optimal dosing, and long-term outcomes. Rigorous, controlled clinical trials and standardized outcome measures are required to validate efficacy and define their role with contemporary management paradigms for IAN injury.