## 4 Discussion  
### Summary of Key Findings  
This retrospective observational study included 120 patients diagnosed with PTTNP, aiming to evaluate the sensory changes over time and identify the clinical and therapeutic factors influencing recovery. Dental implant placement was the most common cause (65.8%), and the inferior alveolar nerve (IAN) was the most frequently affected branch (89.2%), with hypoesthesia alone or combined with allodynia being the most common symptom. The primary outcome was sensory improvement, assessed using the VAS scores at the initial and final visits. Secondary outcomes included the evaluation of symptom onset timing, causative factor removal, Sunderland classification, treatment duration, and treatment modality in relation to VAS improvements. In the implant-related subgroup (\(n=79\)), although the patients presenting within three months showed a trend toward greater sensory improvement, there were no statistically significant differences across the onset-time categories (\(p=0.9071\)). Patients who underwent implant removal showed a greater mean VAS improvement (\(-0.16\)) than those who did not (\(-0.08\)), though this difference was not statistically significant (\(p=0.625\)). Sunderland grades were associated with differences in the initial VAS scores (\(p=0.0284\)), reflecting the relationship between the anatomical severity and baseline symptoms; however, these grades did not correlate with VAS improvements ([PERSON]'s \(q=0.001\), \(p=0.996\)). A significant negative correlation was observed between the symptom onset and the treatment duration ([PERSON]'s \(q=-0.349\), \(p=0.002\)), indicating that an earlier presentation was associated with a longer treatment duration. A marginally significant correlation was also found between an earlier onset and a greater VAS improvement ([PERSON]'s \(q=-0.224\), \(p=0.050\)). Notably, patients with delayed presentation often did not receive active treatment due to the chronic nature of their condition or a reduced expectation of the benefit and were therefore classified within the short treatment duration groups. As a result, some of the shortest treatment durations were paradoxically associated with minimal or no improvement in the VAS scores, reflecting a subgroup that remained untreated (Table 4). Since the analysis in Table 4 included all implant-related patients regardless of the treatment status, potential bias may have been introduced--particularly from the untreated patients grouped under the short treatment durations. To address this, a stratified analysis  
Figure 4: Mean VAS score changes by treatment modality. Bars represent mean changes in the VAS scores from baseline across five treatment groups. Error bars indicate \(\pm 1\) standard deviation (SD). Combined treatment showed the greatest reduction in pain, followed by surgical and physical therapy interventions. Minimal improvement was observed with pharmacologic treatment, and almost no change was noted in the no-treatment group. was conducted including only the 43 patients who actually received treatment (Table 5). When comparing the treated group (\(n=43\)) with the untreated group (\(n=21\)), no statistically significant differences in the log-transformed VAS changes were observed (Mann-Whitney U test, \(p=0.9873\)). Among the treated group, the mean log VAS change varied by treatment duration: the 0-3 and 4-6 month groups showed an improvement, while the 7-12 month group showed a deterioration. However, these differences were not statistically significant (Kruskal-Wallis H = 6.70, \(p=0.1391\)) (Table 5). Among those patients who did undergo treatment, a meaningful VAS reduction was observed, particularly in those receiving multimodal therapy. Among the implant-related cases, implant removal was performed in 32 out of 79 patients (40.5%). The decision to remove the implants was based on persistent neurosensory symptoms, radiographic or clinical evidence of nerve compression, and shared decision-making between the patient and the clinician.