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Dental Implant Impinged On Nerve
Dr. James asks us:
I have a patient where dental implants were placed at the lower left first molar and first premolar positions three months following extraction of the posterior teeth. Unfortunately, the anterior dental implant (12mm Straumann RN) slightly impinged the anterior loop of the mental nerve.
Initially the patient reported numbness of the area, but in the days following, developed and electrical current, TENS type pain. Assessment of the site via OPG and CT occurred at 10 and 14 days, and the offending dental implant was removed at 14 days. The discomfort has proven quite debilitating. The patient was placed on Lyrica by his medico, (neuropeptide blocker) and whilst this improved the pain, the side effects are intolerable.
At five month review there has been some resolution in sensory perception, but pain continues. We are currently investigating surgical exploration of the site, and possible pain management with Acupuncture. Any suggestions?
March 27, 2006 in Treatment Planning & Complications | Permalink
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Comments
I would make a consultation to Dr. Roger A. Meyer from Marietta, Georgia
Posted by: | Mar 28, 2006 1:33:55 PM
I'd refer to someone who repairs such cases rather than exploring myself. Reed Day in Phoenix is outstanding as well as Mark Steinberg at Loyola or Ziccardi at Chapel Hill.
Posted by: Dr. Crystal Baxter | Mar 28, 2006 1:49:39 PM
The pain should have subsided if the implant was removed after 14 days of placement. There is a possibility of Neuroma formation from injury to the nerve. If the pain is still intense, the patient should have microsurgical nerve repair. Mass General Hospital, Dr. Leonard Kaban has done a lot of these repairs. I have done a few but the patients have long term paresthesia or anesthesia. I do not do these repairs at this time.
Posted by: Gary Wadhwa | Mar 28, 2006 2:50:09 PM
I suggest that you contact Dr. Joseph W. Foote at Presbyterian Hopsital, Philadelphia, PA.
Posted by: | Mar 28, 2006 4:55:43 PM
I'm oral surgeon and I perform too much surgery about alveolar nerve. My opinion for this case you should wait for 12 months. During this period you can offer B complex vitamins and moisterd hot compress for related area.If alveolar nerve injured, totally nerve reposition or surgery may be needed.
Posted by: Ozyuvaci Hakan Prof.Dr. | Mar 28, 2006 10:00:50 PM
In all cases where implant come close to the nerve or impinges it, the first clinical sign is altered sensation from the patient the NEXT day so at once under local Anesthesia often made intraseptally I have always relieve the implant of 1 or 2 turns ( unscrew it) and there is a return to normal after few days and we control and explain to the patient
but the point is we never wait 14 days otherwise the damage is extensive and long lasting
I have many cases treated this way and so far we have not lost the implants
Posted by: zeinou | Mar 28, 2006 10:46:39 PM
The mistake you should avoid at first,in fact you should extract it immediately or change into 10mm length implant.In my experience I never care about the lower nerve because I never compress it by the implants.once you make a hole on the nerve,you should immediately change a shorter implant.
sincerely,
Song Guang-bao
Posted by: Song Guangbao | Mar 29, 2006 5:01:09 AM
I would never place a 12 mm implant in the mental foramen area. It is a kiss of death. Why sleep with this kind of sickness over 6 month. I just heard a case where patients actually sued the dentist under fraud and not malpractice does not cover it. Most importantly, please try to protect one another and not to just encourage everyone and their mother to file a law suit....
Posted by: Dr. Dietkwisch | Mar 29, 2006 2:45:38 PM
if you have the slightest numbness and an XRay with impingement remove the implant and after recovery of the nerve replace it with a shorter one
this is the safest way to proceed
Posted by: B Vanassche | Mar 30, 2006 4:18:07 AM
Medical/Legally after 4 months of no improvement the
patient shold be offered the
opportunity for nerve repair
and I agree with referring
to Dr. Kaban for a consult
aleast.
Posted by: DRC | Mar 30, 2006 9:30:31 AM
please give us more details about the pain charachter,also the sensorry test of the nreve.the history you are giving is not matching with nerve injury
Posted by: hossam bargash b.ds m.d.s | Apr 1, 2006 11:03:11 PM
The implant should ALWAYS be removed if paresthesia persist of the local anesthetic should have worn off. The reason is the nerves blood supply is being cut off leading to irreversible damage. Nerve repairs are best addressed within 3 months of injury. Make sure you referr to someone with A LOT of microsurgery repair experience like Dr. Zuniga at UNC or Dr Kavan. Good luck.
Posted by: | Apr 2, 2006 4:47:17 AM
i had this a few years ago, and my oral surery friend said to remove the implant immediately(about 3 days after i placed it)-we then monitored the patient for about 3 more months using the "q-tip directional test". every few weeks we would have the patient in and take a slightly frayed q-tip, have the patient close their eyes and then lightly! brush the q-tip 5 different times in different directions(left to right and right to left). do this at the lip line , mid chin area and angle of the jaw-record your findings -for example "patient was right at determining the direction 0 out of 15 or 15 out of 15. when we started the first week it was 0/15 and each week it got better, until at about 2-3 months it was 15/15. if it had not improved after 3 months we would have referred for consult on nerve grafting, but even this usrgery is only about 60% succesful.
Posted by: scott hamblin | Apr 5, 2006 9:16:25 AM
I have a missing molar in the bottom portion of my mouth. It does not show when I smile, and I have no bone loss. It has been missing for 20 years. I'm encouraged by my dentist to have an implant - Cost $3600.00. I am very happy to leave well enough alone. Would appreciate any comments regarding this. Looking forward to hearing from you.
Thank you!
Posted by: | Apr 6, 2006 5:47:43 PM
I had a two dental implants placed in the upper right side of jaw. Prior to final surgery; placement of abutments, I felt odd sensations and numbness on upper and lower lip. Also pain felt in second implant site and in a root canaled tooth near implant site. I am sure I have developed nerved damage, as a CT scan revealed the implant was placed in bone at an agle and penetrated aveolor ridge. Should I have the implant removed or will it make matters worse? I am in horrendous pain all day long. Thanks!
Posted by: | Apr 16, 2006 7:37:22 PM
It sound to me like a neuroma, neuromas can be treated with the same or similar medications that trigeminal neuralgias are treated. The problem is actually that after surgeries in sensitive areas are finished, a final RX should be taken, in fact, RX of the pilot drill should be taken two mm short of the intended depth to make adjustments of depth to protect the patient.
we should never work so closed to structures, it is not worth it unless there is no other choice.
If we hit a structure and take an RX, immediate removal or immediately backing the implant up a few mm will decrease the risk of permanent damage.
I truly believe your patient will improve, slowly but it will improve, it is already improving.
I would get second opinions for different reasons but I would question surgical intervention since patient is already showing improvement.
Noshir mehta and Dr Scrivani at the Pain center at Tufts dental school are experts in the conservative management of a situation like the one you are describing.
you can reach them at 1 617 636 6817.
Good luck,
Dr Ordonez
Posted by: alvaro ordonez | Apr 19, 2006 12:27:33 PM
A month ago I had two dental implants done on each side of my lower jaw, both molars, on my left side it healed quickly and no problems. On the right side I have half my chin and lip numb... it has been over 30 days and there is still some numbness (no pain) but there is a prickling feeling in the numb chin and lip. Does this mean that the feeling is coming back? I hope so.
Posted by: | Jun 28, 2006 5:39:35 PM
I had an implant 6 weeks ago and have been experiencing numbness and pressure in the tooth immediately adjacent to the implant site. I'm being referred to an endodontist.
Is such numbness and pressure common? What could be the possible cause and treatment?
Thanks so much!
Posted by: | Sep 27, 2006 5:04:27 AM
Have you notified the dr that put this implant in? If not, you should do. Is it upper or lower the implant? Where are the areas of numbness? Any pain? Please let me know further information. Thank you.
Posted by: Rae | Sep 27, 2006 10:39:02 AM
I have had an implant in upper front tooth for many months. When they screwed in the fake tooth three weeks ago it hurt like mad-then the area just below my nose hurts when I put pressure on it at all- do you suppose a nerve is hit or, the implant is too long and I am certainly thinking about a second oppinion- my dentist wants to go ahead and put in the permanent tooth and I say wait- is pain at the time the tooth is screwed in normal? Should I give it much more time? So pain when the tooth is screwed in and pain at bottom of nose. No pain the first few months that the implant was healing. What do you think Thank you!
Posted by: Pat | Oct 7, 2006 11:01:24 PM
Help 7 months ago I had 2 implants put in on the left
lower side @ days later I was in pain and having shocks in chin. My teeth gums lip and chin were numb. I had the doctor removed 1 implant 2 days later and as he removed it I almost flew of the table that is how bad it hurt. He then put a shorter one in. Well about a week went by and I was still in so much pain and i had him removed the 2nd implant. Over the last 7 months i have regained almost all my feelinf back in chin lip and gums and about 3 weeks
ago regaind more feeling in my
teeth but I live in pain every day Im on lyrica and tramadol. Why have I made great improvement in regaining
feeling but still deal with the pain most of my pain is in my teeth a twisting pulling
knawing feeling. also when my upper teeth hit the bottom ones i feel the nerve move in my lip and chin.
Posted by: | Oct 31, 2006 6:06:43 PM
I just had an implant placed in my lower jaw 12/28/06. I phoned my oral surgeon 12/30/06 concerned with the numbness of my lower front teeth, chin, and lip. My lip also periodically has a burning sensation. He attemmpted to assure me that he had not hit a nerve and that I would regain feeling within a couple of months. Everything I have read contradicts his assessment. He also reminded me that there was a 5%chance of this and that I had signed the forms acknowledging this. Is he just covering his rear or what? It seems if I take the wait a couple of months and see attitude, I am asking for permament damage rather than slow recovery. I really want to believe my doctor....Should I???? kathy
Posted by: kathy | Jan 1, 2007 6:11:31 PM
Kathy, Your gut feeling is right, Your doctor is wrong. Seek the advice of a 2nd opinion ASAP. From a dental implant injured patient.
Posted by: Mary MacKenzie | Jan 8, 2007 11:04:36 AM
I had a dental implant a week ago yesterday (Friday). I still have severe throbbing, pain in my jaw and it even spreads to my upper jaw and nasal cavity areas. Is this normal? When will the pain stop? The implant was a bottom front tooth. I apologize that I cannot be more specific, but I do not know the medical name for the tooth.
Posted by: Olivia | Apr 28, 2007 8:19:52 AM
My doctor suggests that I get a molar removed but I can't decide on how I would like to replace this tooth. I have read so much about people losing sensitivity in the face and I am I scared to go forth with implant surgery. However I don't want to lose bone mass in that area and don't want to ruin a perfectly good tooth adjacent to it by gettting a bridge in place, what is my best option? I am only 22 years old and I am scared that by leaving the space empty I will suffer in the future for bone loss. Thank you.
Posted by: Cristina Medeiros | Apr 30, 2007 6:42:39 AM
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