Key Points
-
Outlines types of nerve injury including those that might result from implant placement.
-
Describes techniques for assessing implant related sensory disturbance and recovery.
-
Recommends best management of suspected or actual implant related nerve injuries and treatment algorithm.
Abstract
Introduction Nerve injury during implant placement is a preventable, serious complication with major medico-legal implications. The incidence of implant related inferior alveolar nerve (IAN) injuries varies from 0-40%. This article presents four cases of IAN injury following mandibular implant placement with early removal, referred to the oral surgery department, King's College Hospital, London.
Objectives To assess sensory disturbance and recovery in patients with implant related IAN injury and assess whether early removal of the implants promotes neural recovery. To present recommendations on how to best deal with suspected/actual nerve injuries and prevent their occurrence.
Methods Over the last two years, four patients referred for specialist opinion to the oral surgery department were identified as having sustained implant related IAN injury with early removal (18 hours to four days post-injury). Data were collected by referral to health records.
Results All patients suffered from numbness of the affected inferior alveolar dermatome with three out of four cases also experiencing some form of neuropathic pain. Cases 1 and 2, who had their implants removed at 18 and 36 hours post-injury respectively, regained almost complete sensory recovery. Case 1 also had adjunctive NSAID and steroid therapy. Cases 3 and 4 suffered complete numbness in the inferior alveolar dermatome and did not experience any improvement in sensation following removal of their implants at two and four days post-injury respectively. Both patients with significant persistent neuropathy (Cases 3 & 4) reported functional problems.
Conclusion This cohort of patients may demonstrate that early removal of implants associated with IAN injury (less than 36 hours post-injury) may assist in minimising or even resolution of IAN neuropathy. Adjunctive corticosteroid and high dose non-steroidal anti-inflammatory therapy also appears effective. Implant related IAN injury is a preventable, elective procedure and a suggested protocol of management of suspected injuries, for dental practitioners, is presented.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Caissie R, Goulet J, Fortin M, Morielle D . Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience. J Can Dent Assoc 2005; 71: 185–190.
Ziccardi V B, Assael L A . Mechanisms of trigeminal nerve injuries. Atlas Oral Maxillofac Surg Clin North Am 2001; 9: 1–11.
Kiyak H A, Beach B H, Worthington P, Taylor T et al. The psychological impact of osseointegrated dental implants. Int J Oral Maxillofac Implants 1990; 5: 61–69.
Abarca M, van Steenberghe D, Malevez C, De Ridder J, Jacobs R . Neurosensory disturbances after immediate loading of implants in the anterior mandible: an initial questionnaire approach followed by a psychophysical assessment. Clin Oral Investig 2006; 10: 269–277.
Delcanho R E . Neuropathic implications of prosthodontic treatment. J Prosthet Dent 1995; 73: 146–152.
Rubenstein J E, Taylor T D . Apical nerve transection resulting from implant placement: a 10-year follow-up report. J Prosthet Dent 1997; 78: 537–541.
Wismeijer D, van Mass M, Vermeeren J, Kalk W . Patient's perception of sensory disturbances of the mental nerve before and after implant surgery: a prospective study of 110 patients. Br J Oral Maxillofac Surg 1997; 35: 254–259.
Bartling R, Freeman K, Kraut R A . The incidence of altered sensation of the mental nerve after mandibular implant placement. J Oral Maxillofac Surg 1999; 57: 1408–1410.
Walton J N . Altered sensation associated with implants in the anterior mandible: a prospective study. J Prosthet Dent 2000; 83: 443–449.
Von Arx T, Hafliger J, Chappuis V . Neurosensory disturbances following bone harvesting in the symphysis: a prospective clinical study. Clin Oral Implants Res 2005; 16: 432–439.
Hegedus F, Diecidue RJ . Trigeminal nerve injuries after mandibular implant placement – practical knowledge for clinicians. Int J Oral Maxillofac Implants 2006; 21: 111–116.
Hillerup S, Jensen R . Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg 2006; 35: 437–443.
Worthington P . Injury to the inferior alveolar nerve during implant placement: a formula for protection of the patient and clinician. Int J Oral Maxillofac Implants 2004; 19: 731–734.
Greenstein G, Tarnow D . The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol 2006; 77: 1933–1943.
Shankland W E . Anatomical considerations for mandibular implant surgery. 2. Two common post-operative problems. Dent Today 1991; 10: 48–9, 51.
Arzouman M J, Otis L, Kipnis V, Levine D . Observations of the anterior loop of the inferior alveolar canal. Int J Oral Maxillofac Implants 1993; 83: 443–449.
Von Arx D P, Simpson M T . The effect of dexamethasone on neurapraxia following third molar surgery. Br J Oral Maxillofac Surg 1989; 27: 477–480.
Pogrel M A, Thamby S . Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Am Dent Assoc 2000; 131: 901–907.
Pogrel M A, Maghen A . The use of autogenous vein grafts for inferior alveolar and lingual nerve reconstruction. J Oral Maxillofac Surg 2001; 59: 985–988.
Haas D A, Lennon D . A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc 1995; 61: 319–320, 323–326, 329–330
Hillerup S . Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig 2007; 11: 133–134
Nazarian Y, Eliav E, Nahlieli O . Nerve injury following implant placement: prevention, diagnosis and treatment modalities. Refuat Hapeh Vehashinayim 2003; 20: 44–50, 101.
Elian N, Mitsias M, Eskow R, Jalbout Z N et al. Unexpected return of sensation following 4.5 years of paresthesia: case report. Implant Dent 2005; 14: 364–367.
Robinson P P . Observations on the recovery of sensation following inferior alveolar nerve injuries. Br J Oral Maxillofac Surg 1988; 26: 177–189.
Robinson P P, Loescher A R, Smith K G . A prospective, quantitative study on the clinical outcome of lingual nerve repair. Br J Oral Maxillofac Surg 2000; 38: 255–263.
Blackburn C W . A method of assessment in cases of lingual nerve injury. Br J Oral Maxillofac Surg 1990; 28: 238.
Mason D A . Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 1988; 17: 290–294.
Zuniga J R, Chen N, Phillips C L . Chemosensory and somatosensory regeneration after lingual nerve repair in humans. J Oral Maxillofac Surg 1997; 55: 2–13.
LaBanc J P, Van Boven R W . Surgical management of inferior alveolar nerve injuries. Oral Maxillofac Surg Clin North Am 1992; 4: 425–437.
Author information
Authors and Affiliations
Corresponding author
Additional information
Refereed paper
Rights and permissions
About this article
Cite this article
Khawaja, N., Renton, T. Case studies on implant removal influencing the resolution of inferior alveolar nerve injury. Br Dent J 206, 365–370 (2009). https://doi.org/10.1038/sj.bdj.2009.258
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bdj.2009.258
This article is cited by
-
Developing evidence-based clinical imaging guidelines of justification for radiographic examination after dental implant installation
BMC Medical Imaging (2020)
-
Macrophages in trigeminal ganglion contribute to ectopic mechanical hypersensitivity following inferior alveolar nerve injury in rats
Journal of Neuroinflammation (2017)
-
Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome
BMC Oral Health (2017)
-
Trigeminal nerve injuries after mandibular oral surgery in a university outpatient setting—a retrospective analysis of 1,559 cases
Clinical Oral Investigations (2015)
