Dental Implant Impinged On Nerve

Q. Dr. James asks :
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?

Commend:

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 patientbut the point is we never wait 14 days otherwise the damage is extensive and long lastingI 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

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