Case studies on implant removal influencing the resolution of inferior alveolar nerve injury

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 identifi ed 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 signifi cant 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-infl ammatory 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.

Post-implant neuropathy of the trigeminal nerve. A case series.

“…Their injuries resolved fully suggesting that early removal may facilitate nerve injury resolution. This is indeed also recommended in a previous study 17 and supported by the fact that several patients in this study had their implants removed between 30 hours and 6 days and none made a recovery. This reinforces the recommended practice of undertaking 'Homecheck' with in 12 hours post surgery to enable the patient to report ongoing neuropathy, which may dictate early removal of the implant is required.…”

“…Appropriate planning, assessment and training should be undertaken in order to minimise injury. 17 Avoidance of nerve injury is sometimes attempted by using techniques including nerve lateralisation and alveolar distraction, however, these procedures are themselves high-risk, and may be more likely to result in injury. Interestingly, 25% of 110 edentulous patients included in a randomised controlled clinical trial presented with a degree of altered IAN function before implant placement, perhaps suggesting the need for pre-operative neurosensory evaluation.…”

Douleur neuropathique chronique suite à une chirurgie implantaire : à propos de 8 cas

“…Concernant les critères implantaires, nous avons observé ( [13]. Le rapport de cas de Leckel évoque également la pose de 2 implants en position 36 et 37 [14].…”

“…Ce qui paraît également intéressant dans notre cohorte est la proportion de cas de douleur neuropathique chronique post-implantaire au maxillaire, soit 37,5 % des patients (3/8 patients). La plupart des rapports ou série de cas [13,18,15,16] font référence aux douleurs neuropathiques chroniques post-implantaires suite à une lésion sur le nerf alvéolaire inférieur. Cependant la lésion du nerf maxillaire et ses branches distales doit également rester une priorité diagnostique, bien que l'imagerie ne soit pas pertinente dans ce cas.…”

A Survey of the Opinion and Experience of UK Dentists

“…[44] Adjunctive procedures are also sometimes attempted to avoid implant nerve injury. [45] However, previous studies have indicated that regardless of the surgeon's experience, these high-risk procedures that include bone graft harvesting, posterior alveolar distraction and nerve lateralization, may be more likely to result in participate through electronic postings. Finally, members of the British Association of Oral Surgeons (BAOS) were invited to complete the online questionnaire.…”