Mandibular Nerve Neurosensory Impairment After Dental Implant Surgery: Management and Protocol

Abstract

More than 70% of dentists have experienced patients with postoperative paresthesia/dysesthesia or anesthesia as a result of dental procedures. The most common nerve affected is the mandibular nerve, which may be injured during either implant surgery or bone grafting procedures. However, no organized protocol directed specifically for general dentists, or for the vast majority of specialists, has been published. The protocol presented in this article is divided into 5 periods: during surgery (1) nerve injury is suspected or (2) known nerve transection, post-operative period (3) 1 week and (4) 12 weeks. The appropriate treatment (pharmacology, monitoring, etc.) for each period is suggested, including the referral to a nerve specialist when appropriate.

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

“…A detailed consultation with a full explanation of their symptoms and nerve injury seemed to alleviate many concerns and anxieties, as seen by the 13 patients in this study who were discharged after 2-4 consultations. Early referral to a nerve specialist, as also suggested by Misch and Randolph, 37 is therefore helpful for the management of patients with nerve injury. Honesty in estimating the likeliness of their injury improving also provides the patients with realistic goals.…”

A Survey of the Opinion and Experience of UK Dentists

“…The incidence of dental implant related nerve sensory damage (NSD) has been shown to be as high as 40% in past studies [8,11,[13][14][15][16][17][18][19][20] although at least one prospective large cohort study has shown that risk of TG injuries can be eliminated with meticulous attention to planning and observing good surgical protocols. [61] Nevertheless, the large variation in the reported incidence of NSD suggests that this serious complication of dental implant surgery has not yet been adequately evaluated and reported.…”

“…[1][2][3] TG injuries are characterized by neurosensory disturbances, such as pain, numbness or altered tingling-type sensations (paraesthesia), within the teeth, skin and the mucosa. [4][5][6][7] The inferior alveolar nerve (IAN) and mental nerve (MN) and the lingual nerve (LN) are the most commonly damaged nerves during dental implant treatment [6,[8][9][10][11][12] with some studies reporting an incidence rate of up to 40% of nerve damage following implant placement surgery in the mandible related to the depth and the width of the implant bed preparation. [8,11,[13][14][15][16][17][18][19][20] Local anesthetic injections also cause TG damage due to mechanical or chemical injury.…”

“…[4][5][6][7] The inferior alveolar nerve (IAN) and mental nerve (MN) and the lingual nerve (LN) are the most commonly damaged nerves during dental implant treatment [6,[8][9][10][11][12] with some studies reporting an incidence rate of up to 40% of nerve damage following implant placement surgery in the mandible related to the depth and the width of the implant bed preparation. [8,11,[13][14][15][16][17][18][19][20] Local anesthetic injections also cause TG damage due to mechanical or chemical injury. [8,20,[24][25][26][27] Hemorrhage within the inferior dental canal (IDC) can cause chemical nerve injury (related to the iron content in the hemoglobin directly irritating the nerve tissue), or damage due to direct mechanical pressure and indirect ischaemia.…”

“…[25,[27][28][29] TG injury may also be caused by bone graft harvesting, [30] third molar surgery, endodontics, ablative surgery, trauma, thermal stimuli and ischaemia, and orthognathic surgery, or a combination of these etiologies. [3,4,8,11,27,[31][32][33][34][35][36][37] Iatrogenic TG injuries may result in a neurological deficit ranging from total loss of sensation (anesthesia) to a mild decrease in feeling (mild hypoesthesia), troublesome altered sensation (dysesthesia). [4,21,[38][39][40][41] whereby up to 70% of the affected patients can have pain.…”