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


OBJECTIVE
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.


CONCLUSIONS
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.
Department of Oral Surgery, King's College London Dental Institute, London. nadine.khawaja@kcl.ac.uk
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Khawaja
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Renton
D000328:Adult; D002908:Chronic Disease; D002985:Clinical Protocols; D020209:Cranial Nerve Injuries / Q000150:complications / Q000209:etiology* / Q000601:surgery; D003758:Dental Implantation, Endosseous / Q000009:adverse effects*; D020878:Device Removal; D005157:Facial Pain / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D061221:Trigeminal Nerve Injuries