JIACD
The Journal of Implant & Advanced Clinical Dentistry
Nerve Injury Management: What is your short term and long term treatment protocols
Mon, 04/05/2010 - 06:28 — inveptirrinia
I recently hit the mental nerve with a immediate implant. I took all the precautions prior but still made an error. I removed the implant and grafted. The patient complains of numbness and tingling. What should be my short term and long term treatment options to aid the patient? Steriods? Management? Prognosis?
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Comments
Nerve injury management
Great question, I be curious to hear opinions. The Lit has many different protocols, hard to know whats best.
nerve injury
It has been my experience and advisement to inform the patient, that any dysthesia should be closely monitored. The problem being that the determination of the severity of the injury predicates the requirement for surgical intervention. If the practitioner waits too long to intervene, the chances for surgical correction may be compromised. I would say that an intelligent waiting period would be two weeks (a month at the absolute maximum) for the patient to report any improvement or lack thereof. I t may take as long as six months for a nerve to heal. In the absence of significant improvement, an assessment by an oral neurosurgeon should be accomplished.
Nerve Injury Management
In my experience, the key to nerve management is to act quickly and reduce inflammation. If an implant is causing the nerve injury, it needs to be removed within 36 hours placement. The patient must be put on meds to reduce inflammation at this time as well. I have found this to work very well. If the nerve is actually injured such as cut, severed, etc. you have an entirely different set of problems.
management of nerve injury
One more thing from sinuslifter's adivce,
I have some similiar cases too. I recommend you to give patitent Vit B12 for a few months.
Vit B 12 is known to help nerve regeneration.
Most of case can be normal within 3-6 mns if nerve was not damaged severely.
Mental nerve injury
Four months ago i placed a fixture right on the mental nerve in the 4-5 area. Initial patient complaint was numbness, followed by pain [I guess after feeling started to come back].
Now she complains of extreme sensitivity to cold e.g. breathing in early mornings etc.I am not sure where is this heading. The implants are fully integated
Mental nerve injury response
I had a similar case last year. I placed an implant at site 20 where, unbeknownst to me, was the elusive double mental foramen. Ugh! On the pano, you could definitely see the IAN and MF #1, but you could not really notice anything out of the ordinary coronal to the main mental foramen (which is where MF #2 was). I placed the implant and upon my final film, it looked like the implant was sitting on top of the MF. This puzzled me because I knew I was well short of the MF I saw in the original periapical radiograph and pano. I then thought to myself, "That is either a large marrow space, or a double mental foramen."
I called the patient later that night when I knew the anesthetic should have worn off. The patient said that he was still numb. Yep, it was a double mental foramen! I told the patient to return to the clinic the next morning. I completely removed the implant. Prior to removing the implant, the patient noted numbness of the lip. As I removed the implant, the sensation changed from numbness to a significant burning feeling. I placed enamel matrix derivative into the osteotomy, and placed the patient on high dose steroids. I wanted to do all I could to reduce inflammation. EMD has antiinflammatory properties according to some lit. Over the next 3 months, the patient's numb lip improved with full sensation returning to all areas except one spot about the size of a pin head.
After the original implant site healed, I went back and placed an 8mm implant without issue.
I fully believe that controlling inflammation and early intervention is the key when dealing with nerve injury. Of course, if you fully transect the nerve, that is not going to work. Most implant injuries to nerves are compression injuries, however.
mental nerve injury
This may be developing to a reflex sympathetic dystrophy.
mental n injury
You did the right thing Ti Doc.
Nerve injury management: Protocols
Protocols are limited. You need to remove the insult, if the nerve is transected it as to be reattached, I usually use some type of stem cell like hip aspirate to aid in healing.
Steriods like predinose are key in reducing inflammation and long term affects. Ultimately it may come done to the nature of the nerve injury in looking at the long term prognosis.
Tim
Nerve Injury
Ti Doc: You did a good job. Loma Linda's docs have published some lit on this issue.
Nerve injury issue: What is the success in getting back feeling?
WHen do you start the steriods? If patient needs surgical intervention what is the success of getting feeling back or is the patient doomed?
Nerve injury Management: Phentolamine Mesylate
Great article in this months compendium on the use of oraverse in to manage nerve damage by Stu Froum and Malamed. Definitely worth a read.
Nerve injury Management: Oraverse case in point
I did a a implant in the number 20 position and was to close to the mental nerve. I used oraverse in the case to see and realized I was sitting on top of the nerve. I backed the implant out a turn which immediatley gave the patient relief. Oraverse made the immediate difference in diagnosis.
The patient is doing well and the implant is being restored.
Nerve Injury Management
The area about the mental foramen/ bicuspid region does have a risk of paresthesia. Sometimes avoidance is the best policy. Not to say you did anything incorrect. I think you managed the case nicely.
I think you did great job.
I think you did great job. You did right thing but as the patient is complaining problem then you should re-examine him so that you can be able to diagnose the problem.
Powerplate
Personal Trainer
Medical Negligence Injury
If you feel you are a victim of medical negligence, then be wise to contact a compensation lawyer immediately!
It’s hard to find
It’s hard to find knowledgeable people on this topic, but you sound like you know what you’re talking about!
Thanks & Regards,
Trampolines
Wonderful, it made a great
Wonderful, it made a great platform for those people who are facing such kinds of nervous system problem in their daily life. It absolutely gave good tips for LifeStyle Health Fitness to those.
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