Dental Implant Impinged On Nerve

Dr. James asks us:

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?

52 thoughts on “Dental Implant Impinged On Nerve

  1. 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.

  2. 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.

  3. 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.

  4. 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 patient
    but the point is we never wait 14 days otherwise the damage is extensive and long lasting
    I have many cases treated this way and so far we have not lost the implants

  5. The mistake you should avoid at first,in fact you should extract it immediately or change into 10mm length implant.In my experience I never care about the lower nerve because I never compress it by the implants.once you make a hole on the nerve,you should immediately change a shorter implant.
    sincerely,
    Song Guang-bao

  6. I would never place a 12 mm implant in the mental foramen area. It is a kiss of death. Why sleep with this kind of sickness over 6 month. I just heard a case where patients actually sued the dentist under fraud and not malpractice does not cover it. Most importantly, please try to protect one another and not to just encourage everyone and their mother to file a law suit….

  7. if you have the slightest numbness and an XRay with impingement remove the implant and after recovery of the nerve replace it with a shorter one
    this is the safest way to proceed

  8. Medical/Legally after 4 months of no improvement the
    patient shold be offered the
    opportunity for nerve repair
    and I agree with referring
    to Dr. Kaban for a consult
    aleast.

  9. please give us more details about the pain charachter,also the sensorry test of the nreve.the history you are giving is not matching with nerve injury

  10. The implant should ALWAYS be removed if paresthesia persist of the local anesthetic should have worn off. The reason is the nerves blood supply is being cut off leading to irreversible damage. Nerve repairs are best addressed within 3 months of injury. Make sure you referr to someone with A LOT of microsurgery repair experience like Dr. Zuniga at UNC or Dr Kavan. Good luck.

  11. i had this a few years ago, and my oral surery friend said to remove the implant immediately(about 3 days after i placed it)-we then monitored the patient for about 3 more months using the “q-tip directional test”. every few weeks we would have the patient in and take a slightly frayed q-tip, have the patient close their eyes and then lightly! brush the q-tip 5 different times in different directions(left to right and right to left). do this at the lip line , mid chin area and angle of the jaw-record your findings -for example “patient was right at determining the direction 0 out of 15 or 15 out of 15. when we started the first week it was 0/15 and each week it got better, until at about 2-3 months it was 15/15. if it had not improved after 3 months we would have referred for consult on nerve grafting, but even this usrgery is only about 60% succesful.

  12. I have a missing molar in the bottom portion of my mouth. It does not show when I smile, and I have no bone loss. It has been missing for 20 years. I’m encouraged by my dentist to have an implant – Cost $3600.00. I am very happy to leave well enough alone. Would appreciate any comments regarding this. Looking forward to hearing from you.
    Thank you!

  13. I had a two dental implants placed in the upper right side of jaw. Prior to final surgery; placement of abutments, I felt odd sensations and numbness on upper and lower lip. Also pain felt in second implant site and in a root canaled tooth near implant site. I am sure I have developed nerved damage, as a CT scan revealed the implant was placed in bone at an agle and penetrated aveolor ridge. Should I have the implant removed or will it make matters worse? I am in horrendous pain all day long. Thanks!

  14. It sound to me like a neuroma, neuromas can be treated with the same or similar medications that trigeminal neuralgias are treated. The problem is actually that after surgeries in sensitive areas are finished, a final RX should be taken, in fact, RX of the pilot drill should be taken two mm short of the intended depth to make adjustments of depth to protect the patient.
    we should never work so closed to structures, it is not worth it unless there is no other choice.
    If we hit a structure and take an RX, immediate removal or immediately backing the implant up a few mm will decrease the risk of permanent damage.
    I truly believe your patient will improve, slowly but it will improve, it is already improving.
    I would get second opinions for different reasons but I would question surgical intervention since patient is already showing improvement.
    Noshir mehta and Dr Scrivani at the Pain center at Tufts dental school are experts in the conservative management of a situation like the one you are describing.
    you can reach them at 1 617 636 6817.
    Good luck,
    Dr Ordonez

  15. A month ago I had two dental implants done on each side of my lower jaw, both molars, on my left side it healed quickly and no problems. On the right side I have half my chin and lip numb… it has been over 30 days and there is still some numbness (no pain) but there is a prickling feeling in the numb chin and lip. Does this mean that the feeling is coming back? I hope so.

  16. I had an implant 6 weeks ago and have been experiencing numbness and pressure in the tooth immediately adjacent to the implant site. I’m being referred to an endodontist.
    Is such numbness and pressure common? What could be the possible cause and treatment?
    Thanks so much!

  17. Have you notified the dr that put this implant in? If not, you should do. Is it upper or lower the implant? Where are the areas of numbness? Any pain? Please let me know further information. Thank you.

  18. I have had an implant in upper front tooth for many months. When they screwed in the fake tooth three weeks ago it hurt like mad-then the area just below my nose hurts when I put pressure on it at all- do you suppose a nerve is hit or, the implant is too long and I am certainly thinking about a second oppinion- my dentist wants to go ahead and put in the permanent tooth and I say wait- is pain at the time the tooth is screwed in normal? Should I give it much more time? So pain when the tooth is screwed in and pain at bottom of nose. No pain the first few months that the implant was healing. What do you think Thank you!

  19. Help 7 months ago I had 2 implants put in on the left
    lower side @ days later I was in pain and having shocks in chin. My teeth gums lip and chin were numb. I had the doctor removed 1 implant 2 days later and as he removed it I almost flew of the table that is how bad it hurt. He then put a shorter one in. Well about a week went by and I was still in so much pain and i had him removed the 2nd implant. Over the last 7 months i have regained almost all my feelinf back in chin lip and gums and about 3 weeks
    ago regaind more feeling in my
    teeth but I live in pain every day Im on lyrica and tramadol. Why have I made great improvement in regaining
    feeling but still deal with the pain most of my pain is in my teeth a twisting pulling
    knawing feeling. also when my upper teeth hit the bottom ones i feel the nerve move in my lip and chin.

  20. I had sinus lift and implant placed on #14 (upper left) on 1-15-07 and all healed well within 4 weeks. The site felt great for another 3-4 weeks, then I developed a pain, that feels deep in cheek bone above implant. Implant specialist and general dentist are monitoring, new x-ray shows small black spot at top of implant that was not present at placement. Sometimes, lightly touching the cheek lessens the sensation of pain. Specialists are not sure why all healed well, then many weeks later this issue developed. What could it be? Any advice? The abutment has not yet been placed, while we wait to see if this resolves itself.

  21. I got bone grafted in my front upper jaw Feb. 28 using the bone from my hip, today is May the 6th. and my upper left lip still feel numb, i am due to go back for the screw implant in June. Is this normal or is something wrong?

  22. Dr. Roger Meyer in Atlanta as previously mentioned. He does repairs and grafts 150 cases or so a year and is well published. Seek treatment now. To the OMFS, give me some literature on nerve repair with vitamins. Please. Im stumped. Bill

  23. Why am i not finding any respones to the patients that have had nerve damage such as myself? i had two implants back left and bone graft numbness after 5 days took one implant out lifted the other and felt nothing so doc left that one in. the one that was on the nerve or severed it i almost flew out of the chair still cannot feel my chin left side or teeth and left side of lip. some tingling going on. Asked doctor if i should get an c scan or mri and he was like maybe we’ll see i go every week to check numbness. one month still numb should i go ahead and get the implant back in (or wait if so how long) a shorter one since the 7mm was on the nerve and move forward i want my implants but an nervous. trust the doc.

  24. I had crown (gold) placed on my upper left tooth. I have since experienced numness in my (left)upper lip and nose/nostril. I had never had a gold crown and have never experienced this numness for over 3 months. Maybe someone who has gone thru this can help. Did my nerve get damaged by this crown? It is is a large crown.
    Thank you.

  25. I had a dental implant placed lower left side first molar on Jan 2nd. I had throbbing pain for days immediatley following the surgey. The pain gradulally got worse and worse until it was almost unbearable. The implant was removed four weeks later. I experienced excruciating pain and bled alot during the removal. There was a perforation of the bone causing an abscess to form under the jaw bone. The pain has lessened considerably but I am having a constant dull ache in the implant area radiating outward to my ear. I am currently taking 500 mg of pennicillin and vicodin for the pain. I am worried that I will be left with chronic pain. I know it’s only been one week but I would expect to be almost pain free at this point. Please comment and advise. Thank you.

  26. I wanted to know if there is any way to repair nerve damage from a dental implant surgery. I had surgery performed 18 months ago. After horrible pain during the first week the implant was placed, the doctor finally removed the implant hoping the pain would stop, thinking the screw was just sitting on my nerve. Turns out 18 months later and one implant removal that the pain is still here. My lower left side burns, tingles and is numb on my teeth, chin, and lip. The place where the implant was done cannot be touched with a tooth brush or when I get my dental cleanings because of the pain. I would like to get the nerve repaired, just not sure where to go or who to call. Any suggestions..I am willing to travel.
    Thanks.

  27. To Theresa,
    I don’t think this kind of damage can be repaired. But sometimes it is possible to relieve your symptoms by some treatments. I would refer you to a doktor specialised in neurology. They know best about neuroplastic changes and pain and how your options are to relief your symptoms.
    Good luck

  28. Hi Theresa,
    It figures that the implant has caused something called Axonotmesis or Neurotmesis. The repair for the former is possible though extremely slow.
    Sometimes a drug called Methycobalamine helps.
    Other than that you may con tact a surgeon trained in neural repair.

  29. I also have symptoms as Theresa described but involves more nerve pain on right side of face with implant surgery 15 months ago. Implant is still in tact. I am still learning what triggers cause flareups, most often from oral/external heat and pressure on implant and surrounding tissue. Through research and with trial and error I have had some relief but medicate with Lyrica when intolerable.

    I have been to a neurologist for a poorly executed evaluation. How can a “mesis” type injury be identified for proper treatment, through film or can an EMG trace improper nerve sensation? And how do you know if a neurologist is qualified for this discipline of medicine since most would understandably feel touchy with insinuating type questions?

    Thank you.

  30. Finally someone else is talking about nerve damage. Thank you… I have been trying to get advice for several months. The burning pain never subsides on # 4 site implant. I have not been able to get the crown placed because of the burning. I have been to ENT x2, Periodontist x 2, Oral surgeon ( who placed the implant ) second opintions. Neurologist, general dentist, multiple antibiotics, Tegretol and Lamictal.

  31. HELP! At the advice of a local dentist, I had all of my upper teeth extracted about 7 years ago. The full upper denture was horrible and never fit right. After about 6 months I stopped wearing it altogether. It is impossible to eat healthy foods or even be seen in public. I have a few teeth left on the bottom – decided to get them extracted, get dentures (both top and bottom) and have the dentures implanted. PROBLEM: I’ve been to 3 dentisits. Dentist #1 told me he would extract my teeth, do bone grafting, put in traditional implants and the dentures all in the same day. No big deal and out the door I go. Dentist #2 told me he would extract my teeth, put in mini implants and the dentures all the same day. Said I didn’t need bone grafting but the mini implants were better than the traditional. Dentist #3 insisted I get a CT Scan, then told me he would have to do bone grafting and the process would take about 6 to 9 months. No way a one-day job. HOW CAN 3 DENTISTS ALL LOOK AT THE SAME PANO-REX AND THE SAME MOUTH AND COME UP WITH 3 VERY DIFFERENT TREATMENT PLANS. I am so confused and discouraged. I don’t know who to trust or what to do. I am now becoming fearful of the possible nerve problems that can develop when the implants are placed. Any and all advise is very greatly appreciated.

  32. I have had 3 implants (lower jaw) for several years, due to periodontal disease I visit my dentist every 3 months, we are constantly fighting pockets on and around that area with cleanings,surgeries etc.. I have lost quite a bit of tissue, and often have pain bleeding and inflamation on the site, lately I am having jaw, ear and throat pain on the implant side, my dentist doesn’t seem to think that it is related. Can somebody please comment on that… can implants be removed after all these years??? and is the surgery very complicated?

  33. I Just had two implants done on #19 and 20 in the bottom left jaw on 24th July,2008. At present, I have slight numbness on my bottom left half of my lip. Also very low dull pain at the implant sight. I started to feel slight electrical current below bottom lip. My doctor wants to wait a fews days and evaluate. She thinks she has not touched the nerve on # 20 where she had to go deeper. Any suggestions ?? Thanks

  34. you should ask to get a copy of the post operative x-rays, and take them to an oral surgeon right away. with nerve injuries, time is very important. do what the oral surgeon tells you, they are the experts in these situations.

  35. Hi,
    I never hear any talk about the Marius Bridge. It sounds like a great alternative for someone who does not want or cannot have bone grafts.
    I would appreciate any comments regarding this type of bridge or anything similar.
    thanks so much.

  36. The Marius Bridge is strickly for the upper maxillary. Marius Bridge was specially created for upper jaw reconstruction. The denture treatment utilizes proprietary technology for creating tooth replacement and it gives you choices that offer the rock solid stability of implant support prosthesis while enabling patients to remove the prosthesis for routine cleaning. The cost attached normally is around $5,000.00 depending on the dentist and location.

  37. I had pain in lower rt jaw that could not be duplicated by blasts of air, cold water, etc. After removal of the wisdom tooth, and re-working of the 40-yr old root canal, I still have unbelievable, horrible episodes of pain-usually when I start to eat. I am taking Tegratol, and it helps some, at least pain doesn’t destroy me when I start to talk, etc. The pain is excruciating, but brief–usually about 30 seconds. I know nothing of anatomy-Could the root canal roots be “into” that nerve (trimingual) or what is it.Also the tooth with the root canal is one of a three tooth bridge, also 40 yrs old. mary

  38. Hello,
    I have just had an implant put in on the top right and a veneer on the tooth next to it. I had no problems at all until after the crown was fixed onto the implant. I started to feel numbness in my top and bottom lip. Have told my dentist but he hasn’t said anything yet. Has anyone else have the same problems??It is not painful – just on and off numbness.

  39. on Oct 21 2008 i had #16 removed and my dentist put an implant in at the same time .I had lots of burning pain and swelling pain i went back to my dentist many times and he just kept telling me to Waite.but the pain was to much so i went to an Os who removed the implant the next day .at this point it had been in for 5 weeks.6 days after the implant removal the pain was back .i have a burning pain along the left side of my mouth and gums some times it even feels like i have scalded my toung.im now seeing a consulting Os who has me on lyrica and amitriptalyn so it has now been 4 months and i don’t see improvement i asked if there’s any thing i can do and all i get is “hope it goes away” I have 2 small children and don’t know how long i can go on like this .I’m taking vitamin B NERVE SUPPORT formula and i go to acupuncture .please help me Kim

  40. Ten months ago, I had two lower left implants. I am still as numb and tingly as day one. Despite complaints to the oral surgeon, all she has to say is, “It requires the tincture of time.” I would’ve thought that nearly a year should be sufficient. I am chronically miserable as eating and even talking are no longer fun due to the numbness. I even occasionally drool from the left side of my mouth since I cannot feel it. Do I have any recourse?

  41. Very lucky to have come across this website! I just had a CT scan done 10 days ago to prepare for 2 dental implants. My dentist sent the scan out for a second opinion (right thing to do) due to the fact that he thought the nerve was large and close to where the implants will be embedded. I have looked up nerve re-positioning and have decided it would be something that I do not want to do. So, thanks to all the reading I have done on this site, I think I will opt for a bridge!

    DS

  42. Kim, how are you doing? I lost an implant due to infection and now require bone grafting. im depressed.

  43. As a retired Medical Case Manager, I am aware of a growing number of people who have taken lyrica for period > 6 mos who also report a loss of tooth enamel. Can anyone correlation between the two? Are are there other common issues with both demographics (Lyrica users & Tooth Decay)?

  44. estou para fazer 4 implantes na mandibula e o dentista me disse que pode ter problemas com o nevo sensivel e que pode ficar insesivél por algum tempo ou para sempre. Estou em duvida se faço o implante depois desta noticia, estou querendo desistir.
    Alguém poderia me ajudar a respeito.
    grato, Marcos

  45. in case of nerve impingment,we should unscrew implant about 1-2mm to relieve the nerve as soon as possible from second day of procedure ,the result will be fine for sure good luck!!

  46. I had two 3 and 4 upper implants, after 4 months I went in for the abutment. Periodontist said I needed some bone, no abutment. For the last 4 months, I have had skull pain, (explosion, brain inflamation) tremors, palpitations, feeling of vomit. No fever, sleeplessness nights. I had all kinds of test, mri, nuclear bone, 14 x rays, ultra sounds, been to cardiologist, neurologist, ent, and infectious dr. I returned to my perio and he said he has no idea what it is. ct scan was done,(5 weeks ago) and I have yet to get the report ) I said I think it is a nerve. Dr. said oh no there is no nerve near there. I think he thinks I fell out of a tree. What kind of a dr. should I see for nerve damage? I want to have the implants out now, but I am so frightened that it may exacerbate my condition.

  47. I had 3 implants on left lower side a week ago. I can actually see the metal implant on the front one and it hurts like the dickens. Has anyone had pain in the hip from nerve damage during dental implants? My hip is really killing me, too. It never hurt at all until the implants were put in.

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