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Ask UsPersistent Numbness after Implant Failure
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PK, a dental patient from California, asks:
My wife had an implant failure and now she lost sensation on her lower lip and chin on the side of the dental implants. We are very worried and don’t know what to do. Any comments would be appreciated. Here is the history:
1. On May 21st, 2007, she had two implants put in to place tooth #30 and #31. After the surgery, her dentist told her that the implants were not planted deep enough but he will use bone graft to remedy that. There were some pain initially, but the pain went away after a week or so.
2. On July 16, 2007, she accepted her dentist suggestion of re-doing the implants. A surgery was performed. The implants were removed, the holes were drilled deeper and the implants were placed back.
3. On the next day, she called her dentist telling him that her numbness and the loss of sensation of her lower half lip and chin on the side of the dental implants. He said it was normal and she should wait for the numbness to go away. Later that day, he asked her to go to his office and he decreased the depth of the implants by turning the implants.
4. The numbness persisted the next day. She called the dentist and was told that she should wait a few days for healing.
5. On July 20th 2007, her dentist called again and told her that he had changed his mind after consulting with other dentist and suggested that the implants be removed. The implants were removed that day.
6. After the implant removal, her numbness continued. There were also burning and swelling sensation at her lower lip and chin.
7. On July 27, all stitches were removed. Her dentist told us that he did not think that the damage was permanent and she should wait for the recovery.
8. Right now, late August, her gum looks normal. The numbness and the burring and swelling sensations have not improved. The discomfort seems less in the morning but worsen as the day goes on.
Does anyone have any advice based on the above? Thank You.
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27 Responses to “ Persistent Numbness after Implant Failure ”
Can you tell me, were the implants placed by a general dentist, oral surgeon, periodontist or other practioner? I would want to see the xray taken afer the implants were placed. If they were placed into the nerve then the chances of sensation returning is lower than if they were placed near the nerve.
Take your wife to an oral surgeon for evaluation and follow-up: it’s important to follow the evolution of the “burning and pain” (called “dysesthesia”): if any surgery is warranted, should be considered in the first 3-4 months after the “accident”!
Let me know
Numbness following implant placement is not normal. The decision to try and place the implants deeper in all probability resulted in damage to the nerve. If the nerve was severed, there would be only numbness. When the nerve is intact but traumatized by the drill, the pain symptoms result. Ask to be referred to an Oral Surgeon at the University level for further evaluation. Dr. G
Who placed the implant is not nearly important as how it was placed. I had a similar case referred some 10 years ago, and involved implants placed in the lower and upper. The lower implants involved inappropriately placed pressed fixtures that impinged on the mandibular and mental nerves. My suggestion is to see someone for immediate evaluation and treatment. Normally, steroids and a combination of NSAIDS with neurotin is prescribed. The implant placement site needs to be evaluated carefully, and some type of imaging, possibly a tomographic scan to begin with would be appropriate. A competent oral surgeon with expertise in nerve injuries would be the best resource initially. Second opinions are normally a good idea, but the key here is to move forward quickly. The encouraging news is that most of these injuries seem to progress quite nicely in time. Action now would be most prudent, however.
I suggest you get all records possible and especially the x-rays. I would suggest a University level Neurosurgeon or Oral Surgeon who specializes in microsurgery. The best treatment may be either to use steriods to reduce swelling (if present) to reduce pressure on the nerves, or to attempt to reattach the nerves if severed. A MRI may be necessary to determine if there are severed nerves present.
dear sir,what has happened to your wife(if the information u give is accurate)is plain and simple:she met the wrong dental provider.it is very unfortunate but it is also true.the implants being placed too deep,have damaged the nerve of her jaw.this was a result of poor treatment planning and lack of experience.it happens sometimes.forget this dentist,disregard all offers to attempt to fix the damage done(surgically or pharmaceutically).the best you can do is:LEAVE IT ALONE.if she is lucky,the different symptoms will start to decrease with time and in the end will disappear for good.this usually takes 6-12 months.i have to warn you though that in some(few)cases,these symptoms persist for a life time(depending on the extent of the original damage).so,be patient!
DO NOT…I repeat…DO NOT leave this alone. You are waisting valuable time. Get to a microsurgeon ASAP and DO NOT WAIT!!! She needs to have a CT NOW and get the sensations recorded with 2 point discrimination mapped immediately by a neuromicrosurgeon and he should be determining the treatment at this point. Period. Surgery is usually indicated in three months if there is no improvement and often even if there is limited improvement. Nerve repair can range from just monitoring improvement to a harvested nerve graft. The 3 month window is for monitoring and mapping altered sensations and improvement is up. Thomas Kauffman is correct - who placed the implants isnt the issue at all. Recovery is and this is a very time critical situation in my view. I obviously do not agree with G.K. to wait. Wait for what? David, why did you want to know WHO did it? Why is that important to you? Just curious. Bill
To GK:
waiting more than 3-4 month is a missed opportunity (kind of “golden period”) if surgery is indicated (e.g., non-improving total anesthesia).
Hi PK,
The process of reconnection a severed nerve has the best prognosis if performed within 3-4 month of the injury, hence the prudent recommendation of seeking another opinion from a specialist ASAP. However, the surgical process of reattachment is not easy, hence the recommendation of doing nothing and hoping your wife’s nerve eventually heals. Since she has some feeling, i.e. “burning and swelling” it is likley the nerve is not completely severed. One way to evaluate healing is to mark with a colored pen the area on your wife that has altered sensation and take a photo. A couple of weeks later, repeat the process and determine if the area affected is reduced in size–a good sign that recovery will eventually occur. However, if damage is severe and irreversible without treatment, the longer you wait, the worse the prognosis for recovery. Therefore, the best answer to your question is to consult with an oral surgeon ASAP. I think that your first dentist was doing what he or she thought was in your wife’s best interest by going in the second time to place longer implants. Unfortunately it didn’t work out as planned. I believe you can still trust his or her judgement in recommending an oral surgeon with whom to consult regarding nerve damage. However if his or her recommendation is still to “wait” you must be insistant on a recommendation or choose an oral surgeon on your own.
Dear Sir,iam sure u must be very puzzeled reading so different comments and ideas about what your wife should do.Unfortunately this happens sometimes in the medical field.And patients suffer.I will not persist in trying to convince you that I am right and my colleagues wrong.Still,i am obliged to inform you that 5 different patients treated in different countries by different practicioners for the same problem with your wife(damage to the nerve due to different kinds of surgery),that i happen to know have ALL seen NO IMPROVEMENT in the symptoms they experienced before treatment.Some have even noticed considerable worsening of the symptoms.Ofcourse the different kinds of treatment have also improved ONE thing.The balance of the BANK ACCOUNT of the different doctors.
To George Koukos:
So, you know 5 cases (I’m impressed!!) and you make judgements: how many nerve repairs have you personally performed? Besides, this forum is not to show “I’m write and everybody else wrong”: it’s about solving together cases and help out people in tough times (and “solving” cases doesn’t mean accuse the other pratictioners, but help out: at some point in your career, mishaps happen….if you operate enough).
be well
to Omsjaw:dont know george koukos,dont know you omsjaw. i know george at least has the nerve to say his opinion giving his name without hiding behind a rediculous nickname like you.I also dont understand your assumptions and ironic remarks.Unfortunately,not all of us had the chance of studying at a PG program like OMS.Still,i believe we are entitled to an opinion especially when many times we encounter the mess created by the so-called specialists.Ofcoure mistakes can be cause by any practicioner and arguing about them doesnt help the patient.Still i completely disapprove the tone of your text Omsjaw.And something for the end:NEXT TIME YOU RUSH TO JUDGMENTS,BETTER CHECK YOUR SPELLING FIRST!
My wife and I thank you all for your advices and would like to update you with her conditions.
At the beginning of August, my wife and her dentist went to an oral surgeon for an opinion. The oral surgeon thought it was too soon to try to repair the nerve even thought the damage was apparent. He said that such repair sometimes did more harm to the injury so it was better to wait for a while before such attempt. He thought my wife’s condition will improve gradually but most likely she would not feel normally as before.
In the next month or so, my wife had burning and swelling sensation constantly even though nothing was visible. At time she also had strong tingling sensation. However, she seemed to be able to sense better when I test her by poking her with a toothpick. The area of complete numbness appeared to be shrinking slowly. But when she did sense the toothpick, she felt more like a static shock.
At the beginning of September, my wife visited a Neurologist. He told her that he thought her condition was improving and she will recover without any medical procedure. He said, however, her left chin and right chin probably will never feel the same. He prescribed a medicine but told her only use it when the discomfort is severe. My wife took the pill twice since but did not think it helped directly except caused her severe drowsiness and had to go to bed.
Today, Sept 27, she is still bothered by the burning and swelling sensation. She can feel me poking her most of the time but with a sensation of static shock. We do not plan to have surgical procedure of any kinds.
Sometimes we are very hopeful that she will completely recover, but we have serious doubt other times.
Dear Sir,i am glad to hear that your wife is experiencing some(even slow)improvement.Be patient,explain to your wife that unfortunately such injuries have a very slow(but almost certain)improvement.As i mentioned in a previous email to you,it may take 1 year for her to feel considerable improvement in the symptoms.What is VERY important is that there is a healing process according to the info you are giving us.It will take time…I am also glad to hear that both specialists you met showed a responsible attitude and BOTH discouraged you of attempting a procedure which would probably cause MORE harm to your already exausted wife.Wish you and wife all the best and would appreciate every feedback about her improvement in the future.
Hi, English is not my native language,so, I learnt it as a second/foreign language.Some times I have problem with understanding the real meaning of some statements like when PK says” She can feel me poking her most of the time but with a sensation of static shock”.Will somebody please let me know what he exactly means of POKING HER. Thank you.
dear DrJafari,english isnt my mother language either but from what i understand ,when PK says hes poking her using a toothpick, he means he is trying to test the sensibility his wife has in different areas of her gum by pinching her with a toothpick.A dental professional would use one of our instruments,PK uses what he has!Not a bad idea at all.At least thats what i understand from his email.Hope i answered your question.
merci bien et toutes mes amities, monsieur.
When your wife was seen, did the OMFS do a CT and perform a total mapping of the area in question? I am a general dentist and I think the oral surgeons comments here were related to a time sensitive decision. I would at least gone to a nerve repair specialist for an opinion. OMs jaw was trying to help solve. Bill
PK,
Hi i had the same thing happen to me over the past 2 months. My doctor wanted me to have a cat scan done before the placement of the two implants lower left back jaw. I did and he informed me that it was a tight area to work in but felt confident it would be fine. During surgery he decided to do a bone graft to smooth things out since i had a bridge so long the area was somewhat sunken. I had all the symptons you have right after surgery. Went back within a week removed the front implant and when it was lifted off the nerve i almost flew out of the chair (he unscrewed the back one and i felt nothing so he left it in) i do not know if that happened to you but in retrospect that was a good thing i think because it meant the nerve was not severed (i suppose)after the removal my doctor was very concerned saw me evey week or so poking around. I experienced several stages.
1)total numbness(eery deadness)) left lip and chin, gums and teeth
in front of the implant that was removed.
2)burning and pain and i think the swelling sensation you are referring to at the end of the day after talking all day.
3)I had a touch therapy session and got back about 20-30% of the feeling.
4)within 3 weeks i started to get tingling in the dead part of my chin and lip.
5) almost have full recovery still a little weird tingling but i can FEEL ALL PARTS THAT WERE NUMB!
I went back last week and had my implant (shorter than the 10 a 7)put in and everything is fine.
I was traumatized in the beginning but over the 8 week period i am almost back to full recovery. If i have to live with the little tingles i have which i feel confident will go away i would be happy with that and cannot wait to get my two new teeth. My doctor is exceptional and very expereinced. His total concern for my well being ( even when i was in my very angry stage) is a model for all performing implant surgery..patientance and the c-scan before.Good luck to you it sounds like you are getting better and going through all the stages i went through before getting all feeling back.
I had two implants placed in the lower right jaw (I don’t know the tooth numbers). During the week following the surgery, I had the same symptoms as PK’s wife: lost sensation on the lower lip and chin on the side of the dental implants.
I came back to the doctor one week after the surgery and he decided to replace one of the implants with a smaller implant because he thought the previous one was touching a nerve. I really don’t trust that that’s was the case. At the some time, he unscrewed the other implant.
Since he couldn’t place a shorter implant, he decided to close as is and wait for the healing process so the bone regain mass and can be drilled again (NICE!!!). He told me to come back for follow up in couple weeks and that the other implant can be placed in 3-4 months.
Something that noone mentioned and it happened to me: in the original implant, the drilling the dentist did, caused like an electric shock that made me jump off the chair even when that area was under full anesthesia!!. Now, even after the removal of one of the implants and the unscrewing of the other, I still have EXACTLY THE SAME SENSATION.
I’m really very concern about all this situation and I’m willing to do anything available to recover full senses in the lip and chin area.
The questions I have are:
1) How is PK’s wife doing these days?
2) If the implant was removed, isn’t suppose that the lost in sensation is going away immediately after the anesthesia goes away? Because I don’t see ANY IMPROVEMENT!
3) How about pain of any kind: did you feel any after the implant? If you dind’t LIKE I (I have never had pain after both surgeries) Isn’t that an indication that the nerve/s is/are damaged?
4) In those cases where visits to other specialists or second opinions are needed: Who paid for the expenses given that it might have been a doctor error?
Thank you all and Happy Holidays to you (because for me is going to be a nightmare until this problem is solved)
Mariano
Parasthesia is unfortunatly a fairly common thing in Dentistry
I have had a few cases particularly with wisdom tooth removal
This differs in that the wisdom tooth must be removed for various reasons and we have no choice so if the roots are close to the nerve, its a chance we all take (patient and me )
Also note this is a world wide blog and many of us do not have access to the CAT can to extract a tooth or place an implant
Private practice is life, and frankly stuff happens even to the very best of us..
Implants planned properly should not cause this problem however even the best surgeons have consent forms ..so they also know things can go wrong
It has been my experience however, after taking out wisdom teeth and placing implants for 15 years that parasthesia is rarley permanent.
The nerve DOES regenerate, it is part of the peripheral nervous system so by definition it regenerates
Unlike central nervous system ..brain and spinal cord.
I am privy to several cases done in India where the nerve was actually cut-out and removed due to a very severe case of a suicidally painful condition called trigeminal neuralgia
PAin stopped…
BUT the nerve started regenerating down the canal!
I accept that this is unusual
But be patient.. it would be more unusual if it did NOT get better by itself
ALL my cases have come to full recovery and Ive done some very difficult wisdom teeth where we absolutly knew there would be parasthesia for sure but patient cannot be left with the situation they present
The other side of the coin is when these cases go to court patients have a substantial improvement and some continue to fake it on advice of lawyers
This is not to suggest that it is not a traumatic experience..it does get better .
It was suggested in this blog by Dr Bill Woods that this can be surgically repaired
(He is a bright guy I have read many of his postings) and I agree that it can and should be repaired if properly assessed by an OMFS who will intervene usually in the most severe cases..ususally in private practice the vast majority of cases are compression or abraision of nerve rather than severence or mangling of the nerve
Happy Holidays to all
Dr SS
I agree with Dr. SS. I had a case of parasthesia once simply from and injection needle piercing the main nerve to the mandible. I was younger then and scared stiff. Patient was patient! I stopped by the gas station she and her husband owned every week or two for a while, and after three months she met me at the door with a big grin and said it was completely OK now, the numbness had persisted for three months and then “magically” got better almost overnight. Be patient, don’t automatically blame your dentist, and see what happens. A second opinion from a surgeon is fine - in fact I insisted on it with the above patient because it gave her confidence that I wasn’t just trying to ignore the problem away. Good luck.
as you ask for advice ¬ explanation, you have to take the x rays & consult maxillofacial surgeon,the point is whether the nerve is traumatized ( partial or complete)or ther is some blood collection pressing on the nerve(hematoma)according to the cause the prognosis well be decided.the sooner the better .
Are the symptoms of the implant resting on the nerve the same as the administration of novcaine into the nerve? I had an implant and have numbness more than a year later from the midline of my chin to the corner of my mouth. Lower right; I believe tooth 29.
i have numbness in my hallf left chin and lip after implant will this stay for life time?
I am a user of lasersystems and there is a great deal of literature about the use of Low level laser therapy and the improvements of recovery of periferral nerve systems. At least it can help you with the burning sensation and pain sensation. So search for a dentist using a Low Level Laser device or one with a diodelaser. I think you get at least some improvements of life quality
I had two mini dental implants inserted last week, lower left jaw The first implant went ahead smoothly but when drilling the second the dentist hit my nerve and stopped drilling immediately. He then inserted the mini implant and told me to tell him if I felt any tingling. I did so he loosened it off a little The following day he loosened it a little further but did not want to loosen it any further in case I lost the mini implant. He told me that even if he removed the implant completely the feeling would not come back immediately as the damage was probably done by the drilling and not the implant itsef. He told me that feeling would not return for 2-3 months and if not then he would give me some shots of B12. I have had a very painful week and have taken painfillers and antibiotics along with regular cleaning and mouth washes. Today I have a sore throat and I am hoping that this is not connected. I guess I just have to wait an see. I have been researching on the web and it seems that a tingling sensation seems to be a good sign so I am living in hope that my pain becomes more managable and the numbness eventually wears off. (apart from the very sore throat my pain seems a little better today and I may even try to go without my painkillers at bed time).
Judy Butler U.K. (Dentristry in Hungary)
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