Can it be neuropathy of anterior mandibular incisive canal?

I placed an implant with a bone graft in #27 site, 10 days ago.  The patient returned 2 days later complaining of pain at the site and pain radiating to the mandibular posterior.  I suspected infection and prescribed NSAID, steroids, antibiotics.  The patient kept complaining of pain afterwards and finally I removed the bone graft at 10 days post-op.  The site had a definite odor and I suspected an active infection.  I debrided the site.  The patient is still complaining of pain radiating to his mandibular posterior.  I only did a mental nerve block and local infiltration for the surgery and graft.  On the post-op CBCT scan it appears as though the apex of the implant fixture is impinging on the mandibular incisive canal.  Could this be causing the pain?  Should I remove the implant fixture?

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2 thoughts on “Can it be neuropathy of anterior mandibular incisive canal?

  1. It’s recommended that Implant be at least 2mm cleared from the nerve. Even an implant placed within 1-2 mm of a nerve sometimes gives patient symptoms. If your CBCT shows that the apex of your implant is on the canal, you should remove the implant. Removing the implant would not immediately resolve patient’s symptoms but with good management (using Neurontin, or gabapentin) or referral to an OS specialize in nerve damage, patient would recover. Good luck

  2. I don’t think this would be impinging the incisive canal/nerve, but perhaps there is an anterior loop and the implant is resting on. I would get a CBCT and ask to trace the mandibular canal and presence of an anterior loop. In this case, yes remove the implant.

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