Implant Penetrating the Inferior Alveolar Canal: How to manage?

I see 3 Options: 1) Back out the implant fixture until you don't see it within the confines of the IAN canal and see how the patient responds . Or 2) If the evidence of peri-implantitis is on the same implant that's violated the IAN canal, unscrew the implant out, degranulate, place a collaplug and call it a day. Evaluate the patient regularly to see if paresthesia wanes and if all's well eval for implant placement in a few months. Or 3) Refer to a Periodontist or OS.

Dear Doctor, 1. Diagnosis is important. If you decide to treat this case you must have a CT scan to determine 3 Dimensionally if ,infact, the implant has violated or transected the IAN. 2. This is a possible litigious case so first talk to the dentist who placed the implant and inform him of what is happening and how he would like to handle it. As soon as you begin to treat this patient, you have bought into the litigious process. 3. If you confirm IAN damage from implant surgery and you have decided to treat this patient, then Immediate removal of implant is advised. Transection of the Inferior Alveloar Nerve (Neurotmesis) is possible. We hope that it is only Compression of the Inferior Alveolar Nerve (Axonotmesis). The nerve bundle can be stretched 20% without permanent damage. Stretching of 30% causes structural failure. If it is Axonotmesis you can expect a recovery in 3-4 months. It is important to monitor the healing rate for this, however, because if there is no change in degree of symptoms after 2-3 months, I would suggest that you start the process of referring to a micro neurosurgeon for surgical repair of the Neurotmesis. If there is evidence of complete transection of the IAN, then referral to a micro neurosurgeon should happen as soon as possible. 4. After you remove the implant, I would suggest that you bring the patient in weekly (to begin with) and map out the area of parasthesia. Dr. Carl Misch has an excellant protocol for this evaluation in his text "Contemporary Implant Dentistry". This allows you to determine the recovery rate or if recovery is possible. This in turn allows you to determine when referral is necessary. "According to Girard et al., the inferior alveolar nerve may have the potential for recovery after an injury for as long as 2 years. On the other hand, Sunderland estimates 75% to 90% of the distal nerve atrophies are irreparable after 1 year." This is due to a process called Wallerian degeneration. 5. Place the patient on Non Steroidal Anti-Inflammatories (600-800 mg TID) for 3 weeks. 6. See patient every 2 weeks for the first month and document changes in sensation on your facial map to see if the area is improving and at what rate. 7. If there is no sign of improvement at 8 weeks refer to a microneurosurgeon for a possible Neural graft. THE GOOD NEWS? If this case is Axonotmesis with stretching or compression of the inferior alveolar nerve we would expect recovery within 3-4 months.

in my experience, in these cases take immediately away the implant or if you prefer unscrew the implant and suture or not the wound. secondly an intramuscular injection of 4mg. betametasone sodium phosfate for three . (1-2-4 scheme), eventually to repeat every 10 days for three times in one month. so i obtained the best results in remission of symptoms in few weeks or in two or three months. obviously antibiotics if needed. .

I agree with Dr. Anderson. I would consider using adrenocorticosteroids to reduce the amount of axon sprouting, thus reducing neuroma formation and neuropathy.

Has anyone thought to contact the person that placed the implant?

Retrieve the implant completely. Dexometasone will help to avoid neuroedema.

I agree with the above comment. Have you contacted the treating Dr.? Are you sure you want to be involved in the ensuing legal issues? As well there are ethics issues you need to consider. Have a very open discussion with the patient before you start anything. You're about to be dragged into a huge mess. And by the way- take out the implant, medrol dosepak and 8-12 weeks of anti inflamatories.

Since, peri implantitis, was detected, and edema was noted...would there be a possibility that the implant was placed to lingually, and protruding into the ligual concavity, creating all the following symptoms on IAN. just a though...obtain a 3 DScan, and move forward from that...

Jg, the injury is to the mandibular branch, not the lingual branch. This bit of anatomy is really important for you to understand. A simple 8 second cbct scan would answer most of these questions. I would encourage you to get this patient to an omfs, that treats this condition. Bv