IntraLock mini implant: what is causing paresthesia?

Interesting protocol, I see the patient first two weeks then a month later. I don''t prescribe anything. The nerve re- myelinates approx 1 mm per day(very rough estimate) Look at it logically you would remove or back off an implant within 6 weeks anyway, make that decision at that time. If there significant improvement then I would leave it. Full recovery can take from 3-6 months I tell patients whatever they get back in one year is what they will have. The mental nerve is pretty forgiving.

I think you are deducing there is a "big" nerve damage. I am not. Most definitely there isn't even a section damaged. And if there is it would probably be a tiny tiny branch. Most probably there was heat and a bit of aggression to the cortical bone upwards the nerve and the deflazacort will inhibit the nerve inflammation and it would be resolved in a short time.

Sure. I am also pro-let-the-natural-inflammation-occur (but sometimes when you f.e. extract impacted canines and 3rd molars and place 6 or 8 implants with osteotomes and immediate loading... damn... if I was the patient I would want steroids). But when there is a nerve inflammation it can cause transitory paresthesia and it's better for the patient to have steroids 1-2 weeks in my opinion. But this steroids talking can be a long multi-sided debate.

Six weeks is a good rule to remove implants with the wrench and hand pressure. Since you we're flapless it was most likely the hematoma from injection vs flap retraction. Are you certain you did not perforate the cortical plate? I like at least a small flap to help with orientation towards the bone height. Don't know about the Zorcaine. I would suggest a medrol dose pack which loads and tapers the steroid automatically. Cortisone 50mg x five days is plenty Stop! Glad the patient is getting better so quickly.

Looked up Zorcaine,I have heard of reports of paresthesia with mandibular blocks with septicaine, not sure why. My go to anesthetic is marcaine for longer anesthesia 4-6hrs ave I honestly have never had a problem with that.

Thank you again everyone. I am sure not perforate the cortical plate cause i always put my fingers on both buccal and lingual side to aim for the implant. Yeah i always do flap for regular implants but not those mini implants. Patient is OK with tapping at the implants, only abit of numbness on the lower lip now. Thank you again. we just wait for another week.

I do this also to check my mandibular blocks in the attached gingiva between the canine and lateral! Great minds think alike!!!

Are the paresthesias anything to be concerned about?

I suspect it was the Septocaine since it was infiltrated in that area. The implants at any diameter would not have been in the area. If an implant is too long it will cause a paresthesia regardless of the width. Any blind technique I personally feel is a greater risk for a surgical mishap unless Ct guided with depth control. Even with a mini I without visualizing the crest you have no orientation for depth. If there is adequate width I would use a standard size implant or expand and graft. Minis are nice for provisionals. Just my opinion. Thanks for reading.

Zorcaine and Septocaine are generics and both are actually 4% articaine with epinephrine. A Canadian study in 1993 reported 14 cases of paresthesia out of 11 million injections..... yea....11,000,000. 10 were due to articaine and 4 were due to prilocaine. So there is a infinitesimal possibility that you are correct in fingering septocaine. A CSI should look at all the clues. The more outstanding clue seems to be the crab like nebula configuration of the mental nerve which is sensory in nature. My bet is it is more likely a neuropraxia of the mental nerve due to compression as the mini dental implant is screwed in. From the OPG, it can be seen that the left most mini has strayed quite near the mental foramen due to a misjudgement of the midline. This can be avoided if the midline was defined more precisely and the minis placed accordingly. A standard sized implant is at least double the size and therefore the compression will be quadruple and more likely to cause a profound anaesthesia and not just a paraesthesia. The flapless technique is not a blind technique because we have sophisticated imaging techniques like CBCT which you have kindly pointed out. Though a simple OPG or even a primitive PA is more than enough, all of us having studied the detailed anatomy of the inter-foraminal zone of the mandible which is one of the safest places to place an implant. Even more, we have our super sophisticated thumb and forefinger that no technology to date has duplicated yet. It is not blind but virtually visualized and therefore very safe. If you go to the link in my last post, you can read for yourself in page 19 of that authoritative document co-authored by 21 of their top dentists, that two prospective studies reported 98% survival rates of minis in mandibular overdenture retention. The references are also given in the same document. Thank you for your consideration of these ramblings.

It is still blind when you can't see the bone crest and you are estimating where it is. Without a cone beam I 'm afraid nutrient canals can be mistaken for a nerve. When I state that paresthesia can be caused by the local, it could have traumatized the mental nerve most likely, either from the pressure of the anesthetic or the needle traumatizing the nerve.I don't buy the compression theory and the crab nebula. And I am not impressed with minis other than retention for provisionals. However all surgeons have their preferences and I respect that, I just would not use minis when there is adequate bone in the region. I tailor the technique to the clinical situation always. I think the poster needed to be reassured that the paresthesia would resolve and was handled appropriately. We all have, myself included a tendency to preach what we feel is best based on our experience or the literature. I like to be practical and look at the clinical situation, using the available bone to best advantage with my skill set. I also like to rebuild bone that was lost. This is not meant to be a critique of the poster's work, the implants although mini, are very well placed and parallel. The paresthesia is resolving and I feel it is a good result. I just like to be able to directly see what I am doing and be sure. Thank you for your very elegant treatise and also thank you for reading. I respect your viewpoint.

Thank you all again for your time. Patient is feeling normal on the gingiva of the alveolar crest between the implants-thank you Greg Steiner. He said he can eat normal only a bit of tingling still on the left lip-some time he said he forget about it. Hopefully it will be gone soon. I think we need to look at all the available for implants for patient cause not all patients had the financial to do the best option-lots of success cases for mini, short implants. Some Drs even do full mouth fix bridge with all mini implants and offered classes for it.....I mean every case is differentiated depend on patient fiance, health, age-you will not try to do extensive bone graft/tissue graft on a 80 or so right?just some thought

Gio, that is really wonderful for your patient and also most satisfying for you as a professional. And it did not cost an arm and a leg, just 4 affordable minis and an hour or so plus minimal trauma. We should replicate this experience for many many more of our elders.The loose lower full denture has been a bane to patients and dentists alike. It is an increasing problem because of rapidly aging populations throughout the world. The world will reach aged status about 2040. Aged nation status in UNspeak means 15% of the population having reached 60+. About 30% of these aged are edentulous, which means that many of our elders are suffering from malnutrition, poor self-esteem and low quality of life, all because they cannot eat, speak and socialize due to loose lower dentures. We dentists actually now have the means to ace this problem with mini dental implants! Nuff said.