Lingual nerve damage and implant: recommendations?

Last Updated September 25, 2013

I have a patient who is interested in getting an implant to replace missing #19 [mandibular left first molar; 36]. This patient is currently presenting lingual nerve pain such as burning when his tongue touches #20 [mandibular left second premolar; 35]. According to the patient, the lingual nerve pain started after having a bridge [fixed partial denture] placed 4 years ago from #18-20 [mandibular left second molar to second premolar; 37 – 35]. His left side of jaw was left with numbness and burning sensation. That bridge cracked and became loose. A new dentist replaced the old bridge with a new bridge and the burning sensation got worse.

The patient then had root canal treatment on #18 suspecting crack tooth on cracked root or infection causing the pain. But after the root canal treatment on #18 the patient started having severe pain different from the kind of burning pain he had been previously experiencing. #18 was then extracted by an oral surgeon. Now he only experiences burning sensation on the left posterior side of his tongue. No more burning pain or any pain in the rest of his mouth. Patient wants an implant on #19 site but is worried that the pain will get worse since his endodontist once warned him this might happen. Right now #18-19 area has normal sensation. I have cautioned the patient that installing an implant in #19 might not cause any more lingual nerve pain but that he might experience burning pain again when his tongue rubs against the crown on #19 implant. If that happens I will remove the implant. Have any of you treated cases like this? What do you recommend?

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