Numbness After Implants

Dr. Joglekar, a dental implant patient, asks us:

I had dental implants last year for missing teeth. Within hours of the placement of mandibular dental implants, I developed profound numbness on the right half of lower lip.

Being a doctor (general surgeon),I realised there was nerve injury & requested the implantologist
to unscrew/remove the dental implants (x-ray showed one of the dental implants touching the roof of the inferior alveolar canal). However, the doctor said, “Everything will be OK.” Nevertheless, eventually after 3 weeks he replaced the dental implants.

Fast forward one year, and my numbness has not gone away completely. Do you think the dental implants should have been removed right away? Is this why I am still feeling the numbness? What is the cause of the numbness now? Nerve Damage? Would Dental CT, which was never advised, be necessary now and would it change the management of this case? Kindly advise. Thanks.

58 thoughts on “Numbness After Implants

  1. kfchow-mostdi-msia says:

    I had a patient who experienced numbness of the lower right lip after placement of dental implants on the right molar area. Xrays showed one of the implants impinging on the inferior dental canal. That implant was removed 2 days later and the patient recovered full sensation after about 3 weeks. I think the patient suffered from neuropraxia i.e. compression of the nerve. I guess speed of recovery if at all will depend on the extent of the damage…. is it just compression injury or incision injury….partial incision or full incision. However, since the nerve is running within a well defined channel in the bone, chances of some recovery and even full recovery may be high even in cases of neurometsis. I hope Dr. Joglekar has a full recovery eventually.
    Regards. Dr. kfchow Malaysia

  2. virgilio mongalo dmd says:

    dear dr.Joglekar;
    Definetively a dental ct-scan will provide much needed information to solve your problem. There is a company in Pennsylvania that manufactures dental tomographers called I-CAT,used in conjunction with a sotfware that createS a 3Dimensinal image (NOBELGUIDE)a dentist well versed in virtual surgeries can evaluate the information and help you.I do not know where you are ,but if you call me at 305-271-9202 I can have the ct-3d images examined by an outstanding oral maxillofacial radiologist .i will be waiting to hear from you. dr.mongalo

  3. SF oral surgeon says:

    Dear patient,

    Could you clarify?

    1) When the implants were removed?
    2) Why he “replaced” them after 3 weeks?
    3) Describe the difference in symptoms the night of surgery and present day (1 year from surgery). ie location, sensation in regards to temperature, light touch, proprioception, pain, etc. and any abnormal sensations, dysesthesia, etc.

    It would greatly help my explanation of your case.

    To answer a few of your questions…

    Dental CT Scans are now commonly used to assess the amount of bone stock available, used commonly PRIOR to implant placement, since real measurements can be used to predict the proper length of implants around or near the maxillary sinus and the inferior alveolar nerve. Getting a dental scan will anatomically show the relationship between the implant and the inferior alveolar nerve. Management unfortunately will not change, since 1 year has passed from surgical placement.

    I will look for your reply and comment soon.

  4. Randall says:

    Speaking as a surgeon trained by Dr. Le blanc I must first describe the different levels of nerve injury as they pertain to sensory nerves. category 1 neuropraxia bruising of the nerve usually recovers in 1-4 weeks. Axontemesis damage to the nerve thet leaves the neural sheeth intact recover several months to a year usually associated with tingling. NEUROTEMISIS transection of the nerve usually requiring surgical intervention and is associated with total loss of sensation. As an implantologist I would have taken a ct scan to see if the cannal of the IAN was violated and and if it was would totally remove the implant if I noted no violation I would back the implant a few turns to reduce the compressive effects of the implant on the nerve. Another source of damage to the nerve can be created by the y factor of the bur. Each implant system has a certain amount of drilling that is done past the distance that is needed by the implant itself anotherwords the drilling goes to a deeper level than was planed by the implant surgeon. It is possible to have the implant not violate the IAN cannal but still have a trasection of the nerve by the drill that was used to create the osteotomy.
    I would immediatly seek care from a surgeon who is familiar with repair and dx of inferior alveolor nerve injuries most of these injuries are best treated within one year of the occurance. Best of luck Randall

  5. Malaysian in Japan says:

    Dear Dr. kfchow,
    I’m a Malaysian now studying in Japan and I’m considering a dental implant here. My biggest concern is should there be any complications whatsoever in a few years time, whether I could find proper specialists in Malaysia at reasonable costs considering differences in expertise and technology.

  6. Anonymous says:

    Dear Malaysian in Japan,
    Thank you for your inquiry and I understand your concern. The science of dental implants is quite well known here in Malaysia.Though there are many different brands of implants in the world, basically they are quite similar. They are made of titanium, looks like a screw in one or two pieces and has a rough surface on the threaded area. Placement follows well defined procedures that are well known and universally accepted. In short, there are many competent dental implantologists in Malaysia well versed with the best cutting edge technologies in dentistry. I myself hold a basic degree from Singapore and postgraduate qualifications from England and Germany. There are many others like me here and I assure you that there will be no problems in finding competent implantologists in Malaysia to treat any complications that may arise.
    warmest regards to you and all you blessed Malaysians studying and working overseas.
    Dr. KFChow Malaysia

  7. Rhonda says:

    On May 19, 2006, I had 2 dental implants done… on my left side a molar and right side smaller tooth next to the first molar. 2 weeks after the implants were done I was still experiencing (on my left side only – molar implant) numbness in my gums, lip and chin. I contacted my dr and he backed out the molar as he felt it may be too close to the nerve. After that I started to get tingling, prickling and itchy feelings…It is now September 7, 2006 and I can feel my gums but when they are touched or I bite down it is like and electrical current that goes to my lip and chin? I can feel my lips and chin when touched but it feels still very weird…(*like the feeling when you cut off circulation to your arm and when the feeling returns it is a prickling feeling) Is there anyone out there that has experienced the same situation ? Please let me know as it is frustrating to be alone…. Should I have this implant removed and hope that I become normal feeling again? or should I just try to live with this?

  8. Anthony DeGennaro says:

    Dear Rhonda: Where were the implants placed mandible or maxillary? Are you experiencing pain with the numbness? Have you had an i cat which would provide an image of exactly where the implant is positioned? Your answers will provide more insight.

  9. Rhonda says:

    Dear Anthony DeGennaro: Implant is mandible-lower jaw the molar closest to the front teeth. For 3 months I could not feel my teeth, gums, left side of chin and left side of lip. Since the end of August I have started to feel this itchy, prickling, stiff feeling. Every time I chew on my left side I feel electrical currents in my left chin and lip. Since end of August I can feel my gums when I floss. He took an icat after I had them put in and after 2 weeks he back the implant out slightly and took another one… I did notice that the original icat showed the implant lower than the roots of my other teeth and the 2nd icat the implant was in a row with the other roots of my teeth… Should I just have this implant removed or should I just remain patient. I don’t know how much longer I can bear this discomfort?

  10. Anonymous says:

    Dear Rhonda: It sounds like your doctor may have inadvertently bruised the nerve canal. This is obvious from images viewed in the first i cat where it appeared the implant is lower than the adjacent tooth roots. To correct this, he probably tried to fix it by backing the implant out and then took another i cat which showed the implant in alignment with your adjacent tooth roots. In any event, you should ask him “point blank” if your nerve was compromised by the implant. The good news is that you are not having any pain. This may be temporary. I would get a second opinion either way.
    Hopefully, some professionals will render their advice via this website. Good luck!

  11. Dr Amayev says:

    I placed 2 implants in area of # 19,20 the next day patient reported numbness on a left side of the tongue only. No violation of mandib., mental nerve or perforation of lingual plate seen. I understand there is some type of lingual nerve damage. I raised implant # 19 half turn to release possible pressure on lingual nerve on the next day. 3 weeks after the surgery patient reports no pain, sensitivity comes and go especially feels numb on the tip of tongue. I had a hard time to give this patient mand. block, I know this may also cause this problem but its rare. What do you think this may be and what should I do, if anybody experienced that before. Please let me know.

  12. Rhonda says:

    Dear Anthony DeGennaro: What kind of Dr. should I seek this second opinion from? I am currently working with my regular Dentist and he has completed the crown on the right side that was a success! My Dentist did some research for me and to heal it can take up to a year. He was the one who told me it was bruised and caused excessive swelling as swelling subsides it should get better. He pointed out how it has already much improved (no longer numb) and he says the tingling-itchy feeling is a good sign, the nerves are reconnecting. He told me removing the implant would not guarantee I would be back to normal. I exercise regularly, try to keep a positive outlook and hope for the best. Are there things that I could be doing to aid in this healing process? Vitamins? massage the area? Any advice would be welcomed!

  13. Anthony DeGennaro says:

    Dear Rhonda: I would recommend you consult with an oral surgeon who specializes in placing dental implants. I’m sure they must see nerve injuries and can help you. There are many websites which address nerve injuries. I recall seeing one started by a young man named Ross. If you type in “Nerve Damage from Dental Implants” it should be listed. This site basically serves as a discussion site where people suffering from dental injuries discuss their personal stories and share valuable information. Some talk about medications they take to assist with pain. I recall one person who took Vitamin “E” on a daily basis to speed up the healing process. You may also want to visit with your GP. They may not be experts in this area but certainly have basic knowledge and can point you in the right direction.
    Again, good luck!!

  14. Anonymous says:

    Dear Rhonda,
    I am sorry to hear of your problem. However, nerve damage is one of the possible complications to placing dental implants on the lower jaw molar area. No matter how experienced the dentist or oral surgeon is, sometimes it happens. This is the same in every field of surgical intervention. Such incidences happily are rare when reasonable care is taken, but like I said, it happens even to the best of doctors. But to the patient it happens to, such knowledge brings only a little consolation. From your account, I would agree generally with what your regular dentist has told you. The damage has already been done at the time of surgery and the backing out of the implant was the right step. But nerves have a notoriously unpredictable pace of recovery. It depends on exactly how much damage was inflicted. The accurate assessment of such damage however is very difficult even with the most advanced imaging systems. Also, the healing of nerves is still not completely understood. Lots of research has been done on the healing of nerves and the factors involved together with stem cell research. Christopher Reeves(Superman)’s saga highlighted to the whole world how hard we are trying to understand nerve healing and conversely how little we actually know and how helpless we are when it comes to repairing damaged nerves. The overall lesson is try your best not to damage them and when the damage is done, remove the causative factors as quickly as possible within reason.I agree with your regular dentist in that totally removing the implant at this stage will not improve the situation significantly. Also, the tingling and itchy sensation is a sign of healing. How complete the healing is , only time will tell. But it is encouraging to observe that it is improving with time. All the best and my
    best hopes for a complete recovery.
    Dr.KFChow Malaysia

  15. Anonymous says:

    Dear Dr. Amayev,
    You are right, it is clearly a lingual nerve damage.Caused usually by the raising of a flap on the lingual side and in your case could be by the many attempts of doing the mandibular block.Since the lingual nerve runs outside the inferior dental canal along the lingual aspect of the body of the mandible, backing out the implant will have no influence on the outcome since it is not a matter of the implant impinging on the nerve.From the sequelae, the tongue sensation has a good chance of recovery but as it is nerve recovery is highly unpredictable. Refer to comments to Rhonda.
    warmest regards,
    Dr.KFChow Malaysia

  16. Ben says:

    Dear Dr. Chow: If you are helpless with respect to repairing nerve injuries resulting from poor implant placement, why do you place them? A consent for elective surgery does not give the dental professional license to dismiss his or her error as just a “nerve injury.”
    The surgeon is responsible for the outcome not the patient.

  17. Anonymous says:

    Dear Dr. Ben,
    You do have a point there. I suppose it is for the same reason that a heart surgeon takes the risk in doing a heart op knowing that sometimes there may be complications that may result in the demise of the patient. But success will mean a happy and alive patient for many years. Is the risk worth the benefit? If so, why not? Of course we do not embark on a procedure to deliberate hurt the patient, but sometimes with the best of intentions, complications still occur. Maybe we should omit implant placement on the lower molar area altogether because of the risk of nerve injury. If we do that we should also stop doing removal of wisdom teeth because nerve injuries occasionally happens. If the standard should be that a surgeon must be able to guarantee repair of a nerve injury in the course of treatment that is done with reasonable skill and care, then I am afraid there may be very few such surgeons. Consent for elective surgery is not carte blanche to inflict nerve injury and get away with it. It is an informe d consent from the patient with an explaination of the possible complications, the risk of which the patient is willing to undertake in order to gain a benefit. And if a complication does occur, then it behoves the doctor to do his/her best to resolve it and not dismiss it. How responsible is the surgeon for the outcome after exercising reasonable skill and care? Any words of wisdom ?
    Dr. kfchow.msia

  18. Larry from Brooklyn says:

    You cannot compare dental implants with heart surgery.
    Heart surgery is done due to poor health and potential death. Implants are cosmetic. A person can live without a dental implant. He or she has options such as bridges or dentures. Most people realize there is a risk with any surgery. I think what upsets them is the surgeon’s tendency to distance him or herself from the patient once there is an injury. Also, it appears literally impossible to find another surgeon willing to help the patient. Imagine living in pain for the rest of your life. How would you feel if someone you cared about was injured? Your dealing with human beings here not lab rats!!!!

  19. Rhonda says:

    Dear Dr.KFChow-Thank you for your perspective on repairing of damaged is greatly appreciated. For 3 months gums, chin and lips completely numb. Every night I would massage my face, do facial exercises smiles, frown, puff out my cheeks and teach myself to chew on that side without biting my lip. Bascially, physical therapy to get circulation, feeling and life back to my face. I will never give up and I refuse to take medications because it is uncomfortable. After 3 months, the prickling, tingling and itchy feelings started to occur, Now that I have read your information that these are goods signs as my regular dentist has also stated, It is much more tolerable!!! Ben & Larry thank you also -There is much truth in what you write the Dr. that did my implant has been in my family for many years – he has removed my childrens impacted teeth with success and no problems…He is really a good person, he had no intention of causing me this problem, it was successful for my right sided implant.. just not for my left side. I did choose him and choose this surgery and knew of complications,I am trying to deal with this the best way for me. I hope in someway this helps someone who maybe going through the same situation.

    • Deborah says:

      Dear Rhonda: I hope you are recovering! I had six implants done at one sitting twelve days ago. Two on the right upper, two on the right lower and two on the left lower. The two on the bottom left have caused my left jaw to have “temporal mandibular joint” pain and my bottom left lip and chin are numb! I can feel a tiny tingling sensation, which the surgeon says is a good sign. I go back on Wednesday for a checkup. I have heard of recovery in three weeks and sometimes as long as a year. I rotate ice packs and heat on my jaw for pain. Do you have any other suggestions? I didn’t realize until I found this site how many other people are suffering as well! Any suggestions on relieving the pressure on my jaw is mostly appreciated! Thank you and I wish you better days as well!

  20. Dr Amayev says:

    No matter what kind of surgeons you are anything could happen .Of course we must try to ovoid any possible complication to our patient and treat them with respect but sometimes complication may happen. In order to avoid any possible complication we should just stop what we are doing as been previously mention by Dr Kfchow. I don’t believe that there is a dentist or another type of medical professional or any other profession who never had a complication. We all humans and if we did something we have to try to resolve and help that patient in any possible way if we can. From what Lerry or Ben told us, I don’t know you are a doctors or not but if you are it seems like you both the best and never had any complications in your practice. If you didn’t I am very happy for both of you. Never say this may not happen to you ,look in a future you still practicing. Think about that. May be you don’t have enough experience that why you so positive about your self . I’ve been practicing for 15 years and my practice is limited to implants dentistry only and I still can get complications, but I know how to manage them if I don’t i always ask. There’s no human been in this wold who will know everything. Take your time both of you, and slow down. Good Luck…

  21. Nancy Siegel says:

    Rhonda: You mention numbness and odd sensations as symptoms Are you also having any pain? If so, you might be able to have a nerve block done. Good alternative to medications which do cause horrendous side effects. Best of luck to you. So sorry you were injured.

  22. kfchow-mostdi-msia says:

    Thank you folks for the various comments, the appreciation as well as the brickbats. They both have their uses.The brickbats are good reminders that we are placing implants not into a jaw but into a human being. They really make you think and reevaluate the rationale for doing what we are doing. The human experience is such that nothing venture, nothing gain. Every advance in human civilisation was a result of a venture into the unknown, the benefit of which is usually tied to the prior preparation before the venture. There are many examples in human history where decisions were made to continue on towards discovery in spite of disastrous occurences as a result of even well prepared ventures. Take the Challenger disaster for example, in which the American president after paying due tributes to the explorers who lost their lives reaffirmed the commitment to press on into space in spite of the dangers of the unknown in the name of the quest of the human spirit for knowledge and advancement. We can’t help it! Its hardwired into all of us. Anything less, we will have abandoned the human urge and hunger for discovery and improvement in us.
    Please forgive the philosophising. Back to the issue at hand. I believe that the majority of health professionals hold on to the ideal of doing the best we can to alleviate a health problem that the patient may have.I do not agree that doctors tend to run away from a problem they may have caused. In fact very often they stick on to it and in trying to resolve the problem learn something new that has proven to be of benefit to countless others. Before we fall into the wrong idea that every other person who has an implant done suffers from a nerve injury problem, we must realise that in reality the majority of people with dental implants placed have nothing but praise and thankfulness for its teethlike function, aesthetics and durability lasting for decades. Dental implants are not just for aesthetics but for function which many will tell you are as good as their own teeth if not better! Complications and disasters sometimes occur in any worthwhile human endeavour even with meticulous preparations and precautions but the benefits outweigh the drawbacks. If the drawbacks outweigh the benefits,we will find out soon enough and that particular endeavour for human improvement will naturally cease. The advancement into dental implants is one of the epitomes of the urge of the human spirit towards discovery and progress. We cannot stop but continue to improve as can be testified by the majority of successfully implanted patients. In dental implants,the holy grail of dentistry has been discovered! Onwards the human spirit!

  23. Nancy Siegel says:

    Rhonda: How are you feeling? You mentioned numbness and odd sensations as symptoms. Have you been in pain as well?

  24. SF OMS says:

    Implant placement is a surgical procedure, and with all surgery involves risk/calculated risk, potential complication.

    “Ben” makes a great point. Trained professionals are qualified individuals that can provide the full scope and manage their complications. “Proper” training could have prompted pre-op CT scans?, post-op management of the implant position once abnormal symptoms were present, with either a follow-up scan. I feel there are many clinicians that feel they can place implants and bone grafts, but the one time things dont go perfect, they dont have a clue on what to do. Training incorporates more than the hand skill to place a hold in the jaw and to place a metal screw. Simplified, its just that, I can train any monkey to do that. Its the pre-operative assessment and risk stratification and post-op complication manangement that makes a good surgeon.

    I’m sure if you needed a heart transplant, or a kidney transplant or you’d want the surgeon that has done the most procedures with the best outcome. I’m sure the patients will appreciate your honesty about your experience and history with a particular procedure than trying to gain knowledge and manangement tips off a freakin website. How would you feel if you were that patient?

  25. Rhonda says:

    Dear Nancy Siegel, It has been 4 months since the implant was put in. I could have cut off my lip and chin and would not have felt it. Even when I flossed my teeth could not feel that, many times I have bitten my lip and chin while talking and eating. No pain, around the 3rd month after the implant was put in, end of August and currently,I started to feel prinkling, itchy and tingling, now everytime I chew on my left side I feel electrical currents that go to my jaw to my chin and lip. It is not painful, just (annoying) notice this feeling each day. I try to do things to divert my attention to it, but it is constantly nagging me. It is extremely frustrating, but I am told these sensations are a positive sign which gives me the hope things will change, at least it is no longer numb. None of the Dr’s that I have seen have been able to give me any instruction on how I can help this healing process. Sadly the dr who put in the implant told me I may never get feeling back into my lip and chin and told me to just put the crown on and live with it. So I am trying to figure this out on my own, because no one seems to know how to help me. I am going to continue with my facial exercises and massage… and hope with time it will heal.

  26. Dr Amayev says:

    I totally agreed with SF OMS that each clinician by doing any type of surgery must know what type of complications could be and how to handle them, because any surgery involve some type of risk that associated with them. But my point is that no matter how trained you are if you are oral surgeon, periodontist, prosthodontist, you still may have complications and sometimes it can be irreversible, and you guys have to admit that. I am not saying that you have to do the procedure if you don’t know how to manage the risk with this particular procedure, Iam trying to say to all of you that you must know how to take care of problems that may occur and try help your patients. There is a lot of specialist that will perform worst job compere to some general dentist, and it doest matter who you are. The matter in your knowledge, experience, and professionalism.

  27. kfchow-mostdi-msia says:

    Dear SF OMS,
    With all your training, can you share with us how you would manage Rhonda’s case. A fellow OS. Thank you.

  28. Rhonda says:

    Dr. Dr.kfchow, it appears that there are no dr.’s willing to share their expertise on how to treat numbness after an implant.

  29. kfchow-mostdi-msia says:

    Dear Rhonda,
    It appears that you may be right. I for one has tried my best.Once nerve injury has occurred, the management is first of all to determine the cause and the exact extent of the injury as far as possible.If the injury is just compression, it will recover quite rapidly. If it is partial incision(cut) of the nerve, then the healing will take longer and recovery may not be total. If the incision is total i.e. complete division of the nerve, sometimes the nerve can still reconnect and heal but the outcome is highly unpredictable. In the worst case scenario, if the patient finds that even after many months, there is continued paraesthesia, meaning that there is feeling but not the normal type of feeling(tingling, itchiness, pain but not that painful, just irritating) and the patient feels that he/she cannnot live with it, then the options are one to get a complete nerve block in which case there is complete numbness of the affected lip. Some people prefer a complete numbness to a persistent irritating feeling.This is done by an injection to block the nerve permanently. Alternatively, a surgical reconnection of the nerve can be attempted but it involves more surgery and the results are unpredictable. In most cases the best course of action is to wait and accept the numbness and paraesthesia sometimes with the help of some medication. I have given you the lowdown on this problem as far as I can understand it. I hope that there are other docs who can offer helpful information besides just being critical. Regards and still praying that you will have a full recovery.

  30. Harvey says:

    Rhonda, I am not a Dr but a person who received an implant and my dr nicked my nerve. He just told me that this has never happened and I experience numbness for 8 weeks AND the sensations you talk of…. After 6 months of no change… I had the implant removed – it has been a year now and everything is back to normal… I am looking for other alternatives other than implants. I had to take matters into my own hands because there were no doctors out there that could help me… much like you. Good luck and do what YOU THINK IS RIGHT FOR YOU!

  31. Rhonda says:

    Harvey: Thank you for sharing your experience with me. Do you think if you would have left the implant in eventually it would have eventually returned to normal anyways? I do realize how frustrating this is and how uncomfortable it can be and not sure how much longer I can take it myself. Thank you again for sharing your experience, it is appreciated.

  32. Matthew Keogh says:

    Dear Harvey:

    Did you loose a lot of bone and any adjacent teeth when you had the implant removed? Also, how soon after removal did you have relief from pain?

    Thanks. Since the professionals seem uninterested in this poor woman’s condition, it is good to know that there are patients trying to help.

  33. Jenna says:

    Dear Harvey: Where were your implants placed? Also, I am disappointed by the lack of professional response to Rhonda.

  34. Harvey says:

    Rhonda: I don’t know if I would have had feeling return after a year if I would have left it in, I just didnot want to take a chance of further damage. I did go to another surgeon and he did not know what to do either, I asked if by leaving it in longer would increase the damage, he did not know, nerve damage is unpredictable and little known as I have found out. It was my choice to have it out and with 2 weeks the pressure off my teeth was relieved and feeling was back within 6 weeks. To date I am happy with my decision. Word of advice do not have the same dr that put your implant in – remove it. You say he is nice guy but seek out someone who will assure you and take good care of you. Blessings are with you and hope is still there for you. And those of you asking it was lower tooth next to first molar. No problems after removed, just had to go on antibiotics for 2 weeks and be very careful for 2 weeks, healed quickly and relief was instant no electrical feeling when I bite on it and numbness went away.

  35. SF OMS says:

    Apparently the discussion on this forum lead away from the real topic at hand. And I do apologize to patient Dr. Joglekar for that. I also want to state that I am NOT an expert on neurologic injuries, and my training is not any different from any other traditional OMS program.

    “Randall” has commented on the different types of nerve injury, and the prognosis of each injury. kfchow has also provided good information about the symptoms after nerve injury has occured and some alternative treatments.

    Here’s my 2 cents…
    Obviously there was nerve injury, whether it was from the bone drill (since the drills are longer than the actual size of the implant, or the y factor), or bone compressing the nerve (since the end of the implant is held in by compression after the osteotomy, there are instances where the bone marrow is displaced into the inferior alveolar canal), or direct compression into the nerve with the implant, or nerve transection.

    Depending on the length of time from your intial implant surgery, your options could be as follows. If immediate symptoms of numbness is found (ie hours or the day after, “the novocaine hasn’t worn off” call by the patient, you may have improvement by backing our the implant a few turns. This will only improve the condition described as implant compressing the nerve directly, since it will relieve the compression on the nerve and hopefully not caused permanent ischemia. Nerve injury is dependent on time. Spinal cord injuries are salvagable or managed within the first 8 hours of injury, in which at that particular window massive IV steroids are given to reduce edema and inflammation, thus preserving blood flow to the axons and preventing ischemic death at a cellular level. Local anesthesia can last up to 8 hours if a good bupivicaine block is administered, so lidocaine is what I use in my practice and a follow-up call to ensure no numbness after implant surgery is completed. It my personal preference, and it makes sense to me. After this window, it is likely to have permanent effects of nerve injury if not treated.

    If the other injuries are the cause such as nerve compression by bone, the numbness may not be improved by backing out the implant since it is the bone placing pressure not the implant itself. Also the drill could have “cut” the nerve partially so that some axons are disrupted. These nerve injuries will not respond to the implant being backed out. Nature will take its course and attempt to repair the injured nerve. Fortunately this “inferior alveolar nerve” is encased in a bony tunnel and has a better chance of the “ends of the nerve” finding each other and healing.

    If the injury has been months ago, 4 months is the cut off for surgical attempt to re-anastamose the nerve in my practice. After four months there exists permanent changes which make surgical repair difficult. At best the remaining axons are damaged or even destroyed by wallerian degeneration that re-innervation yields less than optimal results.

    1 year after injury, it is very unlikely you would have any improvement even after nerve “repair”.

    There are different words to describe the symptoms, which are frequently interchanged by dental professionals and erroneously used.

    Paresthesia – simply is an alteration of sensation

    Hypoesthesia – quatitatively decreased sensation

    Anesthesia – total loss of sensation

    dysesthesia – abnormal sensation (ie pain instead of light touch).

    And kfchow you state symptoms of altered sensation such as pain, its dysesthesia where the nerves have healed, but have been cross wired (ie. where nerve endings for touch are joined with pain fibers thus light touch will cause a painful response). At this point, some oral medications such as low-dose tricyclic antidepressants have helped with neuropathic pain. The other option is to ablate the nerve and have total anesthesia like you described instead of dysesthesia, which is not always guaranteed. Neuromas can form at the end of a nerve stump and cause pain as well.

    In your particular case, would the numbness improve with therapy, possibly with low-dose antidepressants, or if you prefer, total anesthesia over dysesthesia, then nerve ablation is an option. As far as the usefulness of he CT Scan, it may possibly show the cause of the numbness or changes since the injury, (ie. distal nerve atrophy or nerve compression by the implant, or nerve canal narrowing). But it wouldn’t change the prognosis at this stage of injury and recovery. I personally would not attempt a nerve repair, it may worsen the altered sensation you have now.

  36. Rhonda says:

    Thank you SF OMS for your insight and expertise. Implants are really great, the implant that was successful on my right side feels just like a natural tooth! Even though my left side has had complications with anesthesia and healing to paresthesia, I am still in hopes of someday resolving this matter. Currently I am seeing a specialist to assess the nerve damage. I do Think that all doctors that put in implants should be given a course in how to deal with implant complications, should they occur. I am not a dr and do not know if this is something out already? Many patiences would appreciate. SF OMS thank you again!

  37. kfchow-mostdi-msia says:

    Thank you SF OMS for your contribution. The technical terms introduced is quite timely at this point of the blog as the readers are getting educated and will be ready for the terms at this point. Initially, we were trying our best to explain in common lingo. It is beginning to be clear that when a nerve injury in dental implantology occurs, there is still no clear universal protocol. I wonder if there is any neurological expert in dental implant nerve injuries who can give us a latest cutting edge treatment protocol? Anyone out there who can do this, do please contribute. Regards to all.

  38. Anonymous says:

    My mother had the first part of a dental implant done in Mexico approximately four months ago. She’s reluctant to get the second part of the dental implant done since she’s experienced constant pain with a little bit of tingling. I think she probably has nerve damage and needs to start with finding a doctor that can do a I-CAT. Any idea at all of what it would cost to get one done with a review of the results? She’s a senior on a very limited income living in AZ (and won’t take money). Also, can I get a little more info on the nerve block. I’d like to let her know that she might not have to live with this the rest of her life, even if it means getting a nerve block.

  39. Anonymous says:

    Has your mother gone back to the originating dr who put in the implant and advised the dr of the problems she is experiencing? If not that would be a good start. Depending on who her primary care physician is she could get a referral to have a ct scan done at a hospital and the radiologist could advise damage or possibly see what could be going on? Does she have a dentist that she sees regularly? She needs to seek help from drs out there and tell her not to stop till she finds one that is sincere and serious enough to help her through this pain and complication.

  40. Linda says:

    I had dental implants placed in my left lower jaw 4 weeks ago. I had no teeth in that area and they had been missing for several years. I had to have a bone graph done 1st and that was done in April 2006. The bone graph was slow in healing. It was too wide leaving a small area of the graph exposed. After 3 months the surgeon realized this area was not going to close and he shaved the graph down and in two weeks the tissue closed and he scheduled me for the implants in a week. Three days after the surgery I was still numb. I know this was unusal because I have been restoring my teeth for the last five years with Implants, Bridges and Crowns and I know what to expect. My left lower lip, chin and gums were numb. I had a deep itch in my chin that I could not scratch. It was a weird feeling. I saw my surgeon one week later, but I had already discovered what I had via the internet, Paresthsia. I am seeing the surgeon now every two weeks as he evaluates my progress. My lip and chin have gone from numbness to pain. It hurts. As long as I am quiet its ok but by late evening my chin is very sore and my lower lip is on fire. This may help others with altered sensation but I find that using Vicks Vapor rub helps me tremendously. Its a topical analgesic and it gives me relief for more than an hour at a time. Also Vitamin B6 helps in repair of nerves. In addition to being a patient I am also a nurse. I enjoyed good health prior to this happening to me. I realize that Dental Implants is a elective surgery but in my case my options were limited. I had no teeth to attach a denture in that area and I had had so much beautiful dental work already done my dentist insisted that a bone graph plus implants was my only alternative. Now I wish I had left well enough alone. But I have one Question. What is the prognosis when the damage is caused by the injection of anesthesia v/s the implants. When He was giving me the injections there was one injection that sent a shooting thrill from my jaw to my temple, I am almosts certain that this caused the paresthsia and will discuss this with him on my next visit. For now we are in a waiting mode, checking the sensation with each visit. He feels confident that the implants are not intruding on the nerve but we are in a wait and see mode.

  41. Rhonda says:

    Linda: I had an implant done 5 months ago and have been experiencing numbness and paresthsia. I was referred to a specialist and went. Many test were done and it is determined that the implant is not the cause of the numbness and paresthsia. He determined that the injection went into the nerve, he said that this is a very rare to occurence. That is very good news for me because I am able save the implant. In the meantime, I am on medication to help me through this healing period, it is really working too, I feel alot better and it prevents flare ups and pain. I have been told usually within a year there is a good chance it will heal but no guarantees. It may not be 100% but there will be improvement. Not always is the numbness due to the implant, there are other factors that may cause the numbness. In the meantime if you are suffering, there are medications out there that really do help. I hope this helps someone out there.

  42. AFGirl says:

    All: I apologize if this is not the correct forum. I am trying to gather information in advance. I am scheduled for a bone graphing surgery 24 Oct, prior to implant surgery. I am missing the teeth on either side of my front teeth (upper jaw). I had baby teeth but no adult teeth, and have dealt with an inferior Marilyn bridge for the past 10 yrs. I am in the military and they are paying for these procedures, plus some veneers and bleaching. All in all, it’s worth too much to refuse, and with the damage done by long-term problems with Marilyn bridges, it is something I cannot afford to put off any longer. I know I have nerve damage as a result of having 4 impacted wisdom teeth removed when I was 18 (7 yrs ago). It makes having any normal procedure difficult, such as an inability to effectively numb an area prior to a filling. Last month, for example, I had an old filling removed and replaced (they said it was loose, though it didn’t bother me). While attempting to numb it, they had to give me numerous injections, and one of the times it shot this painful feeling all through the side of my head, as though I could feel every single nerve all through the right side of my face/head. It continued shooting through spontaneously for most of that day. It is the first time that has ever happened to me. The time before that, when they tried to do a filling and were unable, after 8 injections, to numb the area, I had to have a tooth removed. It could not be worked on as it was very painful and they said it was unhealthy to leave it as it was. I am a non-smoker, and yet I had the bad luck of dry socket. I am just very nervous about the upcoming bone graphing and eventual implants. My luck is not good when it comes to oral procedures. They will be taking bone from the lower left jaw, where that tooth was removed in July, and using some ‘bottled bone’ (cow).
    If there is any pre-procedure advice or sites you recommend, I would surely appreciate it. Also, any post-op information that may be helpful.
    If you have ever been military, you will realize this isn’t much of an option; I am property of the government, and if they say something is necessary for my health, then that must get done. They pay for everything, and they try to provide the best care. I have been referred to a civilian surgeon for these procedures.
    Thanks in advance.

  43. lisa says:

    I had two bottom implants put
    in 7 months ago i have been in pain all of this time. I had full numbness in chin lip gums and teeth I have regained about 85%feeling back in chin lip and gums just about 2 weeks ago gained more feeling in my teeth but they feel painful. At 7 months
    im still slowly healing but whats up with the pain I have been to many doctors had a ct scan and it came back that the implant touched the Ian I did have the implants removed 2 day after and the pain I felt when it was removed was horrible. Im so tired if taking meds its destroying me
    i was an active person and now I feel 100

  44. kfchow-mostdi-msia says:

    Dear AFGirl,
    If you only have baby teeth and no adult teeth, you may be having a generalised medical condition, maybe some sort of syndrome. What exactly is the name of your medical condition? If you have not found out yet, maybe you ought to ask your doctor or find a doctor who can diagnose your condition because it may be relevant to treatment planning of dental implants.

  45. Anonymous says:

    I wrote in about my mother who had the implant done in Mexico. She did return to the surgeon, but unfortunately I’m not sure she understood what he was telling her about what occurred. It sounds like he believes the implant is not touching the nerve so removal of the implant would not necessarily reduce her pain. I am very grateful you mentioned she might be able to have her GP do a referral for a CT scan. She has plenty of medical coverage so this might be an affordable option for her – at least to get her headed in the right direction. THANK YOU –

  46. AFGirl says:

    I am not aware if any condition name. LOL. Sorry. I had the bone graft and I swelled horribly. I looked like I had a softball in each cheek, and severe bruising clear up to my eyes. I have some numbness on my gums over my front teeth, which they said will get better but I really don’t know if it will. My front teeth throb and I feel pressure in my sinuses. They said the sinuses have nothing to do with the bone graft. Well, they discounted that I had a cold, and then a lot of the bone came out because of the pressure, so I have more bone on the right side than the left now. I am just frustrated with it. It still hurts a little but not nearly as bad as the first 2 weeks. I am definitely scared of the implant surgery after this experience!

  47. Jay Jay says:

    Wow, such ignorance out there. I had 6 implants placed june 05. 3 more march 06. The doctor told me I was making it up, had hypochrhondris, all after he hid the fact tht I had osteomeylitis in both sides after a fracture that ocured during surgery, that he failed to even check for my pain source until I had implant infections after the fracture infected, then it went into the mandibular space and I suffered 2 abcessess, two months apart, and now of course have permanent nerve damage. I will be going to have a nerve ablation because it is painful beyond comphrension. The fracture is zig sagging it way across my jaw. I have retained legal service, and this may break ground for other uninformed suffers.They don’t want us to know, it is an easy buck implanting these crops. The research I tried to do was very fragmanted, and thankfully I have a super new oral surgeon, and have been to the best nerve specialist, alas, to late. These oral surgeons are sticking these things in anywhere. My surgeon stuck three more into already infected tissue, telling me the pain was from the over denture, and I fool I am, believed him. Until I was hospitalized near death. I am mentally, physically and emotionally overwhelmed. To learn that I couod have been helped from the top, and have been suffering 2 years. I hav had no solid food in two years. Two years of severe unrelenting pain of varying degrees depending where in hell I was at the time. I await the day he looses his license. And it will happen. The proof is there. Checking a surgeon out wont help, they will stop you dead if they can with their lies in efforts to conceal the crime. In this state, docs are protected. this one did suc a boo boo that he is not saved from himself..

  48. Jay Jay says:

    be scared and get out of that office as soon as posible like with in two months of pain that is not being taken seriously. You only have at best 4 months for any nerve repair.

  49. John Mearns says:

    I had a filling removed and replaced last week. As my dentist administered the anaesthetic I felt immediate pain when injected with the needle and felt my gum/chin/lower lip go numb almost immediately. 5 days have passed now and while the numbness is not so bad as at first it still feels numb. My dentist said this sounds like a bad reaction to the anaesthetic and could take up to two months to ruturn to normal. Does this sound correct?



  50. steve c says:

    John, It sounds like a nerve parasthesia resulting from damage done when the needle touched the nerve being numbed. This does happen occasionally and is almost always temporary. Most cases of parasthesia are seen in the tongue since this nerve is more exposed to being touched by the needle during the injection. It would be unusual for the feeling not to return to normal but it could take up to 3 or 4 months in cases where the nerve was hit squarely.

  51. Steve says:

    I just had 2 implants done, on teeth 3 and 29.
    After the surgeon removed the lower tooth (#29), he started to drill to make the hole bigger for the implant. I don’t remember if it was the drill or another tool but he hit the nerve pretty good and I almost flew out of the chair.
    After waiting a few seconds, he continued and it was soon over.

    The next day, my gums , chin and lips on my lower right side are completely numb. I went back the following day after letting him know and he removed the implant. Said he would do it again in 5-6 months with a smaller implant.

    After he removed the implant he touched the nerve to see if I felt it which I did. He then showed me the x-rays to show me he didn’t go deep enough to cut the nerve.

    I guess my question is, if there was nerve damage, would I not have felt the probe when I went back?
    He insists it will get better but then why did he prescribe prednisolone (steriods) and told me to take Vitamin B12 and some CO Q-10?

    Guess I’m worried this may never get better, its so hard to eat not feeling half of your mouth.

  52. CINDY says:

    Seven months ago I had 2 dental implants put in on my lower left side.After the surgery, I had immediate numbness on my chin and pain in lower mouth with 3 teeth.Today there is a shocking feeling every time i touch my chin or gums. My dr.has been trying to ‘play it off’ by saying ‘just give it time”.He hasn’t once called to see how I was doing.Now I am afraid to see anyone else for fear that maybe the next oral surgeon might protect my Dr. and not help me out and give me the right advice.My question and fear is that how do I know if this is permanent or temporary?Any direction that I go in will cost money that I don’t have.I aked to get my money back,but now i will have more expenses and will be going down a road that I have never been before.I also spoke with an attorney and she says that I am going to have to pay for depositions, court costs etc…. Who can I trust at this point? Who do I see now? nerve repair specialist? oral surgeon? I am afraid that if I just accept any offer from the Dr.and don’t persue this,I will be upset at myself.All I want is to be able to get my normal feeling back again.Can someone help me and give me advice on what to do?The Dr. needs to take responsibility.

  53. "A"non, Fl says:

    Hi Cindy, My name is Cindy also, and I am in the same situation you are. I had a bad implant experience on rt lower jaw 15 months ago that was made worse after the implant was exposed. And yes he also played out the clock and pretended the problem was with denture and could not possibly be his doing. I have limited sensation in areas of face from auto accident but have a sensativity to heat through implant. And have overwhelming burning, pressure and throbbing in jaw, so I do not know of your type of condition.
    Unfortunitely mine has shown the same lack of character and integrity. I received a return call today and was once again blown off. He used to make me wait for an appointment and drive an hour and a half one way to do it in person. Unbelievable isn’t it.
    I would try calling your Doctors office again and let him know your distress. If you do not get a response in a timely manner try calling your state dental board and make a complaint. Other Doctors will appreciate this as it identifies the bad ones, like mine, and helps keep their profession in good standing.

    Let me know how you make out.

  54. "A"non, Fl says:

    Edit for Cindy post:

    Make sure your reviewing board member is not also being paid as expert for Dentists in malpractice cases. It is allowed in some states but far from ethical. If your state allows it call your state rep.


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Posted in CT Scans for Dental Implant Treatment, Patient Questions.
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