|Year : 2017 | Volume
| Issue : 1 | Page : 1-2
Implant-related neuropathic pain: Prevention is the key
Steven R Singer1, Muralidhar Mupparapu2
1 Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, New Jersey, USA
2 Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
|Date of Web Publication||14-Jun-2017|
Steven R Singer
DDS, Professor and Chair, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, New Jersey 07101
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singer SR, Mupparapu M. Implant-related neuropathic pain: Prevention is the key
. J Orofac Sci 2017;9:1-2
Although the dental profession has witnessed the placement of root form dental implants in the last two decades, a new phenomenon has more recently emerged. There has been a steady increase in referrals from attorneys to review the cases wherein implants were misplaced and caused potential nerve damage. Most of these cases involve possible injury to the inferior alveolar nerve based on the clinical features and symptoms. A cursory review of the dental history in these cases reveals that the implants were placed with the aid of minimal and inadequate two-dimensional imaging. Typically, a rather striking postoperative cone-beam computed tomography (CBCT) scan of the region in question, demonstrating the area of implant or implants, is accompanied by the preoperative two-dimensional panoramic and/or periapical radiographs. A few lines from the patient’s chart, inadequately describing the procedure, are often provided. The referring attorney will request a review of these provided records.
What we see on the postoperative scans is often distressing. Osteotomy sites (the implant having been removed soon after placement) that penetrate the inferior alveolar nerve canal are often the common scenario in these cases. Sometimes, the implant itself is still in position and seen deroofing the canal. The resultant injury to the patient is a paresthesia or, worse, a dysesthesia. These injuries “considerably lower the patients’ satisfaction about the therapy.” Irate patients in the United States often will sue their dentist. Fortunately, only a small percentage of the injuries persist after a year.
While the vast majority of dental implants are placed with considerably more success than those mentioned above, iatrogenic injuries to the trigeminal nerve are on the increase with increasing numbers of implants placed. Most, if not all, of these misadventures in implant placement can be prevented with the use of CBCT scans, careful measurements, and knowledge of the relevant anatomy. A software to simulate implant placement can be used with the converted digital imagining and communication in medicine (DICOM) files of CBCT scans to create surgical guides that can vastly minimize the chances of implant placement errors while increasing the accuracy and predictability of the procedure. The key here again is the prevention of a possible nerve injury.
CBCT imaging has become increasingly accessible and affordable over the past few years. In a recent survey, dental students’ positive attitudes portend a large increase in CBCT acceptance in the near future. Students in India have a higher awareness of CBCT than those in Turkey. In 2011, it was reported that most U.S. dental schools were teaching CBCT in both pre- and postdoctoral curricula. Because dental students represent the future of our profession, a surge in CBCT education should eventually lead to an increased utilization of three-dimensional imaging, along with a drop in unfortunate outcomes.
As educators of oral and maxillofacial radiology, we consider it to be our responsibility to introduce each and every dental student to CBCT in both didactic and clinical aspects. It is likely that most of our students will eventually be placing implants and performing surgical procedures rather routinely in critical areas. According to the American Academy of Implant Dentistry, 10% of the U.S. dentists currently place implants, but the number is increasing. The earlier the CBCT is introduced in the curriculum, the better the ultimate outcome of the implants placed by these former students. The lesson to be learned is clear. A safe, observant, and cautious approach to implant selection, placement, and restoration, all under guidance, is recommended, because the results are more predictable.
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