Implant Patient Complains of Numbness but Objective Signs Show No Problems: Recommendations?
I installed an implant in the mandible 5 days prior without any apparent complications. Â The patient returned for a follow up visit after 5 days post-operative. Â Objective signs were within normal limits except for her subjective complaint of heaviness and numbness in her lower lip. Â Should I back out the implant 1mm and see if that relieves her symptoms? Â Could her symptoms be normal for this short time period following the surgical installation of the implant? Â Could normal post-operative swelling and inflammation be causing this numbness? Â Or should I just continue to watch this patient and put off intervention at this time? Â I have prescribed vitamin B complex to promote nerve regeneration. Â What do you recommend?
15 Comments on Implant Patient Complains of Numbness but Objective Signs Show No Problems: Recommendations?
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A Shahab
5/7/2012
The numbness might be related to the soft tissue trauma that has been occurred during the surgery. If every other thing looks normal just follow the patient.
Peter Fairbairn
5/7/2012
With no radiological evidence it is hard to assess , do you have a pre-op scan orpost-op PAs . Your description is vague , symptoms would be noticed in a few hours post treatment.
Did you use and ID block or not ? , Articane ?
Too many missing details
Good luck
Peter
JIM
5/8/2012
There can be no answers to your questions without more info like pre op and post op xrays, scans, intraoral pics, and medical history of patient. How about technique used.....did you raise a flap or did you perform the procedure flapless? Any bone grafting involved? Type and size of implant. Final torque values obtained? D1 bone or was it D4?
DrT
5/8/2012
Yes, it would be very helpful to see how you documented this case. Thank you.
DrT
Dr O
5/8/2012
If the soft tissue in / around the mental foramen was manipulated, swelling of the soft tissue could cause numbness for two weeks or more.
If you wish to protect yourself in a legal sense, remove the implant.
dr.A.k.Meena
5/8/2012
dear friend history of numbness is most probably due to injury of mental nerve if you placed implant aroud 44,45 or 34,35 region.
nothing to worry if it could be a nerve damage that can be repair but it takes time.
it is the matter of time if patients is getting exhausted then try to explain him bcz its a normal complication that can be happen not a serious problem.
dr. dan
5/8/2012
Hope you had written informed consent.
Dr. Rateb
5/10/2012
Hello doctor can you show us more about this case like the obj you know there is cases that the nerve has wide loop or curved back , thank you.
Dr.S.Lin
5/11/2012
Where is the implant placed in the mandible? molar area or premolar area?
Denis cunneen
5/13/2012
Without another clinical details given , it would be prudent to back out the implant 1 or 2 mm .Use only gingival surface anaesthesia .
Richard Hughes, DDS, FAAI
5/13/2012
All of the above made good points. You may want to read Block and Kent's book titled "Endosseous Implants for Maxillofacial Reconstruction" also H L Wang, et al wrote a great paper about injury to the IAN. As per this case, more information is needed.
naser
5/14/2012
when did the numbness started ?if its started the same day of surgery it could be due to nerve injury but if few days later , might be due to inflammation and or infection and edema compressing the nerve within the canal
more follow up is needed
Luis
5/21/2012
How long is the implant placed? Can it be replaced with a shorter one the sooner you do it the better. Need to provide more info to better asses the situation. About 25 years ago I had a similar problem and opted to remove the implant , I did and thank God every thing was normal after that . Good luck.
Dr G. Subraya Bhat
5/23/2012
hello dennis cunnen, can you eloborate more on when to back out the implant 1 or 2 mm , i mean related to the implant placement day, after a week , after 2 weeks or after 2 months, and does ir affect the osseointegration please give your valuable opinion
DENIS CUNNEEN
5/23/2012
BACKING OUT IS REALLY ONLY POSSIBLE IN THE WOVEN BONE STAGE WITHOUT CAUSING SOME LOSS OFF INTEGRATION DUE TO BONY FRACTURE.I WOULD USE IT THEN WITHIN 3 WEEKS IF POSSIBLE.Object is too reduce pressure on a constricted inflamed nerve tissue.I would not use total anesthesia in case my moving of the implant impacted onto the healing nerve tissue itself.The loss of 1 to max 2mm of bony crest should not condemn the implant to failure but does allow further smart people to assess the position and the surgical process and if required simpler removal of the implant.Its not an area where definitive research has shown a clinically proven pathway
