Post-operative parasthesia: recommendations?
Dr. G. asks:
I have a patient who presents with post-operative parasthesia following installation of an implant in #30 site [maxillary right first molar; 46]. I administered local anesthesia by infiltration. I prepared the osteotomy in the usual stepwise manner without any problems. When I used the final drill in the sequence, the patient began to feel a ‘tingle’. I installed the implant without any problems. The radiograph showed that the there was space between the implant and the inferior alveolar canal. But it appears as though I perforated the superior aspect of the canal with the final drill. The area with paresthesia is quite small. Should I administer steroids? Should I remove the implant? What do you recommend?
8 Comments on Post-operative parasthesia: recommendations?
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dr. dan
3/27/2012
Inform the patient of what happened. If this just happened, medrol pack. If it happened a week ago, take it out and don't graft.
Either way, the parasthesia may remain. Tell the patient.
If it doesn't bother them, then make sure you get their signature that it doesn't bother them.
Unfortunately, though, these parasthesias can last.
As far as xrays, did you get a ct scan? How would you know where your implant exactly is with just with a pan or pa?
JIM
3/27/2012
What is the time frame to administer a dose pak? Obviously, the sooner the better but when is it not recommended to use a dose pak?...a week or a few days?
dr. dan
3/27/2012
The dose pack less than 24 to 48 hrs. That's to reduce inflammation.
I have a feeling that it won't help you in this situation.
Alejandro Berg
3/27/2012
Hi Dr G. I would say take a cone beam ct of the implant, if there is distance between the implant and the nerve canal thsi is probably just a hemathoma that is compressing the nerve, so you are in luck and will have to ride it out . Corticoid therapy with vitamin b complex will help and speed the process. If there is intrussion into the canal, remove the implant asap and start the treatment inmediately.
Best of luck
Dr G J Berne
3/27/2012
If the implant was in the "maxillary right first molar" and you've got mandibular n paraesthesia, then you're in deep trouble. I presume that was a typo.
The implant is placed and if it is not in direct contact with the mandibular nerve, then there is not much point in removing the implant-the damage has already been done. The nerve is usually fairly tough if touched by a drill and as long as you haven't severed it and there is no pressure from the implant on the nerve as you appear to indicate, there is a reasonable to good chance that it will recover from the trauma and the paraesthesia will finally disappear over a period of months. If this doesn't happen, then it wouldn't happen by removing the implant also and the patient will be left with paraesthesia and no implant. If the nerve doesn't recover, at least in the interim you've given the patient some hope and if the area is small , the patient more than likely will get used to it and not be overly concerned, particularly if they have a functioning implant.
Richard Hughes, DDS, FAAI
3/28/2012
Again, I suggest to view the paper by Wang et al, which addresses in some detail, injury to the IAN.
A.Tarek
4/25/2012
you have to unscrew the implant two turn anticlockwise..
adminstrate B12 vitamin one month for patien start with injection then tablets...
i had a case like this and its fine now
Rolando
7/30/2012
Yes, of course he can get dotcors to see him and blood tests done.If the out of pocket cost is prohibitive, have him apply for themy simple card membership. They will not deny him and theydo not require a proof of citizenship.
