Iatrogenic inferior alveolar nerve injuries during implants placement: Report of two cases and review of the literature
Labros GOUTZANIS, Aggeliki KARAMANOLI, Dimitra MANIATI, Vagia BOUTLA, Panagiotis GOUTZANIS, Vassilios PETSINIS
Department of Oral and Maxillofacial Surgery (Head: Prof. I. Iatrou), School of Dentistry, National and Kapodistrian University of Athens
Hellenic Archives of Oral & Maxillofacial Surgery (2016) 2, 63-76
SUMMARY: Inferior alveolar nerve (IAN) injuries can be caused iatrogenically, during various operations, and lead to sensory disorders in the lower lip, chin, vestibular gums etc., that are painful for the patient. These injuries often occur during implants placement procedures, which are nowadays a routine practice in Oral and Maxillofacial Surgery, making this subject always relevant. The purpose of this study is to analyse the causes of iatrogenic IAN injury caused during implants placement, as demonstrated through the presentation of two cases and review the relevant international literature. The literature review involves articles on clinical cases in which IAN injury was either caused iatrogenically or prevented by means of accurate preoperative assessment and use of the right surgical procedure. The symptoms of this kind of IAN injury can be temporary or permanent, and vary from mild hypaesthesia to anaesthesia or paraesthesia. The prevention of IAN injury during dental implants placement operations relies heavily on the identification of risk factors, thorough preoperative assessment, correct surgical procedure and experience of the surgeon.
KEY WORDS: Injury, IAN, dental implants
REFERENCES
Αλεξανδρίδης Κ: Εισαγωγή στην εμφυτευματολογία Ιατρικές εκδόσεις Λίτσας 2009: σελ. 64-65, 75-80
Καγδογλής Κ: Νευροχειρουργική: Επιστημονικές εκδόσεις Γρηγόριος Παρισιάνος 1996, σελ. 133-136
Abayev B, Juodzbalys G: Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques. J Oral Maxillofac Res 6(1):e2, 2015a
Abayev B, Juodzbalys G: Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications. J Oral Maxillofac Res 6(1):e3, 2015b
Alhassani AA, AlGhamdi AS: Inferior Alveolar Nerve Injury in Implant Dentistry: Diagnosis, Causes, Prevention, and Management. J Oral Implantol 36(5):401-7, 2010
Basa O, Dilek OC: Assessment of the risk of perforation of the mandibular canal by implant drill using density and thickness pa- rameters. Gerondontology 28:213-220, 2011
Benavides E, Rios HF, Ganz SD, An CH, Resnik R, Reardon GT, Feld- man SJ, Hatcher D, Kim MJ, Sohn DS, Palti A, Perelman ML, Judy KW, Misch CE, Wang HL: Use of cone beam computed tomog- raphy in implant dentistry: the international congress of oral im- plantologists consensus report. Implant Dentistry 21(2):78-86, 2012
De Oliveira Martins D1, Martinez dos Santos F, Evany de Oliveira M, de Britto LR, Benedito Dias Lemos J, Chacur M: Laser therapy and pain-related behavior after injury of the inferior alveolar nerve: possible involvement of neurotrophins. J Neurotrauma 30(6):480- 6, 2013
Deppe H, Mücke T, Wagenpfeil S, Kesting M, Linsenmeyer E, Tölle T: Trigeminal nerve injuries after mandibular oral surgery in a uni- versity outpatient setting―a retrospective analysis of 1,559 cases: Clin Oral Investig 19(1):149-57, 2015
Gupta J, Ali SP: Cone beam computed tomography in oral implants.
Natl J Maxillofac Surg. 4(1):2-6, 2013
Jones RHB: Repair of the trigeminal nerve: a review. Australian Dental Journal 55:112-119, 2010
Juodzbalys G, Wang HL, Sabalys G: Injury of the Inferior Alveolar Nerve during Implant Placement: a Literature Review J Oral Max- illofac Res 2(1):e1, 2011
Juodzbalys G, Kubilius M: Clinical and radiological classification of the jawbone anatomy in endosseous dental implant treatment. J Oral Maxillofac Res 4(2):e2, 2013
Khawaja N, Renton T: Case studies on implant removal influencing the resolution of inferior alveolar nerve injury. British Dental Journal 206:365-370, 2009
Kim JH, Kim SM, Jung HJ, Kim MJ, Lee JH: Effective end-to-end repair of inferior alveolar nerve defect by using nerve sliding technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:28-30, 2011
Kim YK, Yun PY, Kim JH1, Lee JY, Lee W: The quantitative sensory testing is an efficient objective method for assessment of nerve injury. Maxillofac Plast Reconstr Surg 37(1):13, 2015
Leckel M, Kress B, Schmitter M: Neuropathic pain resulting from im- plant placement: case report and diagnostic conclusions. J Oral Rehabil 36(7):543-6, 2009
Lee JY, Jabng JW, Kim SM, Kim MJ, Lee JH: Simultaneous inferior alve- olar nerve regeneration and osseointegration with a nerve growth factor-supplying implant: a preliminary study. American Associa- tion of Oral and Maxillofac Surg 73:410-423, 2015
Leite GMF, Lana JP, Manzi FR, Souza PEA, Horta MCR: Anatomic vari- ations and lesions of the mandibular canal detected by cone beam computed tomography. Surg Radiol Anat 36:795-804, 2014
Lin MH, Mau LP, Cochran DL, Shieh YS, Huang PH, Huang RY. Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: A virtual implant placement study. J Dent 42(3):263-70, 2014
Naitoh M, Hirukawa A, Katsumata A, Ariji E. Evaluation of voxel values in mandibular cancellous bone: relationship between cone-beam computed tomography and multislice helical computed tomog- raphy. Clin Oral Implants Res. 20(5):503-6, 2009
Papanicolaou P, Vlastos K, Fragiskos D, Fragiskos F: The anterior loop of the inferior alveolar nerve. A radiographic study of panoramic radiographs and review of the literature Hellenic Archives of Oral & Maxillofacial Surgery 15(1): 27-36, 2014
Peker I, Alkurt MT, Michcioglu T. The use of 3 different imaging meth- ods for the localization of the mandibular canal in dental implant planning. Int J Oral Maxillofac Implants. 23(3):463-70, 2008
Renton T, Yilmaz Z, Gaballah K: Evaluation of trigeminal nerve injuries in relation to third molar surgery in a prospective patient cohort. Recommendations for prevention. Int J Oral Maxillofac Surg 41:1509–1518, 2012
Yadav S, Verma A, Sachdeva A: Assessment of lingual nerve injury using different surgical variables for mandibular third molar surgery: a clinical study. Int. J. Oral Maxillofac. Surg. 43: 889–893, 2014
Yu SK, Lee MH, Jeon YH, Chung YY, Kim HJ: Anatomical configuration of the inferior alveolar neurovascular bundle: a histomorphometric analysis. Surg Radiol Anat, 2015
Ziccardi VB, Steinberg MJ: Timing of Trigeminal Nerve Microsurgery: A Review of the Literature. J Oral Maxillofac Surg 65(7):1341- 1345, 2007
Zogakis A, Marinis G, Papadeli C,Tezapsidis G, Natsinasa N, Tsitouridis I: Paresthesia of the inferior alveolar nerve. Stoma 37(1):47-59, 2009
Department of Oral and Maxillofacial Surgery (Head: Prof. I. Iatrou), School of Dentistry, National and Kapodistrian University of Athens
Hellenic Archives of Oral & Maxillofacial Surgery (2016) 2, 63-76
SUMMARY: Inferior alveolar nerve (IAN) injuries can be caused iatrogenically, during various operations, and lead to sensory disorders in the lower lip, chin, vestibular gums etc., that are painful for the patient. These injuries often occur during implants placement procedures, which are nowadays a routine practice in Oral and Maxillofacial Surgery, making this subject always relevant. The purpose of this study is to analyse the causes of iatrogenic IAN injury caused during implants placement, as demonstrated through the presentation of two cases and review the relevant international literature. The literature review involves articles on clinical cases in which IAN injury was either caused iatrogenically or prevented by means of accurate preoperative assessment and use of the right surgical procedure. The symptoms of this kind of IAN injury can be temporary or permanent, and vary from mild hypaesthesia to anaesthesia or paraesthesia. The prevention of IAN injury during dental implants placement operations relies heavily on the identification of risk factors, thorough preoperative assessment, correct surgical procedure and experience of the surgeon.
KEY WORDS: Injury, IAN, dental implants
REFERENCES
Αλεξανδρίδης Κ: Εισαγωγή στην εμφυτευματολογία Ιατρικές εκδόσεις Λίτσας 2009: σελ. 64-65, 75-80
Καγδογλής Κ: Νευροχειρουργική: Επιστημονικές εκδόσεις Γρηγόριος Παρισιάνος 1996, σελ. 133-136
Abayev B, Juodzbalys G: Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques. J Oral Maxillofac Res 6(1):e2, 2015a
Abayev B, Juodzbalys G: Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications. J Oral Maxillofac Res 6(1):e3, 2015b
Alhassani AA, AlGhamdi AS: Inferior Alveolar Nerve Injury in Implant Dentistry: Diagnosis, Causes, Prevention, and Management. J Oral Implantol 36(5):401-7, 2010
Basa O, Dilek OC: Assessment of the risk of perforation of the mandibular canal by implant drill using density and thickness pa- rameters. Gerondontology 28:213-220, 2011
Benavides E, Rios HF, Ganz SD, An CH, Resnik R, Reardon GT, Feld- man SJ, Hatcher D, Kim MJ, Sohn DS, Palti A, Perelman ML, Judy KW, Misch CE, Wang HL: Use of cone beam computed tomog- raphy in implant dentistry: the international congress of oral im- plantologists consensus report. Implant Dentistry 21(2):78-86, 2012
De Oliveira Martins D1, Martinez dos Santos F, Evany de Oliveira M, de Britto LR, Benedito Dias Lemos J, Chacur M: Laser therapy and pain-related behavior after injury of the inferior alveolar nerve: possible involvement of neurotrophins. J Neurotrauma 30(6):480- 6, 2013
Deppe H, Mücke T, Wagenpfeil S, Kesting M, Linsenmeyer E, Tölle T: Trigeminal nerve injuries after mandibular oral surgery in a uni- versity outpatient setting―a retrospective analysis of 1,559 cases: Clin Oral Investig 19(1):149-57, 2015
Gupta J, Ali SP: Cone beam computed tomography in oral implants.
Natl J Maxillofac Surg. 4(1):2-6, 2013
Jones RHB: Repair of the trigeminal nerve: a review. Australian Dental Journal 55:112-119, 2010
Juodzbalys G, Wang HL, Sabalys G: Injury of the Inferior Alveolar Nerve during Implant Placement: a Literature Review J Oral Max- illofac Res 2(1):e1, 2011
Juodzbalys G, Kubilius M: Clinical and radiological classification of the jawbone anatomy in endosseous dental implant treatment. J Oral Maxillofac Res 4(2):e2, 2013
Khawaja N, Renton T: Case studies on implant removal influencing the resolution of inferior alveolar nerve injury. British Dental Journal 206:365-370, 2009
Kim JH, Kim SM, Jung HJ, Kim MJ, Lee JH: Effective end-to-end repair of inferior alveolar nerve defect by using nerve sliding technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:28-30, 2011
Kim YK, Yun PY, Kim JH1, Lee JY, Lee W: The quantitative sensory testing is an efficient objective method for assessment of nerve injury. Maxillofac Plast Reconstr Surg 37(1):13, 2015
Leckel M, Kress B, Schmitter M: Neuropathic pain resulting from im- plant placement: case report and diagnostic conclusions. J Oral Rehabil 36(7):543-6, 2009
Lee JY, Jabng JW, Kim SM, Kim MJ, Lee JH: Simultaneous inferior alve- olar nerve regeneration and osseointegration with a nerve growth factor-supplying implant: a preliminary study. American Associa- tion of Oral and Maxillofac Surg 73:410-423, 2015
Leite GMF, Lana JP, Manzi FR, Souza PEA, Horta MCR: Anatomic vari- ations and lesions of the mandibular canal detected by cone beam computed tomography. Surg Radiol Anat 36:795-804, 2014
Lin MH, Mau LP, Cochran DL, Shieh YS, Huang PH, Huang RY. Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: A virtual implant placement study. J Dent 42(3):263-70, 2014
Naitoh M, Hirukawa A, Katsumata A, Ariji E. Evaluation of voxel values in mandibular cancellous bone: relationship between cone-beam computed tomography and multislice helical computed tomog- raphy. Clin Oral Implants Res. 20(5):503-6, 2009
Papanicolaou P, Vlastos K, Fragiskos D, Fragiskos F: The anterior loop of the inferior alveolar nerve. A radiographic study of panoramic radiographs and review of the literature Hellenic Archives of Oral & Maxillofacial Surgery 15(1): 27-36, 2014
Peker I, Alkurt MT, Michcioglu T. The use of 3 different imaging meth- ods for the localization of the mandibular canal in dental implant planning. Int J Oral Maxillofac Implants. 23(3):463-70, 2008
Renton T, Yilmaz Z, Gaballah K: Evaluation of trigeminal nerve injuries in relation to third molar surgery in a prospective patient cohort. Recommendations for prevention. Int J Oral Maxillofac Surg 41:1509–1518, 2012
Yadav S, Verma A, Sachdeva A: Assessment of lingual nerve injury using different surgical variables for mandibular third molar surgery: a clinical study. Int. J. Oral Maxillofac. Surg. 43: 889–893, 2014
Yu SK, Lee MH, Jeon YH, Chung YY, Kim HJ: Anatomical configuration of the inferior alveolar neurovascular bundle: a histomorphometric analysis. Surg Radiol Anat, 2015
Ziccardi VB, Steinberg MJ: Timing of Trigeminal Nerve Microsurgery: A Review of the Literature. J Oral Maxillofac Surg 65(7):1341- 1345, 2007
Zogakis A, Marinis G, Papadeli C,Tezapsidis G, Natsinasa N, Tsitouridis I: Paresthesia of the inferior alveolar nerve. Stoma 37(1):47-59, 2009
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