Dental implants are an exciting and state of the art solution for missing teeth. However, dental implant placement is a serious surgical procedure that can result in permanent nerve damage. The most serious forms of nerve damage after a dental implant procedure involve damage to the inferior alveolar nerve (IAN), which is the nerve that runs through the middle of the jawbone or mandible. A dentist may also damage the lingual nerve, which runs along the bottom of the mouth near the tongue. Thus, dental implant nerve damage typically occurs when a dentist is placing implants in the lower jaw.
Damage to the inferior alveolar nerve or lingual nerve is serious and can cause excruciating and lasting pain, as well as disability or disfigurement. If the dentist damages a nerve during implant placement, the patient must receive treatment as soon as possible to prevent permanent nerve damage and to lessen existing nerve damage. However, there are times when even prompt treatment does not fix the problem, and in those cases, the nerve damage may be permanent.
Causes of Nerve Injury During Dental Implant Procedures
A dental implant procedure is a complex surgical procedure that involves drilling a hole into a patient’s bone and screwing a titanium post into that hole. There are nerves throughout the mouth and jaw, and a dentist should know what nerves and structures could be damaged during a given procedure. Therefore, a dentist should take proper images during the planning stage of the dental implant treatment to avoid any unnecessary damage to a patient’s nerves.
Optimally, a dentist will take three-dimensional images as part of the preoperatory planning phase of the dental implant procedure. If a dentist fails to properly plan, horrible things can happen. Below are some of the more common causes of nerve injury during dental implant procedures.
Drilling Too Deeply
A dentist may damage the inferior alveolar nerve when drilling in the jawbone or mandible too deeply. The inferior alveolar nerve canal, also known as the mandibular canal, runs through the middle of the jawbone. Thus, if a dentist drills too deeply while placing an implant in the lower jaw, the dentist may puncture the canal. This may be referred to as implant drill intrusion. In the more severe cases, the dentist may drill through the canal completely.
Dental Implant Intrusion
Another way a dentist can injure the inferior alveolar nerve during implant placement is by compressing the nerve with the implant or by screwing the implant into the inferior alveolar nerve canal. When the dentist places the implant post into the bone, the tip or apex of the implant can venture too close to the nerve and press on the nerve canal. The implant may also compress on the top of the inferior alveolar canal and cause the roof of the canal to crack. This compression can permanently damage the nerve during the implant procedure, or it can cause damage to the nerve after the implant placement if the implant presses on the nerve too long. In more serious cases, the dentist may screw the implant all the way into the nerve canal or through the nerve canal, directly damaging or severing the nerve.
Bruising Surrounding Tissues
A dentist may also damage the inferior alveolar nerve by damaging the surrounding tissues. This can cause bruising and swelling around the nerve, and the swelling can place pressure on the nerve itself and on the surrounding tissues. Left untreated, this swelling can cause serious pain and permanent nerve damage.
When drilling into the bone, sometimes a dental implant drill may become too hot due to the friction caused by the drilling. If the dentist carelessly allows the drill to heat past a safe temperature, the drill may cause damage to the nerve and surrounding tissues.
Direct Contact with the Nerve
A dentist my damage a nerve during a dental implant procedure by hitting the actual nerve itself with an instrument or with the implant. Obviously, direct contact with the nerve can cause serious damage. Patients who were unfortunate enough to feel this type of injury often experience a feeling like an electrical shock.
Injury to the Lingual Nerve
Although injuries to the inferior alveolar nerve are more common during a dental implant procedure, a dentist may also damage the lingual nerve. Typically, damage to the lingual nerve will occur when a dentist accidentally slips with a rotary tool or other sharp instrument, like a scalpel. Additionally, a dentist may injure the lingual nerve while performing a lingual flap or while performing a third molar extraction.
Symptoms of Nerve Damage After Dental Implant Procedure
There are many ways nerve damage might manifest itself. Nerve damage is somewhat enigmatic, and not everyone will experience nerve damage in the same way. There are, however, some common symptoms that generally describe the way many people will experience nerve damage after a dental implant procedure, including the following:
- Numbness on the same side where the dentist placed the implant;
- Numbness on the lower lip;
- Numbness on the chin;
- Numbness on the tongue or jaw; or
- Tingling, tickling, or burning sensations that arise after dental implant placement.
If you have experienced any of these symptoms after a dental implant procedure, you may have suffered nerve damage.
How Common Is Nerve Damage After Dental Implant
The incidence of nerve injury after the placement of implants is more common than practitioners once thought. In fact, recent literature shows that roughly 1 in every 100 dental implant procedures will result in nerve injuries. The inferior alveolar nerve is the nerve most commonly injured during dental implant procedures, followed by the lingual nerve. As the number of dentists placing implants increases, the number of patients that suffer devastating nerve damage will also continue to increase.
Dental Implant Nerve Damage Treatment
Nerve damage after a dental implant procedure is more likely to be permanent the longer it is left untreated. Thus, it is critical for the practitioner to diagnose and treat the nerve damage at the earliest possible opportunity. Below are some of the more common ways to treat nerve damage after a dental implant procedure.
Some early treatment options may involve removing the implant and cleaning the osteotomy site to relieve pressure and allow healing. Literature suggests that removing any irritants close to the nerve injury site, like blood and bone debris, can help to prevent permanent nerve damage.[i]
Other treatment options may involve prescribing various drugs. For example, corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to help nerve damage after a dental implant procedure. Additionally, adrenocorticosteroids have been shown to minimize nerve damage if administered within 1 week of the surgery.[ii] Finally, other pharmacological treatments may be prescribed. Some of these agents may include antidepressants or anticonvulsants.
In the most serious instances, surgery may be required to repair the nerve damage. Typically, this type of surgery is performed by a microneurosurgeon. Surgical intervention is most successful if performed within three months of the nerve damage.[iii] Studies have shown that roughly half of patients with nerve damage after a dental implant can expect surgical treatment to improve sensation and reduce their nerve damage.[iv]
There are other forms of treatment for nerve damage that a doctor may prescribe that do not involve drugs or surgery. For example, a doctor may suggest the application of cold, or cryotherapy. Like with other injuries inflammation, the application of cold can reduce swelling, minimize damage, and speed up healing. Studies have also shown that acupuncture, electric nerve stimulation, and laser therapy may improve nerve damage.[v]
Dental Implant Nerve Damage Lawsuit
If you have suffered nerve damage after a dental implant procedure, you may have a viable dental malpractice claim. As with any other dental malpractice or medical malpractice lawsuit, the viability of the case depends upon whether the dentist or practitioner breached the standard of care. In other words, if there is evidence to support the fact that the dentist breached the standard of care during your dental implant procedure and damaged your nerve as a result, you may have a good case.
[i]See Gintaras Juodzbalys et al., Injury of the Inferior Alveolar Nerve during Implant Placement: A Literature Review, 1 J Oral Maxillofac Res. 2 (2011).
[ii]See Galloway et al., Role of topical steroids in reducing dysfunction after nerve injury. 110 Laryngoscope 1907-10 (November).
[iii]See Richard Kraut & Omar Chahal, Management of patients with trigeminal nerve injuries after mandibular implant placement, 133 J Am Dent Assoc. 1351 (Oct. 2002).
[iv]See M. Anthony Pogrel, The results of microneurosurgery of the inferior alveolar and lingual nerve, 60 J Oral Maxillofac Surg. 485 (May 2002)
[v]See Gintaras Juodzbalys et al., Injury of the Inferior Alveolar Nerve during Implant Placement: a Literature Review, 1 J Oral Maxillofac Res. 2 (2011).