Nerve disturbances

133 Rating(s).


Posted on By Miguel Martinez In Implants

Pt presented for full mouth extraction, immediate implants and conversion of denture. What appears to be Condensing Osteitis noted on postmandible. After full mouth extraction, and adequate alveloplasty, flap advanced apically to visualize mental foramina prior to placing distal implants at ~30* angle to 1-avoid mental, 2-avoid drilling into sclerotic bone, and 3-better ap spread and cantilever.
After surgery, office provided a technician come in and convert it.
Pt complained of ‘burning sensation’ however responded appropriately to stimulus. I reduced flange on lower right and pt reported ‘less pressure and burning’
Today patient reports pain on both sides. Pt to take a post op CT tomorrow and will see her in the afternoon.

My question is:
if they need to be removed, can i place ~3mm more anteriorly with same implants or are they infected in this probably nutrient void area of sclerotic bone.

Pt put on medrol dose pack already.
Thank you in advance for your help and kind critique
Miguel


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7 Comments

Hi i would probovly advise to remove tilted implants... Seems like you might have room for 2 more in cainine region and i would place 2 more straight ones in 4 region( perferably not loaded..) to make for 6 implants hitting nerve or ant. loop is a big deal i would stay away... And of course i would use new implants not the same ones... There are enough reasons for failure here, we dont add to them. Just my opinion. I wish u luck Aryeh


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An even better plan would be to go distal to foraman if you can seems the hight is right. Consider if possible on ct..


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hello doctor
thanks for your input.
never thought of taking it distal to sclerotic bone; the left side would be a challenge.
i think replacing mesial to where they’re at presently with 60+ implant stability quotient and converting immediately should allow both me and pt to return to normal, relaxed, happy self.

note: implantes placed and converted 3wks ago


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HI MIGUEL. THE SCLEROTIC AREAS ARE REMINISCENT OF CEMENTO-OSSEOUS DYSPLASIA. IT IS BEST TO AVOID DISTURBING BLOOD SUPPLY NEAR THEM AS THEY SOMETIMES ULCERATE AND THEN GO SEPTIC. YOUR IMPLANTS LOOK CLEAR OF THE CANAL AND MENTAL FORAMEN. THE ALTERED SENSATION MAY BE FROM FLAP RETRACTION. I WOULD SUGGEST THE MEDROL AS YOU ARE USING; ADD NEUROBION AND LOW LEVEL LASER THERAPY AND IT SHOULD IMPROVE. A MED SUCH AS LYRICA (GABAPENTIN) OR ALTERNATIVE; MAY ALSO HELP. UNLESS YOUR CBCT SHOWS INCURSION ONTO THE NERVE I WOULD FOLLOW THE ABOVE. I WOULD NOT RUSH INTO REMOVING YOUR HARD WORK. GOOD LUCK


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OH...AND... ADD A NSAID I PRESUME . ON BETTER LOOK AT XRAY YOU MAY BE IN THAT LESION AND POSSIBLY OEDEMA IS CAUSING SYMPTOMS. ITS A GREAT CASE TO LEARN FROM . THANKS FOR POSTING. IF POSSIBLE CAN WE SEE POST OP CBCT WHEN CONVENIENT


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thanks. pt is maxed out pmp for narcotics and has history seeking ‘pain pills’ from other locations. pt complained of max dentures/implants during follow up yesterday. i think i will wait for inflammatory process runs its course. i have been in communication with her and reports feeing bette and in good spirits. lastly, pt has been reading up online regarding her symptoms. i will post any other findings in the following weeks.


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