Symptoms Of Nerve Damage From Dental Implants: When To Seek Help?

A Brief On Dental Implants

Dental implants behave as natural tooth roots and restore the functions of the fallen teeth. Missing teeth deteriorate the quality of your life. The gaps left by missing teeth make it difficult to eat or talk clearly. Further, these gaps make the overall smile awkward. Teeth implants reclaim your confidence, and dentists fix them to restore the lost functions. These tiny titanium screws, inserted into the jawbone, support crowns, bridges, or dentures which serve as artificial teeth. Overall, dental implants improve the ability to chew, add clarity to speech, impart radiance to your smile, and regain confidence. 

Pain After Dental Implants 

Dental implants involve a surgical procedure where your dentist opens the gums to drill a hole in the jaw. They fix the metal screws into the jawbone and close the incisions with sutures. While the dental implant surgery is performed under anesthesia, you won’t feel any pain during the procedure. Further, after the procedure, using painkillers for a couple of days relieves the pain. As the gums heal, you will not notice any discomfort and start to feel normal. 

However, some candidates encounter unexpected pain, discomfort, or numbness after implant surgery due to dental implants nerve damage. Nerves function with the brain and spinal cord to transmit messages between the brain and the entire body. They help you feel sensations, move body parts, and also control some involuntary body functions. Based on their function, they are either sensory or motor nerves. While sensory nerves transmit signals of smell, touch, and taste, motor nerves aid in the movement and functioning of the body organs. 

Significance Of The Nerves Around Oral Parts

The human face is made from different muscles, bones, organs, and an intricate network of sensory and motor neurons. Particularly, the trigeminal nerve (fifth cranial nerve) that originates in the brain subdivides into the ophthalmic, mandibular, and maxillary nerves. While the ophthalmic nerve innervates the nose, forehead, and eyes, the maxillary and mandibular nerves innervate the oral parts. Maxillary nerves branch into the superior alveolar nerves to innervate the cheeks and upper lip. The mandibular nerves innervate the lower lip, chin, and jawline by branching into the inferior alveolar nerve. The superior and inferior alveolar nerves are the prime targets of dental anesthesia, which is a classical approach for nerve block. Healthcare professionals stay extra cautious not to damage the alveolar nerves while carrying out major surgical procedures like jaw reconstruction or teeth implantation. They consider the alveolar nerve positioning while planning surgical procedures.^[1] Damage to the alveolar nerves can cause permanent loss of sensation in the chin, lower lips, and gingiva.  

Dental Treatments Causing Nerve Damage

Jaw reconstruction surgeries that correct birth defects or jaw alignment in facial trauma are a direct but less frequent cause of alveolar nerve damage. However, improper teeth implantation procedures are the most common cause of nerve damage. Indeed, it's the second cause of nerve injury after molar extraction. Nerve damage due to dental implants has an incidence of 0.8 to 33%.^[2] 

Can Dental Implants Cause Nerve Pain?

While dental implants are a successful treatment, they cause nerve pain due to partial or severe nerve injury. Dental implant lower jaw nerve damage causes injury to the sensory inferior alveolar nerve, which carries signals between the brain and the oral parts like the chin, jawline, and lower lip. Note that the severity of symptoms of nerve damage after dental implants varies with the extent of the injury. While dental implants causing nerve damage are genuinely rare, we listed a few instances when this would happen.  

Direct Nerve Injury

Direct mechanical nerve injury during implant surgery can be due to implant intrusion or nerve tear caused by surgical instruments. The inferior alveolar nerve resides within the mandibular canal. Dental implants that are drilled too deep without considering the nerve position cause lasting numbness and loss of sensation.  

Secondary Injury

Secondary nerve injuries occur due to post-operative secondary ischemia, which reduces the nutrient and oxygen supply. This happens in cases of improper fixation where a dental implant pressing on nerve shortens the blood supply to the neurovascular bundle. Candidates experience a tingling sensation, pain, and numbness in the lower jaw.

Unique Anatomical Structures

Understanding the patient's oral anatomy is crucial for the success of dental implants. Candidates with osteoporosis, soft bone issues, autoimmune conditions, and diabetes are not suitable for dental implant procedures. The too scanty or resorbed jawbone can raise the incidence of potential nerve damage. 

Dental Anesthesia 

Besides surgical causes, some experience symptoms of nerve damage after dental injection.  This particularly arises when the injection directly hits the multiple inferior alveolar nerve fibers, causing numbness and tingling sensations. In some cases, the nerve injury is indirect when the injection needle travels too close to the nerves. It damages the epineural blood vessels and leads to compression injury and scar formation, causing cytotoxic injuries. 

Either of the cases requires immediate attention as the symptoms of nerve damage from dental implants can disturb the quality of life.  

Source: NCBI ^{[3] [4]} 

What Are The Symptoms Of Nerve Damage From Dental Implants?

Patients experiencing nerve damage from dental implants often complain of ^{[5] [6]}

• Persistent pain with pins and needles and burning sensation around the implant site. 
• Immense pain, even due to minor, typically non-painful stimuli. Especially the pain is resistant to painkillers or non-steroidal anti-inflammatory drugs (NSAIDs).
• Pain associated with pricking and tingling sensation, which feels like electric shocks along the gums, lips, chin and teeth. 
• Numbness and loss of sensation in the cheeks and lips, making it difficult to sense hot and cold temperatures. 

Overall, nerve damage during dental implant surgery makes it difficult to eat and speak, impairing the quality of life. Don’t delay seeing your dentist when you notice any of these symptoms.  

Diagnosis Of Nerve Damage From Dental Implants

Dentists diagnose nerve damage from dental implants based on the symptoms that patients experience. They examine the implant site and check for signs of redness, swelling, or infection on the gums. This is to rule out the implant site infection or peri-implantitis. Further, they confirm the nerve damage by considering the symptoms and sensory disturbances. They check for the senses of temperature, light, pain, and physical touch. They use specialized tests like the following: 

• Touch detection test: Static two-point discrimination test to evaluate the patient’s detection threshold.
• Hot or cold sensation testing: This test evaluates the patient's ability to detect hot and cold items using heated mirror handles, ice cubes, or water-filled test tubes.
• Pin-prick pain perception test: This test evaluates the patient's pain perception by pinching or touching the area using dental probes or forceps.
• Direction and sharp-blunt discrimination test: To evaluate the patient's ability to detect the direction of stimulus and differentiate between sharp and blunt stimulus. They use soft cotton swabs, soft brushes, and sharp-edged and blunt-tipped dental probes on the implant area to carry out this test. 

Dentists also use advanced imaging techniques to make accurate diagnoses. Dental X-rays and CT scans track the presence of foreign bodies within the mandibular canal, while MRI scans visualize the nerves and tissues and offer a clear picture of the extent of damage. 

Source: ISPUB ^[7], NCBI ^[8]

Dental Implant Nerve Damage Treatment 

The severity of nerve damage from dental implants varies with the severity of injury. Less severe symptoms due to nerve compression, swelling, or ischemia are reversible and patients can recover in a few months. However, structural damage to the nerve causes a permanent loss of sensory, motor, and autonomic functions. 

Note that the earlier the problem is intervened, the better and quick the recovery. Regeneration of the damaged nerve in the right direction reclaims proper sensory functioning. This is typically attained when the treatment is performed within 1-2 weeks of getting dental implants. When patients delay dental implant nerve damage treatment for over six months, the chances of achieving favorable outcomes decrease. It can result in the permanent loss of nerve activity. 

Note that doctors prescribe steroids and NSAIDs to control the pain as you recover. Some doctors also recommend combined therapies of anticonvulsants and antidepressants to prevent short-term pain from getting severe. Depending on the causative factors, dentists adopt any of the following approaches to treat the nerve damage caused by dental implants. 

• Remove the dental implants when they reach the mandibular canal.
• Clean the irritants (debris, blood clots, or swollen parts) from the area around the nerves. This relieves pressure and eases blood flow to the damaged nerve. 
• Nerve specialists prescribe physiological therapies to stimulate damaged nerves. These include low-level laser therapy, electric nerve stimulation, and acupuncture.  

Source: NCBI ^{[9] [10]} Meridian Allen Press ^[11]

While expert care helps to regain nerve functioning, note that nerve pain months after dental implant procedure can cause permanent damage. Ever wondered if such complications would have legal complications? Read along as we address this in the upcoming section. 

Legal Aspects Related To Chin And Lip Numbness After Dental Implant 

Inferior alveolar nerve damage caused by surgical complications during dental implant procedures can lead to significant medicolegal consequences for the dentist or oral surgeon. Such injuries can profoundly impact a patient’s quality of life, causing physical discomfort and a decline in self-esteem. Patients affected by these complications may pursue legal action against the responsible oral surgeon.^[12]

However, malpractice claims can be complex and require in-depth evidence that proves the surgical error or dentist's negligence. Furthermore, the legal procedures surrounding dental practices vary depending on the dentist's geographical location. While malpractice claims are a significant concern in some countries, they may not carry the same weight everywhere. It's always better to take preventive measures than to manage dental implant complications later.

How To Prevent Nerve Damage From Dental Implants? 

Dentists should avoid dental implant nerve damage by adopting best practices to avoid implants contacting the nerves. This is attained by:

Right Evaluation Of Candidacy

Some patients experience significant jawbone loss due to certain medical conditions, such as osteoporosis or autoimmune problems. Dentists need to consider overall medical health before evaluating the candidacy. Further, dentists need to understand the candidate's oral structure anatomy.  Ensuring the correct implant depth and angle of placement is crucial to avoid nerve injuries. Dentists can achieve this by using advanced imaging tools for diagnosis and treatment planning. Using digital X-rays and 3-D scans to determine the nerve position and jawbone quantity ensures precise treatment planning in terms of implant position and number.   

Dental Anesthesia

While dental implant surgery is performed under local anesthesia, the chances of nerve damage due to anesthetics are quite low. High-pressure, intrafascicular injections carry a higher incidence of causing nerve damage. It is recommended to rely on the lowest effective volume, lowest effective concentration, and small needles for injecting local anesthetics before implant surgery. Some dentists also recommend short-acting local anesthetics to reduce the incidence of nerve damage.^[13]

Dental Surgery

Dentists should avoid drilling dental implants too deeply into the jaw bone to prevent nerve damage. Relying on computer-guided surgery is one way to ensure sufficient space is left between the implant and the nerve. Some dentists also use mini dental implants with shorter lengths. While this reduces the chances of implants contacting the underlying nerve, not everyone is a candidate for mini dental implants.   

The success of dental implants relies upon the dentist’s skill set. Getting dental implants from a reliable dentist ensures effective diagnosis and positive treatment outcomes. As a patient, you need to verify the dentist's credentials and qualifications before opting for the treatment. Enquire about the technology used at the clinic. You may also check the ex-patient testimonials and treatment before-after photographs to gain a clear understanding of the dentist's track record. 

Having a trusted partner by your side can ease any burden. Let us help you connect with experienced dentists and state-of-the-art clinics so you can make the best choice for your dental health. Sign up with us today to get started on your journey to a confident smile!

References

1. Anatomy, Head and Neck: Alveolar Nerve
2. Persistent, Neuropathic-Like Trigeminal Pain After Dental Implant Loading
3. Injury of the Inferior Alveolar Nerve during Implant Placement: a Literature Review
4. Inferior Alveolar Nerve and Lingual Nerve Injury
5. Persistent, Neuropathic-Like Trigeminal Pain After Dental Implant Loading
6. Implant-Related Nerve Injury
7. Traumatic Injury of the Inferior Alveolar Nerve after Dental Implant Surgery
8. Pain Management for Nerve Injury following Dental Implant Surgery at Tokyo Dental College Hospital
9. Pain Management for Nerve Injury following Dental Implant Surgery at Tokyo Dental College Hospital
10. Injury of the Inferior Alveolar Nerve during Implant Placement: a Literature Review
11. Neuropathic Pain After Dental Implant Surgery: Literature Review and Proposed Algorithm for Medicosurgical Treatment 
12. The Nature Of Malpractice Claims Related To Nerve Damage After Dental Implants Insertion In Israel During 2005–2020: A Descriptive Study
13. Neurotoxicity Of Local Anesthetics In Dentistry