Common factors in post-implant nerve damage

A STUDY of patients suffering nerve damage following dental implant surgery has identified common factors including inadequate patient consent, pre-operative planning and post-operative referral.

Researchers from the King’s College London Dental Institute carried out a case review of 30 dental implant patients referred to a specialist nerve injury clinic at King’s College Hospital and the findings were published in the British Dental Journal. A detailed history was taken, alongside a clinical examination and assessment of pain levels.

The researchers found that only 11 of the 30 patients were aware of signing consent forms for the implant surgery and of those eight felt they were not explicitly warned about nerve injury. In 15 per cent of cases no radiographic evidence pre or post-operatively was provided by the referring practitioner.

Seventy percent of the nerve-damaged patients were not referred to the specialist nerve injury clinic until more than six months post surgery, despite evidence to show removal of the implant within 30 hours significantly reduces the risk of permanent damage. Only three patients were referred and able to be treated immediately post-surgery.

Over recent years incidence of injury of the inferior alveolar nerve (IAN) has increased as a result of a rise in dental implant surgery. There are approximately 10,000 mandibular (lower jaw) dental implant procedures carried out each year in the UK, and an estimated 100 reported chronic nerve injuries resulting from these procedures.

Among recommendations made by the researchers are that clinicians must ensure all implant patients give adequate consent and are made aware of the risk of nerve damage.

Post-operative follow-up must also be improved. Clinicians should recommend patients undertake a 'homecheck' 12 hours after surgery. This allows them to report ongoing pain, which may dictate early removal of the implant is needed. Severe or extreme pain post surgically may be an indicator of nerve damage and must not be overlooked. A phone call to the patient four to six hours post surgery will enable the surgeon to ascertain if a referral is needed.

Professor Tara Renton, lead author from the King’s College London Dental Institute, said: "As the number of people choosing to have dental implants is on the increase, so is the incidence of nerve injury. It is vital that patients understand the risks of this type of surgery, and clinicians must improve their systems and procedures."