Researchers from King's College London are warning that cases of permanent nerve damage caused by dental implants could increase if steps are not taken to address risks and prevent injury.
They conducted a case review of dental implant patients who were referred to a specialist nerve injury clinic at King's College Hospital, part of King's Health Partners Academic Health Sciences Centre (British Dental Journal, June 8, 2012).
They found that patient consent and information, preoperative planning, and appropriate postoperative referral were inadequate in this patient group.
Incidence of injury of the inferior alveolar nerve (IAN) has increased as a result of a rise in dental implant surgery over recent years, according to the study authors. This type of injury can cause severe pain and altered sensation in the face, affecting everyday activities such as speaking, eating, kissing, shaving, and brushing teeth. These injuries can have a significant effect on a patient's quality of life, and can lead to depression and other mental health problems.
The researchers reviewed 30 patients whose nerve injuries were caused by dental implants. A detailed history was taken, along with a clinical examination and assessment of pain levels. They found the following:
Only 11 of the 30 patients were aware of signing consent forms for the implant surgery; of those, eight felt they were not explicitly warned about nerve injury. Sixty-four percent of patients did not recall providing written consent.
No radiographic evidence pre- or postoperatively was provided by the referring practitioner in 15% of cases.
Of the 30 patients, 70% were referred to the specialist nerve injury clinic more than six months after surgery, despite evidence to show removal of the implant within 30 hours significantly reduces the risk of permanent damage. As a result, only three patients were referred and able to be treated immediately postsurgery.
The researchers also found that this group of 30 patients experienced problems associated with dental implant surgery. For example:
- 70% of the 30 implant patients experienced problems during the procedure, such as severe bleeding and some form of pain during implant placement.
- After surgery, more than half of the 30 patients suffered from constant pain and/or discomfort; 40% complained of numbness.
- 54% said kissing was reduced in pleasure.
- 46% said their speech was affected.
- 30% had problems with eating, drinking, and brushing teeth due to pain.
- 30% reported psychological problems; this included four patients of the 30 who were diagnosed with depression and two with significant depression and suicidal thoughts.
The researchers made the following recommendations for professionals fitting dental implants:
- Clinicians must ensure all implant patients give adequate consent and are made aware of the risk of nerve damage.
- Sufficient preoperative radiographic planning must be carried out.
- Use of shorter implants is suggested to mitigate risk of damaging the nerve.
- If known damage to the IAN has occurred, a referral to a specialist nerve injury clinic must take place immediately.
- Postoperative follow-up must be improved.
- Prompt removal of implants must be carried out within 30 hours if required, to minimize chances of developing chronic irreversible postsurgical nerve pain.
