This topic contains 2 replies, has 1 voice, and was last updated by Jack Wasserstein, DDS 5 years ago.
October 11, 2010 at 10:59 pm #9724October 11, 2010 at 10:59 pm #9747
Local anesthetics are used to anesthetize / numb the area prior to dental implant surgery. Most surgeons will use shorter duration anesthetics less than 6 hours.
If it has been more than 12 hours since the dental implant surgery and you are still experiencing numbness you should contact your doctor as soon as possible.
If the surgery was in the lower jaw (posterior mandible), nerve trauma can lead to this condition which can be temporary or permanent. Temporary numbness can also result from swelling as well as slow metabolic breakdown of the local anesthetic.
Care should be taken prior to dental implant surgery in the posterior mandible to map the location of the nerve. This is accomplished best with 3d cone-beam tomography. These types or radiographs have no distortion and show the location in three dimensions. Mandibular nerve trauma can result from the drilling sequence or placement of the implant. The nerve is housed inside a bony canal that traverses through the posterior mandible (lower jaw). If a drill or implant breeches the canal, the nerve may be severed, lacerated or compressed.
If there is a proximity issue with the resulting implant placement, there is a better chance of recovery if the implant is removed as soon as possible, ideally within 24 hours.
Unfortunately, there is not a lot that can be done once the nerve has been traumatized. These injuries tend to improve very slowly over time, but it can take up to a year for these to recover. There are some surgical techniques to re-splice a severed nerve but they are not very predictable.
Following this type of trauma it is normal for the patient to experience altered sensation of the lip and chin area as well as the teeth. These sensations are described as pins and needles, tingling, electric shooting pains or numbness. These sensations will persist while the nerve is healing. The mandibular nerve does not supply motor function to the lip or chin so movement is not effected, just feeling or sensation.
The peripheral areas heal first, moving toward the center. Change in sensation will not be noticeable from day to day. It is detected on monthly or bimonthly sensation testing. As long as the patient is noticing improvement the area should continue to improve until recovery.
Even in the worse case scenario of permanent mandibular nerve damage, studies have shown that most patients acclimate to this condition with very little impact to their daily lives. The first few months are the biggest adjustment. Patients can develop self confidence issues because they are a afraid that they have undetected food around their lip or are drooling. However, behavioral reflexes and adaptations are cultivated that mitigate these issues. In fact, most patients after living with this condition over a year are not aware of the numbness unless reminded of it.
If you have numbness or a change in feeling in the lip, chin or tooth areas following dental implant surgery, contact your doctor as soon as possible. Be prepared to have the implant(s) removed in the area of the nerve. Be prepared for a referral to a dental specialist with expertise with nerve injuries or a neurologist if the symptoms persist beyond two weeks. Do not be bashful about asking your doctor for a referral. As mentioned earlier, not a lot can be done with mandibular nerve injury but the prognosis is better when treated sooner rather than later. Try not to let this injury consume your life, the psychological impact of this type of injury is far worse then the physical one. Remember that these heal very slowly and that there is no loss of movement of the lip or chin only sensory. Even in the worse case most patients acclimate to the point of being totally unaware of the effected area over time.
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