Implant Injury Case Series and Review of the Literature Part 1: Inferior Alveolar Nerve Injury
Injury to adjacent structures is an unfortunate and avoidable outcome of oral implant placement surgery. Paramount among these is perforation into paranasal sinus; into neighboring tooth root; through cortical plate; and into vessels, canals, and, most importantly, nerves. In most cases, injudicious oral implant placement can be attributed to poor treatment planning. We present the cases of several patients referred for postsurgical radiology that illustrate injury to the inferior alveolar canal by implant impingement, penetration, and even complete obliteration of the nerve and canal in the absence of proper treatment planning and imaging modalities. The authors stress the importance of thorough implant case preparation and planning, which may include the use of cone beam computerized tomography in order to minimize nerve injury.
Patient 1: Cone beam computerized tomographic imaging illustrates 2 implants in the right side of the mandible that have penetrated and traversed the nerve canal.
Patient 2: Implant at position #29, in close relation to the mental foramen. The implant at position #30 was placed significantly subcrestal.
Figures 8–10. Patient 2: Cone beam computerized tomographic imaging clearly illustrates that the implant at position #30 has penetrated the nerve. Figure 11. Patient 3: Preoperative orthopantomograph. Figure 12. Patient 3: Postoperative orthopantomograph after implant placement in the right side of the mandible.
Figures 13–15. Patient 3: Cone beam computerized tomographic imaging better illustrates the extent of the implant length at #31 and the penetration into the nerve canal. Figure 16. Patient 4: Orthopantomographic view demonstrates 4 implants placed in an atrophic, posterior mandible. Note also the sinus penetration.
Cone beam computerized tomographic imaging axial views better illustrate the proximity of the implant apices to the nerve canal roof.
Three-dimensional rendition of the cone beam computerized tomographic imaging showing implants in the right side if the mandible, intimate with the nerve.
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