The Management of Persistent Pain From a Branch of the Trifid Mandibular Canal due to Implant Impingement
The mandibular canal is a conduit that allows the inferior alveolar neurovascular bundle to transverse the mandible to supply the dentition, jawbone, and soft tissue around the lower lip. It is now acknowledged that the mandibular canal is not a single canal but an anatomical structure with multiple branches and variations. Iatrogenic injury to branches of the mandibular canal that carry a neurovascular bundle has been reported to cause injury to the main canal as severe as if the main canal itself is traumatized. These injuries include bleeding, neurosensory disturbance, or the formation of traumatic neuroma, and so far, they have involved cases with the bifid mandibular canal. This current report presents a case of neurosensory disturbance that resulted from the impingement of a branch of a trifid mandibular canal during implant insertion. Its management included analgesics, reexamination, and reinserting a shorter implant.
Figure 1. The cropped dental panoramic tomograph (DPT) shows the left mandible. The arrows show a combination of faint lines indicative of the presence of an accessory canal, which was missed preoperatively. These accessory canals appeared as radiopaque lines that were thought to be bony trabeculae. Figure 2. The cropped DPT showing the implants in the left mandible are distant from the mandibular canal. Figure 3. Arrows show the direct impingement of the mesial implant onto one of the accessory mandibular canals, as seen in 2 different panoramic planes employing the SimPlant software.
Figure 4. Arrows show the presence of 3 different accessory mental foramina, corresponding the abnormality at the left edentulous alveolar region seen in Figure 1. Figure 5. Periapical view of mandibular left first molar area, after replacement of the Ø3.7 mm × 11.5 mm implant with a Ø4.1 mm × 8 mm implant. Arrows point to the radiolucency lined by radiopaque lines apical to the implant.
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