Neuropathic Pain After Dental Implant Surgery: Literature Review and Proposed Algorithm for Medicosurgical Treatment
The objective of this study is to establish an algorithm for the medicosurgical treatment of dental implant-induced neuropathic pain. The methodology was based on the good practice guidelines from the French National Authority for Health: the data were searched on the Medline database. A working group has drawn up a first draft of professional recommendations corresponding to a set of qualitative summaries. Consecutive drafts were amended by the members of an interdisciplinary reading committee. A total of 91 publications were screened, of which 26 were selected to establish the recommendations: 1 randomized clinical trial, 3 controlled cohort studies, 13 case series, and 9 case reports. In the event of the occurrence of post-implant neuropathic pain, a thorough radiological assessment by at least a panoramic radiograph (orthopantomogram) or especially a cone-beam computerized tomography scan is recommended to ensure that the tip of the implant is placed more than 4 mm from the anterior loop of the mental nerve for an anterior implant and 2 mm from the inferior alveolar nerve for a posterior implant. Very early administration of high-dose steroids, possibly associated with partial unscrewing or full removal of the implant preferably within the first 36–48 hours after placement, is recommended. A combined pharmacological therapy (anticonvulsants, antidepressants) could minimize the risk of pain chronicization. If a nerve lesion occurs in the context of dental implant surgery, treatment should be initiated within the first 36-48 hours after implant placement, including partial or full removal of the implant and early pharmacological treatment.

Mandibular incisive canal (arrows). Courtesy of Dr Alp Alantar.

(a) Mapping of the numbness area delineated by dots drawn on the skin. (b) Panoramic radiograph showing superimposition of the implants on the mandibular canal at the 2 mandibular first molar sites. (c) “Crescent moon” sign (arrow) on CBCT. Courtesy of Dr Alp Alantar.

Case of a patient with neuropathic pain (DN4 score = 7/10) due to dental implant surgery at the left mandibular second molar site. (a) Mapping of allodynia affecting the left lower lip and chin. (b) Implant was more than 2 mm distant from the mandibular canal and maintained in its position. Efficacious pain control was obtained by combining initial steroid intake, anticonvulsant (oxcarbazepine), then tricyclic antidepressant (amitriptyline). (c) Reduction of the cutaneous zone of allodynia at 3 months after dental implant surgery. Analgesic treatment was progressively diminished and stopped prior to the prosthetic phase (DN4 score = 1/10). (d) and (e) Postoperative view with the prosthetic crown at 36 months after implant surgery. Courtesy of Dr Alp Alantar.
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