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Oral Surgery/nerve damage after implant

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QUESTION: Two weeks ago i had an implant put in my mouth on the right side of my lower jaw. Unfortunitely  my dentist drilled to far with the implant drill and nicked the Inferior alveolar nerve which provide sensation to my lower lip, chin as well as gums and teeth. It took me a week just to come to terms with
this. My dentist informed me that nerves heal slow and this might take weeks months or even a year. He cant even guarantee ill ever get feeling back. The tightness in my lower right teeth are the hardest thing to deal with right now. Its feels like a have toothpicks stuck between each of them.
My current dilemma is trying to decide whether or not to remove the existing implant that he was able to install. We confirmed by 3d scan that the implant is not near the nerve canal so his feeling was to leave it in. I would rather leave it in and not risk causing more damage to an already injured nerve. Now the confusing part is when i got a second opinion form a different dentist he advise to take the implant out. He acknowledge that there is no physical impingement to the nerve form the implant but wont elaborate further about why to remove it. I want to make sure i give myself every opportunity to heal. I just dont know wether to leave it in or take it out. Any suggestion or any other healing tips would be greatly appreciated. Thanks Mike

ANSWER: Mike  -  my question to you is did the dentist, before he drilled and inserted an implant do a CT scan xray to define the exact location of the nerve.  Now that the surgery has been done and the implant was placed, I am sure xray were taken.  The problem with regular xrays in this type of situation, the 3-D dimensional perspective of the nerve's position relative to the implant should be evaluated prior to the surgery and again now to fully evaluate the true position of the implant related to the nerve.  

My suggestion, depending on the type of dentist who evaluated the area after the implant was placed, is to have a board certified oral and maxillofacial surgeon evaluate the area.  This doctor is better trained as to the bone and the implant position.  

I am not trying to not tell you yes or no about the implants, but without a proper evaluation of the area
the answer will be better and proper.  I hope I haven't created more problems for you, but I believe in a "belt and suspender" approach to making a decision that you need.

If you have additional questions, feel free to contact me again.

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implant
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QUESTION: Joel, Thanks so much for getting back to me so quickly. Yes the dentist did do a 3d Cone Beam CT scan of my entire jaw. He place 2 implants in my mouth in the past without a problem.  While drilling for this recent implant 2 weeks ago i felt a shock as he was drilling. He acknowledged that the nerve was damaged at that point. He then went ahead and placed the implant.  The next day he did a detailed 3d cone beam scan of the implant area and confirmed the tip of the implant is 2mm away from the nerve canal and not violating the nerve canal. He feels its ok to leave it in. I would rather leave it in for 2 reasons. 1. So i dont have to get the implant placed again at a later date. 2. I dont want to risk any further damage to an already damaged nerve.   When i got another opinion from another dentist he felt the implant should be removed. This dentist however didnt see any of the imageing. This is where my confusion lies. I know your not in a position to recommend something because you havent seen the imaging yourself  but assuming the implant is a safe distance from the nerve canal wouldnt  it be ok to leave it in? Ive included the x ray he took immediately after the placement.   Thanks so much again Mike

Answer
Mike - After having viewed the xray, to me it looks like the bone of the canal where the nerve lies was violated.  If this occurred, hitting the nerve is not necessary to produce damage to the nerve.  Bleeding into the canal can put pressure on the nerve and that is sufficient to cause the sensations you are feeling.  

It is probably okay to leave the implant because it is not sitting on the nerve, but bleeding into the canal most likely caused the situation by pressure from the bleeding.  So in my opinion you have nothing to lose by leaving the implant, because removing the implant may not change the pressure from internal bleeding and could possibly cause bleeding again.

I really wish you well and hope the pressure gradually disappears.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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