İMPLANT CERRAHİSİ SONRASI HİPOESTEZİ-6 AYLIK TAKİP: VAKA SERİSİ

Year 2023, , 350 - 355, 15.06.2023

Sefa Aydındoğan , Emine Elif Mutafcilar Velioğlu , Yunus Emre Balaban

https://doi.org/10.15311/selcukdentj.1239175

Abstract

Amaç: Bu vaka serisinin amacı dental implant yerleştirilmesi sonrası direkt sinir hasarı olmaksızın hipoestezi gelişen olguların tedavisinin değerlendirilmesidir.
Olgu: Alt çene premolar bölgede dental implant cerrahisi sonrası 48 saat içerisinde alt dudak ve çenede his kaybı şikâyeti ile kliniğimize başvuran sistemik olarak sağlıklı 3 hastanın klinik ve radyolojik muayenesi yapıldı. Değişik açılardan alınan radyograflarda implantların inferior alveolar sinirle temasının olmadığı değerlendirildi. Klinik değerlendirmede hastaların hepsinde yüzde şişlik tespit edildi. Hastaların duyu kaybı boyutunun tespiti için uyarana karşı 1/10 arasında puan verilerek, mekanoseptif ve nosiseptif testler uygulandı. Hastanın gözleri kapatılarak, sakin bir ortamda, kontralateral taraf kontrol olarak kullanılarak yapılan değerlendirmede hipoestezi teşhisi koyuldu. IV kortikosteroid uygulanmasını takiben (prednisolon, 40 mg), 6 günlük oral prednisolon reçete edildi (kilo başına 1 mg, max 80 mg). İlave olarak cerrahi sonrası ağrı kontrolü için reçete edilen non-steroid antiinflamatuvar (NSAİİ) devam edildi (ibuprofen 400mg, günde 3 kez). Hastalar durum hakkında bilgilendirilip düzenli kontrollere çağırıldı.
Bulgular: 2 hafta sonra yapılan duyu testlerinde %80-90 iyileşme tespit edildi ve ilave medikasyon uygulanmadı. 3 ve 6. ay kontrollerde kontralateral taraftan farklı bir duyu hissi tespit edilmedi.
Sonuç: Dental implantlar günümüzde dişsiz kretlerin rehabilitasyonunda sıklıkla kullanılmaktadır. Dental implant yerleşimi ile alakalı en sık karşılaşılan komplikasyonlardan biri de inferior alveolar sinir (İAS) yaralanmalarıdır. İAS hasarının boyutunu ve etyolojisini tespit etmek bu tip vakaların yönetiminde önemlidir. Semptomların erken tespit edilmesi ve erken steroid uygulamaları hipoestezi bulgularının iyileşmesinde etkili olabilir. Bu vaka serisinin sonuçlarına göre implant cerrahisi sonrası direkt sinir teması hasarı yoksa kortikosteroid ve anti-inflamatuvar ilaç uygulamaları semptomların iyileşmesine katkıda bulunabilmektedir.

Keywords

sinir yaralanması, dental implant, hipoestezi, nerve injury, dental implants, hypesthesia

HYPOESTHESİA AFTER IMPLANT SURGERY 6 MONTHS FOLLOW-UP: CASE SERİES

Abstract

Objective: The aim of this case series is to evaluate the treatment of patients who develop hypoesthesia without direct nerve damage after dental implant placement.
Cases: Three systemically healthy patients were referred to our clinic with the complaint of altered sensation in the lower chin and lip area. Clinical and radiological examinations were performed on patients who learned that implants were placed in the mandibular premolar region within 48 hours. With the radiographs taken from different angles, it was evaluated that the implants were not in contact with the inferior alveolar nerve (IAN). In clinical evaluation, facial swelling and edema was detected in all patients. Mechanoceptive and nociceptive tests were applied by giving a score of 1/10 against the stimulus to determine the extent of sensory changes of the patients. The diagnosis of hypoesthesia was made in the evaluation performed with the patient's eyes closed, in a quiet environment, using the contralateral side as a control. Following IV corticosteroid administration (prednisolone, 40 mg), 6 days of oral prednisolone was prescribed (1 mg per kg, max 80 mg). In addition, the non-steroidal anti-inflammatory (NSAID) prescribed for pain control after surgery was continued (ibuprofen 400mg, 3 times a day). The patients were informed and called for follow-up controls.
Results: After 2 weeks, 80-90% improvement was detected in the senses and no additional medication was administered. No difference was detected from the contralateral side at the 3 and 6 month controls.
Conclusion: Determining the extent and etiology of IAN damage is important in the management of such cases. Early detection of symptoms and early steroid administration may be effective in improving hypoesthesia findings. According to the results of this case series, corticosteroid and anti-inflammatory drug applications may contribute to the improvement of symptoms in the absence of direct nerve contact damage after implant surgery.

Keywords

nerve injury, dental implants, hypesthesia

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