İMPLANT CERRAHİSİ SONRASI HİPOESTEZİ-6 AYLIK TAKİP: VAKA SERİSİ

Yıl 2023, , 350 - 355, 15.06.2023

Sefa Aydındoğan , Emine Elif Mutafcilar Velioğlu , Yunus Emre Balaban

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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

nerve injury, dental implants, hypesthesia

Kaynakça

• 1. Pogrel MA, Thamby S. Permanent nerve involvement resulting: from inferior alveolar nerve blocks. The Journal of the American Dental Association. 2000;131(7):901-7.
• 2. Ziccardi VB, Assael LA. Mechanisms of trigeminal nerve injuries. Atlas of the Oral and Maxillofacial Surgery Clinics. 2001;9(2):1-11.
• 3. Pogrel MA. Damage to the inferior alveolar nerve as the result of root canal therapy. The Journal of the American Dental Association. 2007;138(1):65-9.
• 4. Andrabi SM-U-N, Alam S, Zia A, Khan MH, Kumar A. Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report. Restorative dentistry & endodontics. 2014;39(3):215-9.
• 5. Yoshioka I, Tanaka T, Khanal A, Habu M, Kito S, Kodama M, et al. Relationship between inferior alveolar nerve canal position at mandibular second molar in patients with prognathism and possible occurrence of neurosensory disturbance after sagittal split ramus osteotomy. Journal of oral and maxillofacial surgery. 2010;68(12):3022-7.
• 6. Wijbenga J, Verlinden C, Jansma J, Becking A, Stegenga B. Long-lasting neurosensory disturbance following advancement of the retrognathic mandible: distraction osteogenesis versus bilateral sagittal split osteotomy. International journal of oral and maxillofacial surgery. 2009;38(7):719-25.
• 7. Deppe H, Mücke T, Wagenpfeil S, Kesting M, Linsenmeyer E, Tölle T. Trigeminal nerve injuries after mandibular oral surgery in a university outpatient setting—a retrospective analysis of 1,559 cases. Clinical oral investigations. 2015;19(1):149-57.
• 8. Bagheri SC, Meyer RA, Khan HA, Steed MB. Microsurgical repair of peripheral trigeminal nerve injuries from maxillofacial trauma. Journal of oral and maxillofacial surgery. 2009;67(9):1791-9.
• 9. Tay ABG, Lai JB, Lye KW, Wong WY, Nadkarni NV, Li W, et al. Inferior alveolar nerve injury in trauma-induced mandible fractures. Journal of Oral and Maxillofacial Surgery. 2015;73(7):1328-40.
• 10. Agbaje JO, Van de Casteele E, Hiel M, Verbaanderd C, Lambrichts I, Politis C. Neuropathy of trigeminal nerve branches after oral and maxillofacial treatment. Journal of maxillofacial and oral surgery. 2016;15(3):321-7.
• 11. Politis C, Lambrichts I, Agbaje JO. Neuropathic pain after orthognathic surgery. Oral surgery, oral medicine, oral pathology and oral radiology. 2014;117(2):e102-e7.
• 12. Moraschini V, Poubel LdC, Ferreira V, dos Sp Barboza E. Evaluation of survival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review. International journal of oral and maxillofacial surgery. 2015;44(3):377-88.
• 13. Alhassani AA, AlGhamdi AST. Inferior alveolar nerve injury in implant dentistry: diagnosis, causes, prevention, and management. Journal of Oral Implantology. 2010;36(5):401-7.
• 14. Misch CE, Resnik R. Mandibular nerve neurosensory impairment after dental implant surgery: management and protocol. Implant dentistry. 2010;19(5):378-86.
• 15. Khawaja N, Renton T. Case studies on implant removal influencing the resolution of inferior alveolar nerve injury. British dental journal. 2009;206(7):365-70.
• 16. Silbert BI, Kolm S, Silbert PL. Postprocedural inflammatory inferior alveolar neuropathy: an important differential diagnosis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2013;115(1):e1-e3.
• 17. Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clinical oral investigations. 2007;11(2):133-42.
• 18. Juodzbalys G, Wang H-L, Sabalys G. Injury of the inferior alveolar nerve during implant placement: a literature review. Journal of oral & maxillofacial research. 2011;2(1).
• 19. Abarca M, van Steenberghe D, Malevez C, De Ridder J, Jacobs R. Neurosensory disturbances after immediate loading of implants in the anterior mandible: an initial questionnaire approach followed by a psychophysical assessment. Clinical oral investigations. 2006;10(4):269-77.
• 20. Levitt DS. Apicoectomy of an endosseous implant to relieve paresthesia: a case report. Implant Dentistry. 2003;12(3):202-5.
• 21. Han S, Yeo S, Lee M, Bae Y, Ahn D. Early dexamethasone relieves trigeminal neuropathic pain. Journal of dental research. 2010;89(9):915-20.
• 22. Seo K, Tanaka Y, Terumitsu M, Someya G. Efficacy of steroid treatment for sensory impairment after orthognathic surgery. Journal of oral and maxillofacial surgery. 2004;62(10):1193-7.
• 23. Misch CE. Root form surgery in the edentulous anterior and posterior mandible: Implant insertion. Contemporary Implant Dentistry St Louis, MO: Mosby Elsevier. 2008:221-6.
• 24. Misch CE, & Resnik, R. Mandibular nerve neurosensory impairment after dental implant surgery: management and protocol. Implant dentistry. 2010;19(5):378-86.
• 25. Baltrusch S. The Role of neurotropic B vitamins in nerve regeneration. BioMed Research International. 2021;2021.
• 26. Montava M, Garcia S, Mancini J, Jammes Y, Courageot J, Lavieille J-P, et al. Vitamin D3 potentiates myelination and recovery after facial nerve injury. European Archives of Oto-Rhino-Laryngology. 2015;272(10):2815-23.
• 27. Degala S, Shetty SK, Bhanumathi M. Evaluation of neurosensory disturbance following orthognathic surgery: a prospective study. Journal of maxillofacial and oral surgery. 2015;14(1):24-31.
• 28. Moon S, Lee S-J, Kim E, Lee C-Y. Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury. Restorative dentistry & endodontics. 2012;37(4):232-5.