Gintaras Juodzbalys Hom-Lay Wang Gintautas Sabalys Antanas Sidlauskas Pablo Galindo-Moreno Inferior alveolar nerve injury associ- ated with implant surgery Authors’ affiliations: Gintaras Juodzbalys, Gintautas Sabalys, Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania Hom-Lay Wang, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA Antanas Sidlauskas, Clinic of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania Pablo Galindo-Moreno, Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain Pablo Galindo-Moreno, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA Corresponding author: Prof. Gintaras Juodzbalys Department of Maxillofacial Surgery Lithuanian University of Health Sciences Vainiku 12 LT 46383, Kaunas Lithuania Tel: +370 37 29 70 55 Fax: +370 37 32 31 53 e-mail: gintaras@stilusoptimus.lt Key words: alveolar nerve, cranial nerve injuries, dental implants, inferior, mandibular canal, mandibular nerve, paresthesia Abstract Objectives: Inferior alveolar nerve (IAN) is the most commonly injured nerve (64.4%) during implant treatment. At present, no standardized protocol exists for clinicians to manage IAN injury related with implant surgery. Therefore, the purposes of the present article were to analyze the reasons for nerve injury and to propose guidelines in managing IAN injury. Material and methods: Patients with IAN sensory disturbances after implant treatment were recruited for the study. Sixteen patients, eight men and eight women, with a mean age of 52.2 ± 8.1 years participated in this study. Patient examination, treatment, and IAN sensory function recovery monitoring were performed following six-step IAN injury during dental implant surgery (IANIDIS) protocol. The control group was composed of 25 healthy volunteers who never had IAN sensory disturbances or any trauma in the maxillofacial region. Results: The IAN sensory disturbances were scored as following: 5 (31.25%) had hyperalgesia and 11 (68.75%) expressed hypoalgesia. The mean asymmetry index (AI) was calculated for each patient and varied from 0.6 to 3.2. Overall, 31.3% of nerve injury patients were classified as mild, 31.3% as moderate, and remaining 37.5% as severe injury. All patients were successfully treated with proposed IANIDIS protocol. Conclusion: The most frequent (50%) risk factor for IAN injury was intraoperative bleeding during bone preparation. The most common (56.3%) etiological risk factor of nerve injury was dental implant. A six-step protocol aimed at managing patients with IAN injury, during dental implant surgery, was a useful tool that could provide successful treatment outcome. In 1995, Worthington wrote: “The number of practitioners performing implant surgery has increased dramatically over the last 15 years. As confidence is gained they tend to accept increasingly challenging cases and it is to be expected that the incidence of problems and complications will increase” (Worthington 1995). It was a discerning remark; inferior alveolar nerve (IAN) injuries remain a serious complication with incidence ranged from 0% to 40% (Delcanho 1995; Rubenstein & Taylor 1997; Wismeijer et al. 1997; Dao & Mellor 1998; Bartling et al. 1999; Walton 2000; Ziccardi & Assael 2001; von Arx et al. 2005; Abarca et al. 2006; Greenstein & Tarnow 2006; Hegedus & Diecidue 2006; Tay & Zuniga 2007; Misch 2008; Alhassani & AlGhamdi 2010; Misch & Resnik 2010). The IAN supplies the mandibular molar and premolar teeth and adjacent parts of the gingival. Its larger terminal branch emerges from the mental foramen as the mental nerve. Three nerve branches come out of the mental foramen. One innervates the skin of the mental area, and the other two proceed to the skin of the lower lip, mucous mem- branes, and the gingiva as far posteriorly as the second premolar. The incisive branch, a continuation of the IAN, supplies the canine and incisor teeth (Ziccardi & Assael 2001; Abarca et al. 2006). It is interesting to know that the IAN is the most commonly injured nerve (64.4%), followed by the lingual nerve (28.8%) (Tay & Zuniga 2007). The differences between IAN injuries and other peripheral sensory nerve injuries are predominantly iatrogenic and not resolved within the first 8 weeks after injury. Inferior alveolar nerve injury can result from traumatic local anesthetic injections, during dental implant site preparation or placement (Hegedus & Diecidue 2006), or Date: Accepted 1 August 2011 To cite this article: Juodzbalys G, Wang HL, Sabalys G, Sidlauskas A, Galindo- Moreno P. Inferior alveolar nerve injury associated with implant surgery. Clin. Oral Impl. Res. 24, 2013, 183–190 doi: 10.1111/j.1600-0501.2011.02314.x © 2011 John Wiley & Sons A/S 183