Persistent pain after dental implant placement: A case of implant-related nerve injury

Abstract

A 48-year-old woman visited one of us (R.D.) for a second opinion regarding severe pain that began six weeks earlier after placement of an implant into her mandibular right first premolar region (Figure). She recalled that profuse bleeding had to be controlled when the implant site was prepared, and she experienced sharp pain as the implant was being inserted. As the local anesthetic wore off, she developed severe deep aching and burning pain at the implant site. She then experienced sharp stabbing pains whenever she touched or brushed the area around the implant. Also, her right lower lip felt unpleasant, which caused difficulty in drinking and affected kissing. The patient reported that she had been pain free before the implant procedure. The patient returned to the dentist who had placed the implant. A radiograph revealed that the implant was not impinging on the inferior alveolar canal (IAC). Initial treatments included a course of antibiotics, a combination of analgesics and anti-inflammatory drugs. A moderate degree of pain relief was achieved, and the dentist advised her to wait and see if the pain resolved before possibly referring her to a neurologist or pain specialist. The patient’s medical history was significant for depression, anxiety, insomnia, irritable bowel syndrome (IBS) and gastroesophageal reflux disease. The patient was taking the combination analgesic hydrocodoneacetaminophen, as well as escitalopram and esomeprazole. Is this pain related to the implant placement? Is this a common complication? What questions should be asked and how should the dentist evaluate the complaint? What is the appropriate management of this patient?