Neuropathic pain due to section of inferior alveolar nerve after implant placement - 6 Pages

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Neuropathic pain due to section of inferior alveolar nerve after implant placement

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Neuropathic pain due to section of inferior alveolar nerve after implant placement AUTORES Dr. Jaime Molinos Morera, Implant specialist at Clínica MEID, Madrid, Dr. J. R. Molinos Granada, Implant specialist at Clínica MEID, Madrid, Dr. Ana Molinos, Dentist, Orthodontics specialist at Clínica MEID, Madrid, Dra. M. Castillo, PhD neurociencias y dolor URJC, Investigador colaborador clínica MEID Madrid Introduction This paper presents the case of a 74-yearold woman with a complicated clinical picture of chronic neuropathic pain, secondary to a dental implant. Due to the patient’s age and the type of pain, the prognosis was quite guarded, as the literature and clinical experience demonstrate that it tends to become chronic and is difficult to resolve, with results that leave much to be desired1-3. The case needed to be approached by implementing new techniques to treat this type of pain and achieve an effective response for these patients. One of the therapeutic alternatives could be the patient’s neurofunctional recovery by means of localised nonablative radiofrequency treatment, also known as diathermy or Tecartherapy 4-6. Key words: neuropathic pain, complication, implant, neurofunctional recovery, nonablative radiofrequency. Case description The patient visited our clinic to get a second opinion. General data - 74-year-old woman; postmenopausal; body mass index - (BMI): 20; resection of the medial meniscus of the left knee; non-Hodgkin lymphoma in 2013 treated with radiotherapy and chemotherapy; restless legs syndrome; insomnia; and phlebitis and thrombophlebitis of superficial vessels. Dental history - Various implants fitted in another dental clinic. They are not specified in the surgical notes, but we know they included pieces implanted in positions 34 and 36. That procedure was performed on 9 May 2016. The patient complained of severe pain from the first day, which was not alleviated with medication. - The osseointegrated implant in position 36 was extracted seven days after surgery due to 6 Fig. 1. A panoramic x-ray revealed implants in 27, 26, 25, 24, 14, 15, 16, 17, 34, 45 and 46. The patient presented scant separation to the inferior alveolar nerve in the third quadrant due to inferior maxillary atrophy caused by the absence of teeth. Figura 1. Se observan implantes dentales en 27, 26, 25, 24, 14, 15, 16, 17 34, 45, 46. Y la escasa altura al nervio dentario inferior en el tercer cuadrante debido a la atrofia del maxilar inferior por ausencia de piezas dentales. severe pain after sectioning the inferior alveolar nerve. The osseointegrated implant in 34 showed no signs of infection or mobility. - The patient consulted several specialists and doctors without success. - Mandibular canal compression was ruled out based on the dental CBCT scan provided by the patient and carried out in September 2016. - Her primary care physician referred her to the Maxillofacial Surgery Service of the Hospital Universitario Rey Juan Carlos (Madrid) in January 2017. She was prescribed Hidroxil to stimulate nerve regeneration. She still reported pain in the reevaluation and was referred to the Pain Unit at the Hospital de Alcorcón (Madrid). At this institution on 27 April 2017, the patient underwent ablative radiofrequency on the left mental nerve, according to the report she provided. No change was recorded in the intensity of the pain. - Her current medication consists of: gabapentin 300 mg, Lexatin [bromazepam] 1.5 mg, zolpidem 10 mg, paracetamol 1,000 mg, Rivotril [clonazepam] 0.5 mg, ropinirole 1 mg, Septrin Forte 800/160 mg and Nolotil [metamizole] 575 mg. Primary complaint When the patient visited our clinic, she presented neuropathic pain secondary to left alveolar nerve damage. The pain was chronic, burning and piercing. The patient could not sleep for more than three hours in a row, so it was unrefreshing. In addition, the pain affected her daily life and she experienced difficulty speaking, eating and drinking normally. The patient was very depressed due to the pain, the person accompanying her said she had not been the same since the pain began and looked very gaunt; in fact, she had lost weight (approximately four kilos). Anamnesis A 74-year-old patient was referred to our clinic from another centre, where she was fitte

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Caso dolor neuropático secundario a seccion del nervio dentario inferior tras la coloacion de un impante dental AUTORES Dr. Jaime Molinos Morera, Implantólogo. Clínica MEID, Madrid, Dr. J. R. Molinos Granada, Implantólogo Clínica MEID, Madrid, Dr. Ana Molinos, Dentist, Orthodontics specialist at Clínica MEID, Madrid, Dra. M. Castillo, PhD neurociencias y dolor URJC, Investigador colaborador clínica MEID Madrid Introducción Se presenta el caso de una mujer de 74 años con un cuadro complicado de dolor neuropático crónico, secundario a un implante dental. Tanto por la edad de la paciente, como...

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capenergy various juxtaosseous implants, implementing expansion and bone densification, not specified in the surgical notes. The implants were Eckermann Hexagon Evolution. The patient only complained of pain in positions 34 and 36. According to the report by the implantologist who placed the implants, there was poor bone availability and it was very soft. The implant in the fourth quadrant was angled more toward the distal to avoid the mental nerve, while the implant in the third quadrant was positioned vestibular to the alveolar nerve. Autologous grafts were used. The usual medication was...

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capenergy PAIN SCALE / ESCALA DE DOLOR IMPACT ON THE QUALITY OF LIFE / AFECTACIÓN CALIDAD DE VIDA Graph 1. VAS for pain, scale from 0 (absence of pain) to 10 (the most severe pain). Graph 2. Evolution of the percent of impact on the patient’s quality of life. Gráfica 1. EVA del dolor escala del 0 (ausencia del dolor) al 10 (El dolor más intenso) Gráfica 2. Evolución de la porcentual de afectación en la calidad de vida de la paciente. distal” para evitar el nervio mentoniano y en el tercer cuadrante colocó el implante “por vestibular del nervio dentario”. Realizó injertos autólogos. Le pautó...

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