I am writing in response to "Management of Patients With Trigeminal Nerve Injuries After Mandibular Implant Placement" by Drs. Richard Kraut and Omar Chahal (October JADA). The article underscores the need for accurate and detailed mapping of nerve deficits when they occur, and the need for accurate work-ups prior to the placement of endosseous.
However, I have another way to minimize the chance for injury to the inferior alveolar nerve; by infiltrating the surgical site with local anesthesia, rather than giving a full inferior alveolar nerve block. This has two benefits.
First, there is no chance for nerve injury secondary to giving the block. Second, if the inferior alveolar nerve is not blocked, the patient will begin to experience an uncomfortable feeling as one approaches the inferior alveolar canal. Therefore, the clinician can safely stop placement and either opt to place a smaller implant or take an X-ray to verify the placement with the position of the inferior alveolar nerve.
Now, with the advent of Septocaine, I have found that patients can be anesthetized successfully for the surgical insult, but still retain the ability to sense encroachment of the inferior alveolar canal. Although this approach will not lessen the chances of lingual nerve or mental nerve injury related to flap development, it will likely lessen the chances of the long-term inferior alveolar nerve injury.
