| Autor: |
Alantar A; Oral Surgery Unit, Max Fourestier Hospital, Nanterre, France., Béatrix JC; Centre Hospitalier Sud Seine-et-Marne, Site de Nemours, Nemours, France., Marti G; Maxillofacial Surgery Unit, Clinique Saint-Jean, L'Ermitage Hospital, Melun, France and Johns Hopkins University School of Medicine, Baltimore, USA., Princ G; Oral and Maxillofacial Surgery in private practice, Paris, France., Rei N; Department of Stomatology, Faculty of Dentistry, University of Montréal, Québec, Canada., Missika P; Department of Oral Surgery, Faculty of Dentistry, University Paris-Diderot, Paris, France and Department of Oral Surgery, Tufts University School of Dental Medicine, Boston, Massachusetts, USA., Cesaro P; Department of Neurology, Henri Mondor University Hospital, APHP, Créteil, France., Lefaucheur JP; Faculty of Medicine, University Paris-Est-Créteil and Clinical Neurophysiology Unit, Henri Mondor University Hospital, APHP, Créteil, France., Sorel M; Faculty of Medicine, University Paris-Est-Créteil and Pain Center, Centre Hospitalier Sud Seine-et-Marne, Nemours, France. |
| Abstrakt: |
The objective of this study is to establish an algorithm for the medicosurgical treatment of dental implant-induced neuropathic pain. The methodology was based on the good practice guidelines from the French National Authority for Health: the data were searched on the Medline database. A working group has drawn up a first draft of professional recommendations corresponding to a set of qualitative summaries. Consecutive drafts were amended by the members of an interdisciplinary reading committee. A total of 91 publications were screened, of which 26 were selected to establish the recommendations: 1 randomized clinical trial, 3 controlled cohort studies, 13 case series, and 9 case reports. In the event of the occurrence of post-implant neuropathic pain, a thorough radiological assessment by at least a panoramic radiograph (orthopantomogram) or especially a cone-beam computerized tomography scan is recommended to ensure that the tip of the implant is placed more than 4 mm from the anterior loop of the mental nerve for an anterior implant and 2 mm from the inferior alveolar nerve for a posterior implant. Very early administration of high-dose steroids, possibly associated with partial unscrewing or full removal of the implant preferably within the first 36-48 hours after placement, is recommended. A combined pharmacological therapy (anticonvulsants, antidepressants) could minimize the risk of pain chronicization. If a nerve lesion occurs in the context of dental implant surgery, treatment should be initiated within the first 36-48 hours after implant placement, including partial or full removal of the implant and early pharmacological treatment. |
