Sensory Changes Related to Dental Implant Placement: A Scoping Review

Aims: To perform a scoping review of the literature to elucidate the occurrence of nerve damage related to dental implant placement and the factors causing the sensory changes. Methods: An extensive electronic search was conducted using the Cochrane Library, Medline via Ovid, PubMed, Wiley Online, Science Direct, CINAHL, and the Google Scholar databases from the year 1950 to 2020. Results: The search resulted in 1,067 articles, out of which 76 were selected for this review. The articles were categorized as literature review articles, retrospective studies, prospective studies, and case series/case reports. Altogether, 2,526 subjects were assessed retrospectively, with 5.27% transient and 1.39% persistent sensory changes, and a cohort of 2,750 subjects were followed prospectively, with 6.22% transient and 1.31% persistent sensory changes. A total of 336 subjects were enrolled in various case reports and case series, with 5.95% transient sensory changes and 84.52% persistent neurosensory changes. The articles included were not of high quality and have variations in their study designs and reporting procedures, with limited sensory change data to include in this study. Conclusion: After surgical placement of dental implants in 5,612 patients, the incidence of transient sensory changes was 5.63%, and the incidence of persistent sensory changes was 6.33%. Factors affecting the incidence were: mandibular location of the implant, with the inferior alveolar nerve as the most commonly affected nerve. The common symptoms reported were paresthesia and dysesthesia. Age and gender were among other factors, for which data were not available in all the articles.

dental implants; sensory changes; transient and permanent; trigeminal neuropathy

1. Hong DGK, Oh JH. Recent advances in dental implants. Maxillofac Plast Reconstr Surg 2017;39:33.

2. Alghamdi HS, Jansen JA. The development and future of dental implants. Dent Mater J 2020;39:167–172.

3. Beschnidt SM, Cacaci C, Dedeoglu K, et al. Implant success and survival rates in daily dental practice: 5-year results of a non-interventional study using CAMLOG SCREW-LINE im-plants with or without platform-switching abutments. Int J Implant Dent 2018;4:33.

4. Conti PCR, Bonjardim LR, Stuginski-Barbosa J, Costa YM, Svensson P. Pain complications of oral implants: Is that an issue? J Oral Rehabil 2021;48:195–206.

5. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121–132.

6. Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical complications of osseointegrated implants. J Prosthet Dent 1999;81:537–552.

7. Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2002;29(suppl 3):197–212.

8. Greenstein G, Cavallaro J, Romanos G, Tarnow D. Clinical recommendations for avoiding and managing surgical complications associated with implant dentistry: A review. J Periodontol 2008;79:1317–1329.

9. Lamas Pelayo J, Peñarrocha Diago M, Martí Bowen E, Peñarrocha Diago M. Intraoperative complications during oral implantology. Med Oral Patol Oral Cir Bucal 2008;13:e239–e243.

10. Vázquez-Delgado E, Viaplana-Gutiérrez M, Figueiredo R, Renton T, Gay-Escoda C, Valmaseda-Castellón E. Prevalence of neuropathic pain and sensory alterations after dental implant placement in a university-based oral surgery department: A retrospective cohort study. Gerodontology 2018;35:117–122.

11. Benoliel R, Kahn J, Eliav E. Peripheral painful traumatic trigeminal neuropathies. Oral Dis 2012;18:317–332.

12. Dao TT, Mellor A. Sensory disturbances associated with implant surgery. Int J Prosthodont 1998;11:462–469.

13. Eliav E, Herzberg U, Ruda M, Bennett GJ. Neuropathic pain from an experimental neuritis of the rat sciatic nerve. Pain 1999;83:169–182.

14. Gregg JM. Neuropathic complications of mandibular implant surgery: review and case presentations. Ann R Australas Coll Dent Surg 2000;15:176–180.

15. Higuchi KW, Folmer T, Kultje C. Implant survival rates in partially edentulous patients: A 3-year prospective multicenter study. J Oral Maxillofac Surg 1995;53:264–268.

16. Ellies LG. Altered sensation following mandibular implant surgery: A retrospective study. J Prosthet Dent 1992;68:664–671.

17. Ellies LG, Hawker PB. The prevalence of altered sensation associated with implant surgery. Int J Oral Maxillofac Implants 1993;8:674–679.

18. Bartling R, Freeman K, Kraut RA. The incidence of altered sensation of the mental nerve after mandibular implant placement. J Oral Maxillofac Surg 1999;57:1408–1412.

19. Al-Sabbagh M, Okeson JP, Khalaf MW, Bhavsar I. Persistent pain and neurosensory disturbance after dental implant surgery: Pathophysiology, etiology, and diagnosis. Dent Clin North Am 2015;59:131–142.

20. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018;169:467–473.

21. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6:e1000097.

22. Arksey H, O’Malley L. Scoping studies: Towards a method-ological framework. Int J Social Res Methodol 2005;8:19–32.

23. Armstrong R, Hall BJ, Doyle J, Waters E. Cochrane update. ‘Scoping the scope’ of a cochrane review. J Public Health (Oxf) 2011;33:147–150.

24. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 2018;18:143.

25. Sucharew H, Macaluso M. Progress notes: Methods for research evidence synthesis: The scoping review approach. J Hosp Med 2019;14:416–418.

26. Nugraha B, Gutenbrunner C, Barke A, et al. The IASP classification of chronic pain for ICD-11: Functioning properties of chronic pain. Pain 2019;160:88–94.

27. Lin CS, Wu SY, Huang HY, Lai YL. Systematic review and meta-analysis on incidence of altered sensation of mandibular implant surgery. PloS One 2016;11:e0154082.

28. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Hoboken, NJ: John Wiley & Sons, 2011.

29. Muller E, Ríos Calvo MP. Pain and dental implantology: Sensory quantification and affective aspects. Part I: At the private dental office. Implant Dent 2001;10:14–22.

30. Juodzbalys G, Wang HL, Sabalys G. Injury of the inferior alveolar nerve during implant placement: A literature review. J Oral Maxillofac Res 2011;2:e1.

31. Greenstein G, Greenstein B, Desai RN. Using drill stops on twist drills to promote safety and efficiency when creating osteotomies for dental implants. J Am Dent Assoc 2014;145:371–375.

32. American Dental Association Council on Scientific Affairs. The use of conebeam computed tomography in dentistry: an advisory statement from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2012;143:899–902.

33. Tyndall DA, Price JB, Tetradis S, et al. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:817–826.

34. Kwon HB, Park YS, Han JS. Augmented reality in dentistry: A current perspective. Acta Odontol Scand 2018;76:497–503.

35. Mozer PS. Accuracy and deviation analysis of static and robotic guided implant surgery: A case study. Int J Oral Maxillofac Implants 2020;35:e86–e90.

36. Misch CE, Resnik R. Mandibular nerve neurosensory impairment after dental implant surgery: Management and protocol. Implant Dent 2010;19:378–386.

37. Padmanabhan H, Kumar AV, Shivashankar K. Incidence of neurosensory disturbance in mandibular implant surgery - a meta-analysis. J Indian Prosthodont Soc 2020;20:17–26.

38. Vazquez L, Saulacic N, Belser U, Bernard JP. Efficacy of panoramic radiographs in the preoperative planning of posterior mandibular implants: A prospective clinical study of 1527 consecutively treated patients. Clin Oral Implants Res 2008;19:81–85.

39. Renton T, Dawood A, Shah A, Searson L, Yilmaz Z. Post-implant neuropathy of the trigeminal nerve. A case series. Br Dent J 2012;212:e17.

40. Politis C, Agbaje J, Van Hevele J, et al. Report of neuropathic pain after dental implant placement: A case series. Int J Oral Maxillofac Implants 2017;32:439–444.

41. Devine M, Taylor S, Renton T. Chronic post-surgical pain following the placement of dental implants in the maxilla: A case series. Eur J Oral Implantol 2016;9(suppl 1):179–186.

42. Carter E, Yilmaz Z, Devine M, Renton T. An update on the causes, assessment and management of third division sensory trigeminal neuropathies. Br Dent J 2016;220:627–635.

43. Jacobs R, Quirynen M, Bornstein MM. Neurovascular disturbances after implant surgery. Periodontol 2000 2014;66:188–202.

44. Dannan A. Traumatic injury of the inferior alveolar nerve after dental implant surgery: A literature review. Int J Dent Sci 2013;12:1–7.

45. Juodzbalys G, Wang HL, Sabalys G, Sidlauskas A, Galindo-Moreno P. Inferior alveolar nerve injury associated with implant surgery. Clin Oral Implants Res 2013;24:183–190.

46. Renton T. Oral surgery: Part 4. Minimising and managing nerve injuries and other complications. Br Dent J 2013;215:393–399.

47. Tinastepe N, Oral K. Neuropathic pain after dental treatment. Agri 2013;25:1–6.

48. Greenwood M, Corbett I. Dental Emergencies. Chichester: John Wiley & Sons, 2012.

49. Palma-Carrió C, Balaguer-Martínez J, Peñarrocha-Oltra D, Peñarrocha-Diago M. Irritative and sensory disturbances in oral implantology. Literature review. Med Oral Patol Oral Cir Bucal 2011;16:e1043–e1046.

50. Siqueira JTT, Siqueira SRDT. Persistent pain, sensory abnormalities, nervous injury and loss of implant after dental implant surgery: Clinical approach suggestion. Revista Dor 2011;12:172–181.

51. Sánchez Garcés MA, Escoda-Francolí J, Gay-Escoda C. Implant complications. In: Turkyilmaz I (ed). Implant Dentistry. The Most Promising Discipline of Dentistry. InTech Open, 2011:369–396.

52. Kim SG. Clinical complications of dental implants. In: Turkyilmaz I (ed). Implant Dentistry. A Rapidly Evolving Practice. InTech Open, 2011. doi: 10.5772/17262.

53. Alhassani AA, AlGhamdi AST. Inferior alveolar nerve injury in implant dentistry: Diagnosis, causes, prevention, and management. J Oral Implantol 2010;36:401–407.

54. Moore PA, Haas DA. Paresthesias in dentistry. Dent Clin North Am 2010;54:715–730.

55. Renton T. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dent Update 2010;37:350–352, 354–356, 358–360 passim.

56. Misch K, Wang HL. Implant surgery complications: Etiology and treatment. Implant Dent 2008;17:159–168.

57. Peñarrocha M, Cervelló MA, Martí E, Bagán JV. Trigeminal neuropathy. Oral Dis 2007;13:141–150.

58. Greenstein G, Tarnow D. The mental foramen and nerve: Clinical and anatomical factors related to dental implant placement: A literature review. J Periodontol 2006;77:1933–1943.

59. Hegedus F, Diecidue RJ. Trigeminal nerve injuries after man-dibular implant placement–practical knowledge for clinicians. Int J Oral Maxillofac Implants 2006;21:111–116.

60. Worthington P. Injury to the inferior alveolar nerve during implant placement: A formula for protection of the patient and clinician. Int J Oral Maxillofac Implants 2004;19:731–734.

61. Mraiwa N, Jacobs R, Steenberghe D, Quirynen M. Clinical assessment and surgical implications of anatomic challenges in the anterior mandible. Clin Implant Dent Relat Res 2003;5:219–225.

62. Vallerand WP. Peripheral trigeminal nerve injuries. N Y State Dent J 1992;58:27–30.

63. Scarano A, Sinjari B, Murmura G, Lorusso F. Neurosensory disturbance of the inferior alveolar nerve after 3025 implant placements. Implant Dent 2017;26:735–743.

64. Deppe H, Mücke T, Wagenpfeil S, Kesting M, Linsenmeyer E, Tölle T. Trigeminal nerve injuries after mandibular oral surgery in a university outpatient setting–a retrospective analysis of 1,559 cases. Clin Oral Investig 2015;19:149–157.

65. Kütük N, Demirbas¸ AE, Gönen ZB, et al. Anterior mandibular zone safe for implants. J Craniofac Surg 2013;24:e405–e408.

66. Kwon TG, Kim SY, Kim JB. The prevalence of sensory disturbance after implant surgery—Retrospective survey of implant practitioners. J Korean Assoc Oral Maxillofac Surg 2004;30:339–344.

67. Hartmann A, Welte-Jzyk C, Seiler M, Daubländer M. Neurophysiological changes associated with implant place-ment. Clin Oral Implants Res 2017;28:576–581.

68. Al-Khabbaz AK, Griffin TJ, Al-Shammari KF. Assessment of pain associated with the surgical placement of dental implants. J Periodontol 2007;78:239–246.

69. Abarca M, van Steenberghe D, Malevez C, De Ridder J, Jacobs

R. Neurosensory disturbances after immediate loading of implants in the anterior mandible: an initial questionnaire approach followed by a psychophysical assessment. Clin Oral Investig 2006;10:269–277.

70. Kubilius R, Sabalys G, Juodzbalys G, Gedrimas V. Traumatic damage to the inferior alveolar nerve sustained in course of dental implantation. Possibility of prevention. Stomatologija 2004;6:106–110.

71. El-Sheikh AM, Hobkirk JA, Howell PG, Gilthorpe MS. Changes in passive tactile sensibility associated with dental implants following their placement. Int J Oral Maxillofac Implants 2003;18:266–272.

72. Walton JN. Altered sensation associated with implants in the anterior mandible: A prospective study. J Prosthet Dent 2000;83:443–449.

73. Wismeijer D, van Waas MA, Vermeeren JI, Kalk W. Patients’ perception of sensory disturbances of the mental nerve before and after implant surgery: a prospective study of 110 patients. Br J Oral Maxillofac Surg 1997;35:254–259.

74. Johns RB, Jemt T, Heath MR, et al. A multicenter study of overdentures supported by Brånemark implants. Int J Oral Maxillofac Implants 1992;7:513–522.

75. Astrand P, Borg K, Gunne J, Olsson M. Combination of natural teeth and osseointegrated implants as prosthesis abutments: A 2-year longitudinal study. Int J Oral Maxillofac Implants 1991;6:305–312.

76. Kiyak HA, Beach BH, Worthington P, Taylor T, Bolender C, Evans J. The psychological impact of osseointegrated dental implants. Int J Oral Maxillofac Implants 1990;5:61–69.

77. van Steenberghe D, Lekholm U, Bolender C, et al. The applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: A prospective multicenter study on 558 fixtures. Int J Oral Maxillofac Implants 1990;5:272–281.

78. Du Toit J, Gluckman H, Gamil R, Renton T. Implant injury case series and review of the literature part 1: Inferior alveolar nerve injury. J Oral Implantol 2015;41:e144–e151.

79. Givol N, Peleg O, Yarom N, Blinder D, Lazarovici TS. Inferior alveolar neurosensory deficiency associated with placement of dental implants. J Periodontol 2013;84:495–501.

80. Mourào L, Moutinho H, Canabarro A. Role of homeopathy in post-surgical dental implants paresthesia—A case report. J Case Stud Homeopathy 2013;1:6–10.

81. Wright EF. Persistent dysesthesia following dental implant placement: A treatment report of 2 cases. Implant Dent 2011;20:20–26.

82. Stamatin O, Voroneanu M, Stelea C. Post-Implant neurological complications in the horizontal mandibular arch. International J Med Dent 2011;2:197–201.

83. Al-Ouf K, Salti L. Postinsertion pain in region of mandibular dental implants: A case report. Implant Dent 2011;20:27–31.

84. Yoon SH, Merrill RL, Choi JH, Kim ST. Use of botulinum toxin type A injection for neuropathic pain after trigeminal nerve injury. Pain Med 2010;11:630–632.

85. Rodríguez-Lozano FJ, Sanchez-Pérez A, Moya-Villaescusa MJ, Rodríguez-Lozano A, Sáez-Yuguero MR. Neuropathic orofa-cial pain after dental implant placement: Review of the literature and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e8–e12.

86. Leckel M, Kress B, Schmitter M. Neuropathic pain resulting from implant placement: Case report and diagnostic conclusions. J Oral Rehabil 2009;36:543–546.

87. Khawaja N, Renton T. Case studies on implant removal influencing the resolution of inferior alveolar nerve injury. Br Dent J 2009;206:365–370.

88. Liang X, Lambrichts I, Corpas L, et al. Neurovascular distur-bance associated with implant placement in the anterior mandible and its surgical implications: Literature review including report of a case. Chinese J Dent Res 2008;11:56–64.

89. Elian N, Mitsias M, Eskow R, et al. Unexpected return of sensation following 4.5 years of paresthesia: Case report. Implant Dent 2005;14:364–370.

90. Flanagan D. Delayed onset of altered sensation following dental implant placement and mental block local anesthesia: A case report. Implant Dent 2002;11:324–330.

91. Kim YT, Pang KM, Jung HJ, Kim SM, Kim MJ, Lee JH. Clinical outcome of conservative treatment of injured inferior alveolar nerve during dental implant placement. J Korean Assoc Oral Maxillofac Surg 2013;39:127–133.

92. Peñarrocha M, Peñarrocha D, Bagán JV, Peñarrocha M. Post-traumatic trigeminal neuropathy. A study of 63 cases. Med Oral Patol Oral Cir Bucal 2012;17:e297–e300.

93. Renton T, Yilmaz Z. Profiling of patients presenting with post-traumatic neuropathy of the trigeminal nerve. J Orofac Pain 2011;25:333.

94. Tay AB, Zuniga JR. Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg 2007;36:922–927.

95. Libersa P, Savignat M, Tonnel A. Neurosensory disturbances of the inferior alveolar nerve: A retrospective study of complaints in a 10-year period. J Oral Maxillofac Surg 2007;65:1486–1489.

96. Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: Records of 449 cases. Clin Oral Investig 2007;11:133–142.

97. Caissie R, Goulet J, Fortin M, Morielli D. Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience. J Can Dent Assoc 2005;71:185–190.

98. Chaushu G, Taicher S, Halamish-Shani T, Givol N. Medicolegal aspects of altered sensation following implant placement in the mandible. Int J Oral Maxillofac Implants 2002;17:413–415.