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Mandibular Nerve Neurosensory Impairment After Dental Implant Surgery: Management and Protocol

Misch, Carl E. DDS, MDS*; Resnik, Randolph DMD, MDS

doi: 10.1097/ID.0b013e3181effa92
Clinical Science and Techniques

More than 70% of dentists have experienced patients with postoperative paresthesia/dysesthesia or anesthesia as a result of dental procedures. The most common nerve affected is the mandibular nerve, which may be injured during either implant surgery or bone grafting procedures. However, no organized protocol directed specifically for general dentists, or for the vast majority of specialists, has been published.

The protocol presented in this article is divided into 5 periods: during surgery (1) nerve injury is suspected or (2) known nerve transection, post-operative period (3) 1 week and (4) 12 weeks. The appropriate treatment (pharmacology, monitoring, etc.) for each period is suggested, including the referral to a nerve specialist when appropriate.

*Clinical Professor, Temple University, PA; Misch International Implant Institute; Private Practice, Beverly Hills, MI.

†Clinical Professor, Temple University, PA; Misch International Implant Institute, Beverly Hills, MI; Private Practice, Pittsburgh, PA.

Reprint requests and correspondence to: Carl E. Misch, DDS, MDS, 16231 West 14 Mile Rd., Beverly Hills, MI 48025, Phone: 248-642-3199, E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.