1. Topic: Technical and biological complications Presented at the 20th Annual Scientific Meeting of the European Association of Osseointegration 10-13 October 2012, Copenhagen, Denmark Presented at the 20th Annual Scientific Meeting of the European Association of Osseointegration 10-13 October 2012, Copenhagen, Denmark References Conclusions INFERIOR ALVEOLAR NERVE INJURY- A SERIOUS COMPLICATION IN IMPLANT DENTISTRY:TWO CASES REPORT INFERIOR ALVEOLAR NERVE INJURY- A SERIOUS COMPLICATION IN IMPLANT DENTISTRY:TWO CASES REPORT 468 1.N.A. Drage, T. Renton,Inferioralveolarnerveinjury related to mandibular third molar surgery: an unusual case presentation,Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 93 (2002), pp. 358–361 2.C.G. BlackSensory impairment following lower third molar surgery: a prospective study in New Zealand N Z Dent J, 93 (1997), pp. 68–71 3.V. Lopes, R. Mumenya, C. Feinman, M. HarrisThird molar surgery: an audit of indications for surgery, post operative complaints and patient satisfaction, Br J Oral Maxillofac Surg, 33 (1995), pp. 33–35 4. M.P. de Boer, G.M. Raghoebar, B. Stegenga, P.J. Schoen, G. BoeringComplications after third molar extractionQuintessence Int, 26 (1995), pp. 779–784 Abstract Case Report Introduction HULYA KOCAK BERBEROGLU(1) F P AMILA BRKI(2) BANU GURKAN KOSEOGLU(1) ENDER ILKER(1) CETIN KASAPOGLU(1) (1) ISTANBUL UNIVERSITY, DEPARTMENT OF ORAL SURGERY, ISTANBUL, Turkey (2) Sarajevo University, Faculty of Dentistry, Bosnia and Herzegovina, Bosnia and Herzegovina Dental implants are one of solutions for replacing missing teeth, in which tratment planning, anatomical landmarks such as nerve structures might play an important role. In cases of limited vertical alveolar bone, inferior alveolar nerve is likely to be injured during dental implant site osteotomy or implant placement. Sensory disturbances, as a consequences of this complication, vary from anesthesia, paresthesia, dysestesia and hypoesthesia. The aim of this presentation is to describe two clinical cases of inferior alveolar nerve injuries after dental implant placement and management of them. The first case describes a case of 55 year-old female patient who referred from private dental practice, with complaints of 8 months persisting numbness of left lower lip and chin. The radiographic examinations including panoramic radiographs and computerize tomography (CT) scans, revealed an implant intrusion into mandibular canal in the area of left lower second molar. The second case also describes an implant intrusion into mandibular canal in the area of left lower second molar, diagnosed by panoramic radiographs in 67 year-old female. The patient had complaints on pain in region of the placed dental implant. Replacement of a missing tooth by dental implant applications increases over time. İf the distance between implants that placed and important anatomical landmarks is not set properly,this simple prosedure can cause significant complications. The damage of the nerve becouse of edema can be easily recovered in a short time by medical threatment but the damage due to mechanical trauma needs a surgical threatment and has a longer recover time about 6 months-2 years,even has the risk of not complietly recovering.Early intervention increases the chance of success.Using of cortizon, antiepileptic drugs, removing of implants and microsurgery are the threatment options. The aim of this study is to discuss the lower lip paresthesia due to dental implant at the two cases. Proper pre-surgery plannings with radiographic and computerize tomography (CT) scans are helpful in establishing anatomic structures, helping to avoid any sensitivity issues as a consequence of inferior alveolar nerve injury after implant placement. Discussion N. alveolarisa inferior, N. lingualis, N. Mentalis are the most injures branches of N. Trigeminalis.(Kalladka,Zicardi, Robinson) The third molar surgery, ortoghnotic surgery, maxillofacial trauma, preprosthetic surgery, endodonthic therapy are the iatrogenic couses of nevre injuries.(Vincent, Zicard, Poort) İn addition to all these iatrogenic couses, the increasing use of implants in replacing missing teeth raise the nevre injuries.(Ardekian)Nerve injuries due to implant surgery are mostly seen at N. Alveolaris inferior and N. Mentalis. Reasons of nerve damage on these are the wrongly calculated placement of implants and grefts on the atrophic posterior mandibula.Nerve damage can change the quality of a persons life becouse of pain, hyposthesia, hyperesthesia.(Hillerup)Early treatment plays essential role in nevre damage (Hillerup)To give the patients cortizon, on which nevre damage may occur, before,peri and after the surgery,can prevent the damage.(Awward, Konji, Al-Bishri) Patient should be followed at the first week, first month,sixth mounth and first year.There is a wide scale on pain; from different level of namness to the painly sense.On implant patients, if the sensory disorder doesn’t recover, to backout 2-3 mm of implants, even removing it may be a solution. Case 2:In the case of the second patient, no treatment was performed, thus the patient had refused to wear mobile prosthesis after prospective removal of the dental implant. Case 1: A 55 year old women had an implant surgery 8 months before and after that she feeled cold and numbness. Her doctor recommended cortizon and vit B but eventough nothing has changed.. At the radiographic examinations we see that on the left molar region of mandibula there is a implant just on the mandibular canal. After local regional and infiltrative anasthesia with the help of trephine drill the implantwas removed. 10 days after the operation the stitches has been taken and lower-level laser therapy with diode laser applied. The complaints of patient decreased. Case 2: A 67 year old patient who has complaints on the left mandibula. On panoromic radiographs diagnosed that implant intrusion into mandibular canal in the area of left second molar. Patient refused to removal of implants and wear prothesis. Figure 1. Figure 2.