臨床研究
下歯槽神経移動術を併用しインプラントを埋入した８例： 術後の知覚障害の長期経過観察
キーワード:
inferior alveolar nerve repositioning,
neurosensory disturbance,
neurosensory recovery,
dental implant
2010 年 23 巻 3 号 p. 460
詳細
2010 年 23 巻 3 号 p. 460
Purpose:The appropriateness of implant placement combined with repositioning of the inferior alveolar nerve was examined based on long-term observation and assessment of neurosensory recovery in 8 patients (7 females and 1 male).
Materials and methods:The patientsʼaverage age at surgery was 53.0±13.3 years old, with a total of 9 surgeries. The number of implants placed was 15, all endosseous implants. There was one case of complete and 2 cases of partial nerve severance during surgery. The average observation period from surgery to final follow-up was 166±55.8 months, ranging from 70 to 218 months. Analysis of sensory disturbance was based on the results of four different sensory tests, and on the recorded chart descriptions of patientsʼ complaints reinterpreted according to the modified HIGHET classification separated into S0,S1/2,S3 and S4 phases.
Results:At the initial examination the day after surgery, neurosensory disturbance was observed in 8 of 9 cases in phase S0 (numbness). At the final check-up, 7 cases were in phase S4 (normal sensation) with the other 2 cases in phase S3 (paresthesia absence of pain and hyperalgesia). One of the S3 cases died of unrelated causes 76 months after surgery, and one suffered cerebral infarction and dementia at 70 months postoperatively, making the test results unreliable. All 7 cases reached recovery via S0, S1/2 (pain and hyperalgesia) and S3. The average period for each phase was 2.5±3.4 months for S0;30.0±33.9 months for S1/2;and 45.0±43.4 months for S3. An average of 92±41.2 months was necessary before returning to normal sensation (S4). The survival rate of the 15 placed implants was 100%.
Discussion and conclusion:It was concluded that the implant placement combined with repositioning of the inferior alveolar nerve presented here is appropriate in mandibular molar cases where alveolar bone is in a state of advanced resorption. However, prior to surgery, the doctor must obtain informed consent, with the patient recognizing that they will probably experience some disturbance in sensation, and it could take several years before returning to normality.
