Politis Constantinus, Agbaje Jimoh, Van Hevele Jeroen, Nicolielo Laura, De Laat Antoon, Lambrichts Ivo, Jacobs Reinhilde
Int J Oral Maxillofac Implants. 2017 Mar/Apr;32(2):439-444. doi: 10.11607/jomi.5241.
To report on a cohort of patients referred to a tertiary center because of neuropathic pain after dental implant placement.
This retrospective study of pain after dental implant placement involved a minimum follow-up of 12 months after the initial diagnosis of neuropathic pain or persistent, uncontrolled postoperative pain at the Department of Oral and Maxillofacial Surgery, Leuven University, Leuven, Belgium, from January 2013 to June 2014.
Following clinical and radiologic examination, the cause of pain was established in 17 of 26 patients, while the cause was unknown in 9 of 26 patients. Regular implants were placed in the mandibles of 18 patients; in the remaining 8 patients, 6 received regular implants and 2 received a zygoma implant in the maxilla. Surgical management alone brought relief to 2 patients, surgical and pharmacologic management did so for 12 patients, and pharmacologic management alone brought relief for 10 patients.
Early removal of an at-risk implant seems justified, preferably within 48 hours after placement. No treatment, either surgical or medical, seems to cure neuropathic pain, but amitriptyline appears to be associated with consistent improvement in symptoms.
报告一组因牙种植体植入后神经性疼痛而转诊至三级中心的患者情况。
这项关于牙种植体植入后疼痛的回顾性研究,纳入了2013年1月至2014年6月在比利时鲁汶大学口腔颌面外科初次诊断为神经性疼痛或术后疼痛持续且无法控制的患者,至少随访12个月。
经过临床和影像学检查,26例患者中有17例疼痛原因明确,26例中有9例原因不明。18例患者在下颌植入常规种植体;其余8例患者中,6例接受常规种植体,2例在上颌接受颧骨种植体。仅手术治疗使2例患者疼痛缓解,手术和药物联合治疗使12例患者疼痛缓解,仅药物治疗使10例患者疼痛缓解。
早期取出有风险的种植体似乎是合理的,最好在植入后48小时内进行。无论是手术还是药物治疗,似乎都无法治愈神经性疼痛,但阿米替林似乎与症状的持续改善有关。