Chronic post-surgical pain following the placement of dental implants in the maxilla: A case series

Purpose: To present ten cases of chronic post-surgical neuropathic pain (CPSP) arising after placement of maxillary dental implants, in order to raise awareness of this potential complication of treatment. Materials and methods: Data collected from the case notes of consecutive patients presenting to the orofacial pain clinic, with neuropathic pain arising after placement of maxillary dental implants. Results: Nine out of 10 patients were female, with an average age 55.4 years. Six patients had a significant medical history (depression, peripheral neuropathic pain, irritable bowel syndrome and fibromyalgia). Six patients had single implants placed, four had multiple implants. Four patients experienced pain during implant placement. Onset of pain was immediate in nine patients. Pain intensity (visual analogue scale) ranged from 2 to 9 (average 5.6). Pain was constant in all patients. Exacerbating factors included stress, tiredness, low mood and cold weather. Implants were removed in two patients however pain did not resolve. Pain management was complex; including medication (anti-epileptics and tricyclic antidepressants), Botox injections and cognitive behavioural therapy, however pain did not completely resolve in nine cases. Conclusions: Persistent pain after dental implant placement may occur with no apparent organic cause and without any neurosensory deficits. Practitioners must be aware of chronic post-surgical neuropathic pain as a possible complication of implant placement, particularly in patients with a significant medical history. Consideration should be given as to whether these patients are suitable for implant rehabilitation. Patients reporting very severe and prolonged postoperative pain following implant surgery should be considered at risk of CPSP and referred to a specialist in orofacial pain. Keywords: chronic pain, dental implant, neuropathic pain, postoperative complications