Implant Too Close To Nerve, Nerve Injury Protocol | Oral Surgery Techniques #6 with Dr. Gallagher
Key Concepts: 1 – Debride before you decide: #31 had periapical radiolucencies, a bulbous root and furcation involvement, so after sectioning the bridge I spent about 5 minutes removing granulation tissue and irrigating before judging the site for an implant. 2 – Respect the inferior alveolar nerve: the canal sat about 13 mm below the crest, but infection can thin its roof, so you don't know how close you are until the site is clean and the osteotomy begins. 3 – If the CBCT shows the implant compressing or entering the canal, take it out. I grafted above the site (2 cc) without packing bone down toward the nerve; if the injury is obvious, consider not grafting at all. 4 – Place implants 1–2 mm below the crest to allow for the 0.5–1 mm of bone loss expected in the first 1–1.5 years. The #30 implant torqued to 45 Ncm and got a healing abutment the same day. 5 – Nerve injury protocol: a Medrol dose pack early (6-5-4-3-2-1 taper), plus vitamin B complex, acetyl-L-carnitine and alpha-lipoic acid for 1–2 months when paresthesia is present or anticipated. Key Instruments/Materials: • CBCT: checked the implant's relationship to the inferior alveolar canal after placement. • Osteotomy burs: prepared the implant sites while staying clear of the nerve canal. • Bone graft (2 cc) and membrane: filled the #31 site after the implant came out. • 4-0 PTFE suture: figure-eight over the membrane plus a security stitch over its middle; it doesn't collect debris or smell like 4-0 Vicryl. • 3-0 chromic gut suture: closed the #30 implant site. Sponsors: * Instrument Partner Of This Project – (Looking for a partner with instruments, I'll be talking about and showing the instruments I used in each case) * Dental Implant Partner - (I place 3 different brands of implants and I'm waiting for my favorite one to partner with me on this project so I can finally reveal it!) * Bone Grafting Partner - (This could be you! You know who you are lol let me know) Top 14 Viewers on this Episode on TikTok LIVE 131 Q&A: 1st – JuliaJayBird1023, @crazycatperson2021 2nd – @emmac623 3rd – Diandler, @diandler143 4th – Ricky T, @daynightsigns 5th – @theorysmasher 6th – TitoRDH, @titordh6 7th – @user3939509162103 8th – User248, @jacob12456789 9th – RadiantRedRose|FitnessOver 40, @radiantredrose26 10th – @ilg_7 11th – @jtbc_8 12th – Ethan, @ethan.rn 13th – @..ff098 14th – whatever, @justintyme49 Now available on: - Dr. Gallagher’s Podcast & YouTube Channel Watch in this episode = Citizen Ecozilla Diver (my overnight on-call watch in residency) 10.2026 #podcast #dentalpodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #oralsurgeon #doctorgallagher #doctorgallagherspodcast