606 Theories and techniques of oral implantology

short time. In the mandible, the perforation is in-variably on the inner aspect of the bone, and it is palpable only by bimanual examination. Perforation into the maxillary sinus, although not dangerous, results in any unstably set pin (Fig. 13-63). In the nose, not only may the pin be unstable, it will also irritate (Fig. 13-64). If the pin is unstable, it should be remnoved. If there is enough of the pin in bone to give good support, the protruding part must be removed by cutting it below the nasal mucosa at the nasal bone level. This is accomplished like an apicoectomy.

When injury to the mandibular nerve during implantation is suspected and a proper diagnosis cannot be made because of too deep anesthesia, the canal should be temporarily sealed with a short post. Later the post can be removed and the implantation completed. Usually no anesthesia is needed at this point. At most, instilling a few drops of an anestheticum will be enough to make the operation pain-less.

If the operator is reasonably certain that no accident occurred during implantation and yet the patient complains of mandibular nerve irritation,

Fig. 13-62. Overshooting accidents. A, The post overshot a lower premolar and went through the jaw. It was immediately withdrawn into the bone and this radiograph taken. B, Five weeks later. C, In this case, overshooting was detected only after cementation. Radiograph taken 1 year after the operation. (From Orlay, H. G.: Endodontic implants, J. Oral Implant Transplant Surg., pp. 44-53, 1965.)

Fig. 13-63. Pins perforating the maxillary sinus. Although usually no problems arise for the patient, the pins become more unstable. (Courtesy H. G. Orlay.)

Fig. 13-64. Pins perforating the nasal vestibulum as well as the sinus. The pin in the nose will be very irritating. (Courtesy H. G. Orlay.)