Complication after Lingual Plate Perforation: options?

Patient had the implant done 3 months ago with no CBT unfortunately. Patient symptoms - severe incomfort at effort. Soft tissue around the area looked a bit darker than on the opposite side. CBT scan now done and found out that on the lower side this implant is perforating the lingual plate. Threads outside bone is touching a nerve. Is extraction and restoration best?

Paolo Rossetti comments:

Although it is not an ideal condition I would consider leaving it there if no specific symptoms are present suggesting a nervous or vascular lesion. What do you mean by "severe discomfornt at effort"?

Dr K G comments:

I would take it out and let it heal. No further risk to be taken with this.

Bogdan Theiss comments:

During the 3 months after placement patient did not exercise as advised by former surgeon. After exercising couple of times now this appeared - an exercise min.10km run in one go. I advised to stop for now. Consulted with other peers and if is to be kept there could be a risk of sublingual hematoma.

Richard Winter comments:

Did you place the implants? Please proof-read what you wrote. Do you mean severe discomfort? What is "at effort?" I would recommend you work with an oral surgeon to diagnose and treat as this is really something that could result in long term sequelae.

Bogdan Theiss comments:

Patient had the implants done in another country. By discomfort at effort meaning after a long running(10km) - feels a pulsating pain on the lingual side right next to the implant. The pain dissapears in hours and comes back only at effort. It looked odd to me but then I saw the threads on the CBT which seem to touch the alveolar nerve. Palpated the area and patient confirmed it. Patient is 30years old with athlete history.

Matt Helm DDS comments:

According to the CBCT the implant is not touching the inferior alveolar nerve. However, a local hematoma may be impinging on the nerve and that may be the cause of pain when you palpate the area. Regardless, this implant should be removed ASAP and allowed to fully heal before attempting another one. Unless you are thoroughly versed in oral surgery I strongly suggest that you work with an oral surgeon or, completely refer the case to one. You should not want to own this mistake made by someone else.

Dr J comments:

Remove and wait 3-6 months And then replace with a tissue level implant and no need to go do deep

Robin I Raub DDS comments:

With the history you've given, and the response from others, take the implant out. Graft the site and wait 4-6 months. If you're going to place implants in the future just take the plunge and get a CT. I'm on my second machine, a HDX pano+ CT, about $56K. Its convenient, you will find more uses for it and it will open up a whole new world for you!!

Richard Benian comments:

Remove the implant, graft the site, but do not over pack it into the sublingual space! Wait 4-6 months, make surgical guide and get CBCT scan with guide in the mouth. Determine volume of bone, height of bone/width of bone. Determine size of implant to place based on CBCT. In this day and age I *HIGHLY* recommend treatment planning for implants using a CBCT.

Be aware that after 3-4 months of healing already, this implant may be difficult to remove. Be carful not to fracture lingual cortex! Using trephine burs may also remove portion of lingual cortex leaving deficiency of lingual bone.