Paresthesia follwing damage to the inferior alveolar nerve during implant surgery

Dear colleagues---please this is an emergency.

Please see the implant and compressed canal in the attached files. I hope you can see the files.

This is the case in brief:

1. an implant was placed in site # 19 (lower left first molar) 5 days ago. The patient recalls some pain during the operation.

2. Sensation of lip-chin did not return 24 h.

3. day after the operation her dentist replaced the implant with a shorter implant--the one you see in attached files.

4.nothing had changed in sensation till now.

5.patient was seen by another doctor and according to her there was some minor sensation during "tickling" with an instrument ...

6.In CT that was done today i see that immediately apical to the implant the canal looks compressed. In the immediate neighbouring cuts i see the canal is well defined.

7. I couldnt see this patient till now---so my impression is based on her report to me and the CT.

As I have no much knowledge on such cases I seek for immediate help because I think something urgent need to be done.

I hope my impression that the nerve wasnt cut is true, but i am still worried there might be some pressure which may eventually cause ischemia and permanent damage.

My specific question at this moment:

1. Should i suggest removal of the implant immediately?

2. Any medications?

3. Should i refer her to a neurlogist? any other specialist?

Please try your best to share with me all your ideas and thoughts ASAP.

Yours,

Cobi Landsberg