Inferior alveolar nerve transposition with involvement of the mental foramen for implant placement

Inferior Alveolar Nerve (IAN) transposition is an option for prosthetic rehabilitation in cases of moderate or even severe bone reabsorption for patients that do not tolerate removable dentures. The aim of the present report is to describe an inferior alveolar nerve transposition with involvement of the mental foramen for implant placement. The surgical procedure was performed under local anesthesia, by the inferior alveolar, lingual and buccal nerve blocking technique. Centripetal osteotomy was performed, and bone tissue was removed, leaving the nerve tissue free in the foramen area. After that, transsection of the incisor nerve was performed, and lateral osteotomy was started from the buccal direction, toward the trajectory of the IAN. The procedure was concluded, by making use of a delicate resin spatula to manipulate the vascular-nervous bundle. The drilling sequence for placing the dental implants was performed, and autogenous bone was harvested using a bone collector attached to the surgical suction appliance. After the implants were placed, the bone tissue previously collected during the osteotomies and drilling processes was placed in order to protect the IAN from contact with the implants. The surgical protocol for inferior alveolar nerve transposition, followed by implant placement presented excellent results, with complete recovery of the sensitivity, seven months after the surgical procedure.     

Inferior alveolar nerve lateral transposition

Purpose

We determined the outcomes of 18 inferior alveolar nerve lateral transposition procedures in 15 consecutive patients. The advantages and disadvantages of this technique are discussed.

Results

The surgical protocol for inferior alveolar nerve transposition, followed by implant placement, presented excellent results, with complete recovery of the sensitivity within 6 months after the surgical procedure.

Discussion

Inferior alveolar nerve transposition is an option for prosthetic rehabilitation in cases of moderate or even severe bone reabsorption for patients that do not tolerate removable dentures.

Conclusions

It is concluded that inferior alveolar nerve transposition can be safely and predictably performed with low risk to the mental nerve sensibility. Each patient should be advised of the chance of permanent nerve deficit throughout the distribution of the mental nerve. Alternative restorative solutions should also be considered.     

Inferior alveolar nerve transposition in combination with Br?nemark implant treatment.

The surgical protocol for inferior alveolar nerve transposition together with the Br?nemark implant treatment is described. The short-term follow-up results of the first ten procedures are presented and show an initial 2- to 3-week duration of anesthesia. In all regions treated, signs of paresthesia/hypoesthesia have been registered for 1 to 7 months. After 6 months, seven of the regions recovered completely with regard to nerve sensation.     

Inferior alveolar nerve lateralization and implant placement in atrophic posterior mandible

The aims of this article were to describe the surgical technique of the inferior alveolar nerve lateralization followed by implant installation by means of a clinical report and also to discuss the importance of an adequate surgical and prosthetic planning for atrophic posterior mandible rehabilitation.     

Endosseous implant placement in conjunction with inferior alveolar nerve transposition: a report of an unusual complication and surgical management

Inferior alveolar nerve transposition and placement of endosseous implants is one of the treatment options for patients with an edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal. The possible complications associated with this technique include prolonged neurosensory disturbances, infection, and pathologic fracture. This report presents the surgical management of a patient who sustained a mandibular fracture after inferior alveolar nerve transposition for the placement of 3 endosseous implants.     

Inferior alveolar nerve repositioning in conjunction with placement of osseointegrated implants: a case report

A procedure for relocation of the inferior alveolar nerve to facilitate placement of endosseous implants is described. The technique permits placement of implants in an atrophied mandibular alveolar ridge that lacks sufficient vertical height superior to the mandibular canal. Placement of a fixed prosthesis instead of a removable appliance is facilitated.     

Inferior alveolar nerve repositioning in implant surgery

Severe resorption of the posterior mandible possesses one of the most difficult restorative challenges to the implant surgery today. This resorption may prevent the placement of dental implants without the potentially damage to the inferior alveolar nerve. To create the opportunity of insertion dental implants of adequately length in those cases, the technique of nerve repositioning has been advocated. The purpose of this article is to describe two cases of nerve repositioning combined with placement of dental implants. Both cases showed appropriate postoperative healing without damage to the inferior alveolar nerve. The inferior alveolar nerve repositioning technique seems to be an acceptable alternative to augmentation procedure prior to dental implants placement in cases exhibiting atrophic posterior mandibular ridges.     

Inferior alveolar nerve transposition and reposition for dental implant placement in edentulous or partially edentulous mandibles: a multicenter retrospective study

The aim of this study was to evaluate the success and complications following inferior alveolar nerve (IAN) transposition/reposition for dental implant placement in edentulous or partially edentulous mandibles. This was a multicenter retrospective study; patients who had undergone IAN transposition/reposition at four surgical clinics were retrospectively evaluated. Adverse effects, especially neural disturbances, were recorded and followed. Overall, 68 IAN reposition and 11 nerve transposition procedures were performed in 57 patients (only three patients reported on smoking). The residual bone above the IAN was an average 3.88 ± 1.98 mm. A total of 232 dental implants were inserted in the area after transposition/reposition of the nerve. The average follow-up time was 20.62 ± 9.79 months, ranging from 12 to 45 months. One implant loss was observed during the follow-up period. Four patients reported prolonged transient neural disturbances immediately following surgery (5% of the operations). The duration of neural disturbances after the surgery ranged from 1 to 6 months. No permanent neural damage was reported. Thus, within this study's limitations, it can be concluded that IAN transposition and reposition are useful adjunct techniques for managing severely atrophic edentulous or partially edentulous mandibles with dental implants. The risk of neural dysfunction appears to be low.     

Preserving alveolar ridge anatomy following tooth removal in conjunction with delayed implant placement

1. Prior to placing implants, the health of the adjacent teeth and supporting tissues should be good. The presence of acute infection (exudate, granulation tissue, gingival hyperplasia), poor oral hygiene, or active chronic periodontal disease are associated with an increased incidence of infection or tissue breakdown. 2. Avoid excessive dissection of papilla. 3. Stabilize membranes with apical tacks and secure the coronal portion to the implant with the cover screw. 4. Relieve the periosteum to allow for a tension-free closure. 5. Avoid postoperative trauma on the surgical site.     

Inferior alveolar nerve repositioning

Nerve repositioning is a viable alternative for patients with an atrophic edentulous posterior mandible. Patients, however, should be informed of the potential risks of neurosensory disturbance. Documentation of the patient's baseline neurosensory function should be performed with a two-point discrimination test or directional brush stroke test preoperatively and postoperatively. Recovery of nerve function should be expected in 3 to 6 months. The potential for mandibular fracture when combining nerve repositioning with implant placement also should be discussed with the patient. This can be avoided by minimizing the amount of buccal cortical plate removal during localization of the nerve and maintaining the integrity of the inferior cortex of the mandible. Additionally, avoid overseating the implant, thus avoiding stress along the inferior border of the mandible. The procedure does allow for the placement of longer implants, which should improve implant longevity. Patients undergoing this procedure have expressed overall satisfaction with the results. Nerve repositioning also can be used to preserve the inferior alveolar nerve during resection of benign tumors or cysts of the mandible. This procedure allows the surgeon to maintain nerve function in situations in which the nerve would otherwise have to be resected.     

MRI在下牙槽神经移位牙种植术前的临床应用

目的:利用先进的MRI方法显示IAN,用于IAN移位牙种植术前分析.方法:6例牙槽嵴严重萎缩患者,全景片、CT显示可用牙槽骨量严重不足,特别是IAN走行显示不清.MRI 3D MP-RAGE扫描,检查IAN走行和分支.结果:6例患者MRI图像清晰的显示出IAN的位置和分支及环状结构,准确测量牙槽嵴顶与IAN的距离.讨论:这种新的MRI方法清楚的显示IAN走行并且能够显示其环形结构.MRI图像也能够测量IAN与牙槽嵴顶之间距离.对于一些手术创伤感染导致全景片、CT显示下颌管不清的病例,MRI也能够显示其走行和环状结构.结论:MRI显示IAN用于牙种植术前设计,具有较良好的应用价值和CT无可比拟的临床特点.     

Lateralization of the inferior alveolar nerve with simultaneous implant placement: a modified technique

PURPOSE: Several nerve repositioning techniques have ben presented in the literature, each with limitations. This article presents a new technique involving the use of 2 osteotomies, with minimizes particularly the potential duration of sensory disruption and the risk of nerve paresthesia and inadvertent nerve transection or compression. MATERIALS AND METHODS: Ten patients ranging in age from 47 to 67 years were selected for nerve lateralization utilizing the modified technique. A total of 23 cylindrical implants were placed. An average follow-up period was 29.8 months. RESULTS: Of the 10 patients, 4 experienced total return of sensation within 3 to 4 weeks. One patient experienced complete recovery at 6 weeks. DISCUSSION: Creating 2 osteotomies as described minimizes the chances for postoperative neuropraxia and nerve paresthesia or anesthesia. CONCLUSION: When there is moderate-to-severe bone resorption of the mandible posterior to the mental foramen, repositioning the inferior alveolar nerve using both an anterior and posterior osteotomy allows for more bone to accommodate ideal placement and greater length of implant.     

Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: A virtual implant placement study

Objectives

To investigate the prevalence and morphological parameters of lingual concavity, and whether these factors are related to a higher risk of inferior alveolar nerve (IAN) injury when performing an immediate implant surgery in posterior mandible region.

Methods

The CBCT images from 237 subjects (1008 teeth) were analysed the shape of the mandibles (C, P, U type), dimensional parameters of lingual concavity (angle, height, depth), and its relation to inferior alveolar canal (IAC) (A, B, C zone), RAC (distance from root apex to IAC) and probability of IAN injury. Multiple logistic regression modelling to determine the odds ratio of variables that made an important contribution to the probability of IAN injury and to adjust for confounding variables.

Results

The U type ridge (46.7%) and the most concave point located at C zone (48.8%) are most prevalent in this region. The mandibular second molar presents highest risk for IAN injury than other tooth type (p < 0.001), which were 3.82 times to occur IAN injury than the mandibular second premolar. The concave point located at A zone and B zone were 7.82 and 3.52 times than C zone to have IAN damage, respectively. The probability of IAN injury will reduce 26% for every 1 mm increase in RAC (p < 0.001).

Conclusions

The tooth type, morphological features of lingual concavities, and RAC are associated with risks of IAN injury during immediate implant placement.

Clinical significance

Pre-surgical mapping of the IAC and identification of its proximity relative to the lingual concavity in the posterior mandible regions may avoid unpleasant complications, specifically when performing immediate implant procedures.     

Complications associated with inferior alveolar nerve repositioning for dental implant placement: a systematic review

Inferior alveolar nerve (IAN) repositioning has been used widely in recent years as an alternative approach for dental implant placement in the atrophic posterior mandible. The aim of this study was to answer the question: What are the complications associated with IAN repositioning? A systematic literature review performed in accordance with the PRISMA statement, using the PubMed (MEDLINE), Cochrane Library, and Scopus databases, identified a total of 116 articles related to this technique. Of those articles, 24 were included in the final review. Lateralization was the chosen technique in seven studies, transposition in 15 studies, and two studies reported both techniques. The longest follow-up period was 49.1 months and the shortest 6 months. Of the patients who underwent lateralization, 95.9% initially showed a neurosensory disturbance, and the condition remained at the end of the study for 3.4% of those patients. With regard to the patients who underwent transposition, neurosensory alterations were observed in 58.9% of patients initially, and the condition remained for 22.1% of those affected at the end of the study. Only one study found no neurosensory disturbance at any time. More data consolidation is necessary to determine scientifically if, which, and when the IAN repositioning technique can be recommended.     

Inferior alveolar and lingual nerve imaging

At present, there are no objective testing modalities available for evaluation of iatrogenic injury to the terminal branches of the trigeminal nerve, making such clinical diagnosis and management complicated for the oral and maxillofacial surgeon. Several imaging modalities can assist in the preoperative risk assessment of the trigeminal nerve as related to commonly performed procedures in the vicinity of the nerve, mostly third molar surgery. This article provides a review of all available imaging modalities and their clinical application relative to preoperative injury risk assessment of the inferior alveolar nerve and lingual nerve, and postinjury and postsurgical repair recovery status.