J Korean Assoc Oral Maxillofac Surg.  2023 Dec;49(6):347-353. 10.5125/jkaoms.2023.49.6.347.

Implant placement with inferior alveolar nerve repositioning in the posterior mandible

• Kim D
• Lim T
• Lee HW
• Lee BS
• Choi BJ
• Ohe JY
• Jung J

• KMID: 2550298
• DOI: http://doi.org/10.5125/jkaoms.2023.49.6.347

Abstract

This case report presents inferior alveolar nerve (IAN) repositioning as a viable approach for implant placement in the mandibular molar region, where challenges of severe alveolar bone width and height deficiencies can exist. Two patients requiring implant placement in the right mandibular molar region underwent nerve transposition and lateralization. In both cases, inadequate alveolar bone height above the IAN precluded the use of short implants. The first patient exhibited an overall low alveolar ridge from the anterior to posterior regions, with a complex relationship with adjacent implant bone level and the mental nerve, complicating vertical augmentation. In the second case, although vertical bone resorption was not severe, the high positioning of the IAN within the alveolar bone due to orthognathic surgery raised concerns regarding adequate height of the implant prosthesis. Therefore, instead of onlay bone grafting, nerve transposition and lateralization were employed for implant placement. In both cases, the follow-up results demonstrated successful osseointegration of all implants and complete recovery of postoperative numbness in the lower lip and mentum area. IAN repositioning is a valuable surgical technique that allows implant placement in severely compromised posterior mandibular regions, promoting patient comfort and successful implant placement without permanent IAN damage.

Keyword

Inferior alveolar nerve repositioning; Nerve lateralization; Nerve transposition

Figure

• 

  Fig. 1 Preoperative panoramic X-ray.

• 

  Fig. 2 Cone-beam computed tomography images showing the distance between the inferior alveolar nerve and crestal bone in the first premolar, second premolar, and first molar regions.

• 

  Fig. 3 A. Buccal movement of the mental nerve using 3-0 black silk and bony window formation to expose the inferior alveolar nerve. B. Implant placement following nerve transposition toward the buccal aspect.

• 

  Fig. 4 Postoperative panoramic X-ray.

• 

  Fig. 5 Postoperative cone-beam computed tomography images of implants in the first premolar, second premolar, and first molar sites, as well as the repositioned inferior alveolar nerve in the second molar area.

• 

  Fig. 6 Preoperative panoramic X-ray.

• 

  Fig. 7 Cone-beam computed tomography images illustrating the distance from the mental nerve and inferior alveolar nerve to the alveolar crest, as well as the distance from the alveolar crest to the opposing teeth.

• 

  Fig. 8 A. Buccal movement of the inferior alveolar nerve using a periosteal elevator. B. Implant placement following nerve lateralization toward the buccal aspect.

• 

  Fig. 9 Postoperative panoramic X-ray.

Reference

References

1. Lee DJ, Saponaro PC. 2019; Management of edentulous patients. Dent Clin North Am. 63:249–61. https://doi.org/10.1016/j.cden.2018.11.006. DOI: 10.1016/j.cden.2018.11.006. PMID: 30825989.

2. Kageyama I, Maeda S, Takezawa K. 2021; Importance of anatomy in dental implant surgery. J Oral Biosci. 63:142–52. https://doi.org/10.1016/j.job.2021.01.002. DOI: 10.1016/j.job.2021.01.002. PMID: 33524607.

3. Levin L, Nitzan D, Schwartz-Arad D. 2007; Success of dental implants placed in intraoral block bone grafts. J Periodontol. 78:18–21. https://doi.org/10.1902/jop.2007.060238. DOI: 10.1902/jop.2007.060238. PMID: 17199534.

4. Lemos CA, Ferro-Alves ML, Okamoto R, Mendonça MR, Pellizzer EP. 2016; Short dental implants versus standard dental implants placed in the posterior jaws: a systematic review and meta-analysis. J Dent. 47:8–17. https://doi.org/10.1016/j.jdent.2016.01.005. DOI: 10.1016/j.jdent.2016.01.005. PMID: 26804969.

5. Terheyden H, Meijer GJ, Raghoebar GM. 2021; Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies. Int J Oral Maxillofac Surg. 50:1249–58. https://doi.org/10.1016/j.ijom.2021.01.005. DOI: 10.1016/j.ijom.2021.01.005. PMID: 33589294.

6. Du Toit J, Gluckman H, Gamil R, Renton T. 2015; Implant injury case series and review of the literature part 1: inferior alveolar nerve injury. J Oral Implantol. 41:e144–51. https://doi.org/10.1563/aaid-joi-d-14-00022. DOI: 10.1563/AAID-JOI-D-14-00022. PMID: 24945089.

7. Juodzbalys G, Wang HL, Sabalys G, Sidlauskas A, Galindo-Moreno P. 2013; Inferior alveolar nerve injury associated with implant surgery. Clin Oral Implants Res. 24:183–90. https://doi.org/10.1111/j.1600-0501.2011.02314.x. DOI: 10.1111/j.1600-0501.2011.02314.x. PMID: 22092662.

8. Abayev B, Juodzbalys G. 2015; Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: a systematic review of surgical techniques. J Oral Maxillofac Res. 6:e2. https://doi.org/10.5037/jomr.2014.6102. DOI: 10.5037/jomr.2015.6102.

9. Naves Freire AE, Iunes Carrera TM, Rodriguez LS, Lara de Carli M, Filho AP, Costa Hanemann JA, et al. 2019; Piezoelectric surgery in the inferior alveolar nerve lateralization with simultaneous implant placement: a case report. Implant Dent. 28:86–90. https://doi.org/10.1097/id.0000000000000855. DOI: 10.1097/ID.0000000000000855. PMID: 30624393.

10. Deryabin G, Grybauskas S. 2021; Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances. Int J Implant Dent. 7:44. https://doi.org/10.1186/s40729-021-00334-x. DOI: 10.1186/s40729-021-00334-x. PMID: 34105021. PMCID: PMC8187674.

11. Martínez-Rodríguez N, Barona-Dorado C, Cortés-Breton Brinkmann J, Martín Ares M, Calvo-Guirado JL, Martínez-González JM. 2018; Clinical and radiographic evaluation of implants placed by means of inferior alveolar nerve lateralization: a 5-year follow-up study. Clin Oral Implants Res. 29:779–84. https://doi.org/10.1111/clr.12857. DOI: 10.1111/clr.12857. PMID: 27122305.

12. Martínez-Rodríguez N, Barona-Dorado C, Cortes-Breton Brinkmann J, Martín-Ares M, Leco-Berrocal MI, Prados-Frutos JC, et al. 2016; Implant survival and complications in cases of inferior alveolar nerve lateralization and atrophied mandibles with 5-year follow-up. Int J Oral Maxillofac Surg. 45:858–63. https://doi.org/10.1016/j.ijom.2016.01.005. DOI: 10.1016/j.ijom.2016.01.005. PMID: 26837718.

13. Wang Y, Jiang J, Guan Y, Si M, He F. 2021; Retrospective study of short versus standard posterior implants and analysis of implant failure risk factors. Int J Oral Maxillofac Implants. 36:1129–36. https://doi.org/10.11607/jomi.8930. DOI: 10.11607/jomi.8930. PMID: 34919609.

14. Khajehahmadi S, Rahpeyma A, Bidar M, Jafarzadeh H. 2013; Vitality of intact teeth anterior to the mental foramen after inferior alveolar nerve repositioning: nerve transpositioning versus nerve lateralization. Int J Oral Maxillofac Surg. 42:1073–8. https://doi.org/10.1016/j.ijom.2013.04.012. DOI: 10.1016/j.ijom.2013.04.012. PMID: 23706291.

15. Scarano A, Mortellaro C, Brucoli M, Lucchina AG, Assenza B, Lorusso F. 2018; Short implants: analysis of 69 implants loaded in mandible compared with longer implants. J Craniofac Surg. 29:2272–6. https://doi.org/10.1097/scs.0000000000004518. DOI: 10.1097/SCS.0000000000004518. PMID: 29621074.

16. Lorean A, Kablan F, Mazor Z, Mijiritsky E, Russe P, Barbu H, et al. 2013; Inferior alveolar nerve transposition and reposition for dental implant placement in edentulous or partially edentulous mandibles: a multicenter retrospective study. Int J Oral Maxillofac Surg. 42:656–9. https://doi.org/10.1016/j.ijom.2013.01.020. DOI: 10.1016/j.ijom.2013.01.020. PMID: 23481542.

17. Schwartz-Arad D, Levin L, Sigal L. 2005; Surgical success of intraoral autogenous block onlay bone grafting for alveolar ridge augmentation. Implant Dent. 14:131–8. https://doi.org/10.1097/01.id.0000165031.33190.0d. DOI: 10.1097/01.id.0000165031.33190.0d. PMID: 15968184.

18. Pieri F, Forlivesi C, Caselli E, Corinaldesi G. 2017; Short implants (6mm) vs. vertical bone augmentation and standard-length implants (≥9mm) in atrophic posterior mandibles: a 5-year retrospective study. Int J Oral Maxillofac Surg. 46:1607–14. https://doi.org/10.1016/j.ijom.2017.07.005. DOI: 10.1016/j.ijom.2017.07.005. PMID: 28751181.

19. Castellano-Navarro JM, Castellano-Reyes JJ, Hirdina-Castilla M, Suárez-Soto A, Bocanegra-Pérez S, Vicente-Barrero M. 2019; Neurosensory issues after lateralisation of the inferior alveolar nerve and simultaneous placement of osseointegrated implants. Br J Oral Maxillofac Surg. 57:169–73. https://doi.org/10.1016/j.bjoms.2019.01.006. DOI: 10.1016/j.bjoms.2019.01.006. PMID: 30712958.

20. Hassani A, Saadat S, Moshiri R, Shahmirzad S, Hassani A. 2015; Nerve retraction during inferior alveolar nerve repositioning procedure: a new simple method and review of the literature. J Oral Implantol. 41 Spec No:391–4. https://doi.org/10.1563/aaid-joi-d-13-00108. DOI: 10.1563/AAID-JOI-D-13-00108. PMID: 24344674.