Mandibular Fracture as a Complication of Inferior Alveolar Nerve Transposition and Placement of Endosseous Implants: A Case Report (original) (raw)
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Nerve transposition and implant placement in the atrophic posterior mandibular alveolar ridge
Journal of Oral and Maxillofacial Surgery, 1994
The results obtained with a modified surgical technique for transposition of the inferior alveolar nerve followed by immediate placement of endosseous implants in mandibles with moderate to severe atrophy are presented. Ten transpositions of the inferior alveolar nerve together with the installation of 21 implants were performed in six patients. The mean postoperative follow-up time was 23 months, with a range of 12 to 46 months. All implants with functioning pontics remained stable, with no mobility nor signs or symptoms of pain and infection during the follow-up period. Postoperative radiographic evaluation disclosed no pathologic bone loss around the implants. Neurosensory evaluation was performed using the two-point discrimination test. One patient with unilateral transposition had objective neurosensory dysfunction at 12 months postoperative, although all the nerve function were reported as normal by the patients. Strict patient selection criteria are necessary, with full awareness by the patient of the possibility of long-term or even permanent nerve paresthesia, when this procedure is contemplated.
International Journal of Implant Dentistry, 2021
Background The purpose of this study was to analyze medium-to-long-term implant success and survival rates, and lower lip sensory disturbance after placement of dental implants with simultaneous inferior alveolar nerve (IAN) repositioning. Methods Fifteen patients (3 men, 12 women) treated in two centers were included in this retrospective study. The ages of the participants ranged from 19 to 68. A total of 48 dental implants were placed in 23 posterior mandibular segments simultaneously with IAN transposition or lateralization. The residual bone above the IAN ranged from 0.5 to 7.0 mm. Crestal bone changes were measured using cone beam computed tomography (CBCT) images. Disturbance of the IAN was evaluated subjectively using a modified questionnaire. Results The healing process was uneventful in fourteen patients. In one patient, spontaneous fracture of the operated mandible occurred on tenth day after the surgery. The implant in the fracture line was removed at the time of open re...
IP innovative publication pvt. ltd , 2019
Bone resorption in posterior mandibular region creates a challenge in placement of dental implants and prosthetic rehabilitation due to presence of inferior alveolar nerve (IAN). Several alternatives treatment modalities are suggested: the use of short implants, cortical implants, guided bone regeneration, appositional bone grafting (both autogenous and allograft), distraction osteogenesis, inclined implants tangential to mandibular canal, and the lateralization of the inferior alveolar nerve. In this paper, we will present IAN repositioning cases and simultaneous implant placement and asses the success of implants, severity of nuerosensory disturbances and its impact on present day implant dentistry.
Severe Atrophy of the Posterior Mandible and Inferior Alveolar Nerve Transposition
The International Journal of Periodontics & Restorative Dentistry
The paper presents the inferior alveolar nerve transposition as a successful surgical technique when other treatment options are not possible in the severely resorbed posterior mandible. Based on three clinical cases, this technique is presented in conjunction with implant placement and immediate loading. The paper aims to present the mandibular nerve transposition as a therapeutic method and an important approach, engaging clinicians to use it when other opportunities are impossible.
The International Journal of Periodontics & Restorative Dentistry
Currently, there are several techniques being used in the posterior mandible to increase alveolar bone height and width. However, each of these has potential complications and limitations. The purpose of the current study was to present the surgical technique and restorative considerations for implant placement lateral to the inferior alveolar nerve (IAN) in cases of severely atrophic edentulous posterior mandibles. In the current study, 26 implants in 16 patients were successfully placed lateral to IAN and restored with splinted screw-retained prostheses, with a follow-up time after loading that ranged from 3 months to 6 years. Two patients reported complications: one had a temporary paresthesia that resolved 3 months after implant placement, and the second had minor paresthesia, which was reduced after implant removal but remained in a small area on the left corner of her lip.
Scripta Scientifica Medicinae Dentalis
INTRODUCTION: The aim of this investigation was to evaluate the 5-year outcomes regarding presence of intraoperative and postoperative complications and the survival rate of implants placed simultaneously with lower alveolar nerve lateralization or transposition. MATERIAL AND METHODS: implants placement was performed on 34 patients with advanced atrophy of the posterior mandible simultaneously with lower alveolar nerve lateralization or transposition. Transposition was done only in two cases; in the rest of the cases lateralization of lower alveolar nerve was performed. RESULTS: The survival rate at the end of the fifth year after implant placement was 100%. The mean height of residual bone at the region of implant placement was 2.76 mm. The mean marginal bone resorption for at the fifth year was 0.309 mm. In 20.6% of cases a positive BOP (bleeding on probing) was registered. 14.7% of the patients were free of symptoms of NSD (neuro-sensory dysfunction). In the rest of the patients the mean duration of NSD was 2.06 weeks. In 76.4% of patients the symptoms of NSD of nervus alveolaris inf. resolved after the second week. The maximum period of reported NSD was 6 weeks. No permanent NSD occurred. CONCLUSION: Properly performed lateralization or transposition of the lower alveolar nerve is associated with minimal risk of permanent neuro-sensory dysfunction and providing an opportunity for placement of intraosseal implants in the posterior mandible with high survival rate.
PubMed, 2014
Background: To emphasize the characteristics and possible pitfalls of nerve reposition in cases of severe bone resorption in the posterior mandibular area, and to modify hard- and soft-tissue manipulation accordingly. Methods: We analyzed retrospectively, 7 patients in which we performed full arch lower jaw rehabilitation. The patients presented for oral rehabilitation having a minimal residual bone above the mandibular canal and had undergone inferioral veolar nerve (IAN) displacement with modified surgical technique for fixed prosthetic rehabilitation. Results: Eleven procedures of nerve repositioning were performed on severely atrophic mandibles. The average age of the patients was 43.29 years (12.37 SD). Residual bone above the mental foramen ranged between 0.5 mm and 1.5 mm, with an average of 0.93 mm (0.35 SD). In total, 32 dental implants were inserted into the area simultaneously with nerve displacement. The average follow-up time was 35.71 months(41.75 SD), ranging between 7 and 120 months. Conclusions: Severe atrophic cases require special attention due to the loss of keratinized tissue around the crestal area.The use of a modified surgical approach and specific surgical instruments provides a safer working environment for the operator and ensures optimal results.
Long Term Follow-Up in Inferior Alveolar Nerve Transposition: Our Experience
BioMed Research International, 2014
Introduction. Inferior alveolar nerve transposition (IANT) is a surgical technique used in implantoprosthetic rehabilitation of the atrophic lower jaw which has not been well embraced because of the high risk of damage to the inferior alveolar nerve (IAN). There are cases in which this method is essential to obtain good morphologic and functional rebalancing of the jaw. In this paper, the authors present their experience with IANT, analyzing the various situations in which IANT is the only surgical preprosthetic option. Methods. Between 2003 and 2011, 35 patients underwent surgical IANT at our center. Thermal and physical sensitivity were evaluated in each patient during follow-up. The follow-up ranged from 14 to 101 months. Results and Conclusion. Based on our experience, absolute indications of IANT are as follows: (1) class IV, V, or VI of Cawood and Howell with extrusion of the antagonist tooth and reduced prosthetic free space; (2) class V or VI of Cawood and Howell with presence of interforaminal teeth; (3) class V or VI of Cawood and Howell if patient desires fast implantoprosthetic rehabilitation with predictable outcomes; (4) class VI of Cawood and Howell when mandibular height increase with inlay grafts is advisable.
Mandibular fractures associated with endosteal implants
Oral and Maxillofacial Surgery, 2009
Purpose The purpose of this study is to report four cases of mandibular fractures associated with endosteal implants and to discuss prevention and treatment of these types of fractures. Discussion To evaluate whether the patient's anatomy allows insertion of implants, radiological exams that demonstrate the height and the labial-lingual width are needed. To reduce the potential fracture problem, the mandible can be restrengthened with bone grafting techniques. The treatment of a fracture in an atrophic mandible is always a challenge because of the diminished central blood supply, the depressed vitality of the bone, and the dependence on the periosteal blood supply. The basic principles in fracture treatment are reduction and immobilization of the fractured site for restoration of form and function. Conclusions If implants are placed in severe atrophic mandible, iatrogenic fracture of the mandible may occur during or after implant surgery because implant placement weakens the already-compromised mandible. A few millimeters of cortical bone should remain on both the labial and the lingual sites after the hole for insertion of an implant has been drilled. A 3-D surgical planning should be recommended at least in severe atrophic mandibles in order to prevent a severe reduction of bone tissue.
Case Report: An Extreme Case of Alveolar Bone Resorption in an Edentulous Mandible
2019
The alveolar processes of the mandible and maxilla develop in response to tooth eruption and serve as the principal mechanism of tooth support. When teeth are lost or extracted, the result is resorption of the alveolar bone. The rate of resorption is variable between individuals but will progress over time. During dissection, varying examples of alveolar resorption are observed in edentulous donors. A 76-year-old female donor presented an extreme case of alveolar bone resorption during dissection in our Head and Neck Anatomy course. The body of the mandible in this case was extremely short, with a vertical height in the molar region of 5mm and 8mm in the canine area. The dissection revealed the superior surface of the bone to have an open groove containing the inferior alveolar nerve and vessels. The maxilla also demonstrated severe resorption. This loss of bone has significant implications for restoration of function by dental implants or removable prosthesis. It is not unusual to find resorption that has significantly reduced the height of the mandibular body to the extent that the mental foramen opens superiorly on the bone. However, an open mandibular canal with the neurovascular bundle exposed throughout the dental arch is much more unusual. Individuals with this degree of resorption present great challenges in treatment. There is no means to provide retention for a mandibular removable prosthesis. Pressure of prosthesis on the inferior alveolar and mental nerves would potentially produce pain and paresthesia and/or numbness. Placement of dental implants is complicated at best. To provide minimal requirements for implant placement would require vertical augmentation of the mandible along with transposition/reposition of the inferior alveolar nerve