Page 9 - GP Fall 2020

Bilateral Inferior Alveolar Nerve Lateralization - A Novel Technique
in an Atrophic Mandibular Ridge

By Soujanya Koyalada, BDS, Vijay Prakash Nautiyal, BDS, MDS, and Kateel Shashidhara Kamath, BDS, MDS

Abstract Case Report during flap reflection to preserve the integ-
Rehabilitation of an atrophic posterior man- A 27-year-old male patient (Figure 1) rity of the periosteum and neurovascular
dible poses a significant challenge during presented for rehabilitation of edentulous bundle where it exits the mental foramen
placement of implants because of possible maxillary and mandibular ridges. Reha- and enters the soft tissue. A window was
complications from encroachment of the bilitation of the mandibular arch (Figure created in the buccal cortical plate posterior
inferior alveolar canal. Inferior alveolar 2) with a fixed implant-supported hybrid to the mental nerve (Figures 5,6) in order
nerve repositioning is one of the accepted
methods in managing such situations. This Figure 5.
article is a case report of a 27-year-old male Prepared
patient who required rehabilitation of an cortical
extremely atrophic mandibular ridge with window on
the inferior alveolar neurovascular bundle right side of
located 4 to 5mm below the crest of the al- ridge.
veolar ridge. The presented procedure does
not involve a complicated augmentation Figure 1. Figure 2. Preoperative
procedure, advanced diagnostic modal- Preoperative intraoral view. Figure 6.
extraoral view.
ities or equipment. The technique is very Prepared
economical and includes bilateral inferior prosthesis was planned. The preoperative cortical
alveolar nerve lateralization with simulta- work-up included diagnostic casts, a di- window on
neous implant placement performed with agnostic wax-up, surgical templates and left side of
ridge.
precise surgical technique under general assessment of the IAN using panoramic
anesthesia. The procedure was successful radiography (Figure 3). Radiographic ex-
with osseointsegration of the implant with-
out loss of neurosensory function. to leave a sufficient amount of marginal
crestal bone so as to allow for later prepa-
Key Words: Inferior Alveolar Nerve Lat- ration and then countersinking of fixture
eralization, Neurosensory Disturbance, sites. Initially, the bone was drilled with
Atrophic Ridges. copious saline irrigation using a round bur
and then a straight fissure bur on a straight
Introduction hand piece in order to create dimensions of
Rehabilitation of edentulous mandibular Figure 3 - Preoperative OPG. approximately 8mm of height and 25mm
posterior atrophic ridges using implants is amination revealed that the inferior alveo- of length. After removal of the cortical
subject to anatomical, surgical and biolog- lar canal was located 4 to 5mm below the layer (Figures 7,8) surrounding the canal,
ical difficulties, which poses a challenge crest of the ridge bilaterally, which defied a curette was used to remove spongy bone
to the dental team. In such situations, re- the placement of implant without nerve around the canal. Once the neurovascular
1
storative options include the usage of short repositioning. IANL and simultaneous im- bundle was clearly visible, it was freed
fixtures, bone grafting to increase ridge plant placement was planned based on the from the canal and moved laterally with a
height, and complicated imaging studies assessment.
to allow for positioning of implants along- Figure 7.
side but not into the nerve canal during the After evaluation of the patient’s systemic Buccal cortex
2
procedure. Apart from this there are nerve status, the surgical procedure was planned removed from
repositioning procedures, namely IANL under general anesthesia. A crestal incision prepared
(Inferior Alveolar Nerve Lateralization) was placed in the edentulous molar region cortical
window.
and IANT (Inferior Alveolar Nerve Trans- of one side to the contralateral molar region.
position) enabling suitable long fixtures A full thickness labial mucoperiosteal flap
that can be simultaneously placed without was raised to expose the alveolar ridge and
encroaching on the IAN (Inferior Alveolar buccal cortex (Figure 4). Care was taken Figure 8.
Nerve). Intraoperative
Figure 4. view after
This study discusses a case of bilateral Surgical removal of
IANL coupled with simultaneous implant exposure prepared
placement in an atrophic mandibular ridge. of buccal buccal cortex
cortex and on both sides.
mental
nerve.
www.nysagd.org l Fall 2020 l GP 9