Inferior Alveolar Nerve Transpositioning for Implant Placement

Premature loss of posterior teeth in the mandible, failure to replace lost teeth as well as systemic factors may result in progressive resorption of the alveolar ridge. At present, oral and maxillofacial surgeons aim to reconstruct the lost bone and masticatory function via posterior mandibular grafting and/or implants. However, anatomic limitations such as the inferior alveolar nerve (IAN) may limit this. Various treatment methods are availa‐ ble for treatment of patients with posterior mandibular atrophy presenting with a super‐ ficial IAN; each has its own merits and drawbacks. [1,2] Use of removable or fixed prosthetics and reconstruction of the dentoalveolar system by dental implants are among the available treatment options; a superficial IAN often precludes use of the latter. Im‐ plant-based reconstruction has several advantages i.e. allows for placement of longer im‐ plants, bone preservation, better functionality etc. and is gaining more proponents. However, certain conditions should be met in order for an implant to be placed. The most important condition is the quality and quantity of the bone. The amount of resorp‐ tion, density of the bone and level of the nerve may limit implant placement. Recon‐ struction and rehabilitation of the dentoalveolar system in cases with alveolar ridge atrophy is a challenge for maxillofacial surgeons and prosthodontists. To date, several treatment options such as augmentation techniques with bone grafts [3], cartilage [4] or hydroxylapatite [5], vestibuloplasty [6] and several osteotomy techniques [7] have been suggested. Such treatments are still indicated as alternatives for cases in which for some reason dental implants cannot be placed [8]. In order to place an implant, we need ade‐ quate bone volume (both mediolaterally and mesiodistally) with optimal bone density.