Neurovascular Disturbance Associated with Implant Placement in the Anterior Mandible and its Surgical Implications : Literature Review including Report of a Case

Volume 11, Number 1, 2008 The anterior mandible is mostly considered as an idenal and safe area for rehabilitation of the edentulous mandible with oral implants. Nevertheless, the use of volumetric imaging has allowed the visualising of canal structures in the anterior mandible, which might assume some elaborate neurovascularisation. These findings may be linked to the fact that, in the past two decades, some authors have reported neurosensory disturbances and haemorrhage in the anterior mandible1–21. This may underline the need for presurgical assessment of neurovascular structures prior to anterior mandibular surgery. Unfortunately, there are few publications on anatomical variations in dimensions and morphology of these canals22–24. Considering the increased use of oral implants, the occurrence and anatomic variability of the mandibular incisive canal and lingual canal (superior and inferior genial spinal canals and lateral lingual canal) have regained attention to optimise surgical planning and avoid complications23,24. In the present report, a case is presented in which oral implant placement caused nerve disturbance, and a further review is carried out to clarify this observation and explain other case reports on neurosensory disturbance after anterior mandibular surgery. A review of the literature is also performed on all documented case reports on haemorrhage and related anatomical structures in the anterior mandible. The article also includes a report on Abstract: Nowadays, oral implants are routinely used for rehabilitation of the edentulous mandible as this procedure is often considered uncomplicated, especially when limiting implant placement to the symphyseal area. Nevertheless, a case of nerve disturbance in the anterior mandible after the implant placement is described. Therefore, surgical, radiographic and anatomic considerations are reviewed in order to encounter the risks for neurosensory disturbance and haemorrhage. It is clear that preoperative radiographic planning of oral implant placement in the anterior mandible should pay attention to the mandibular incisive and lingual canals, besides the mental one, to avoid any neurovascular complications.