INFERIOR ALVEOLAR NERVE TRANSPOSITION IN CONJUNCTION WITH DENTAL IMPLANT PLACEMENT

Year 2019, Volume: 29 Issue: 2, 306 - 312, 22.03.2019

Sercan Küçükkurt Tuğçe Biçer Aytuğar

https://doi.org/10.17567/ataunidfd.285591

Abstract

ABSTRACT

Introduction: In the posterior mandible, dental implants are usually used to support
fixed prostheses. In many cases, serious bone resorption occurs in this region
following tooth extraction and it is difficult to place implants in appropriate
sizes due to the limitation of vertical distance of the inferior alveolar nerve
(IAN). There are regenerative or
reconstructive procedures in the posterior mandible to provide rehabilitation
with implants in cases of excessive vertical bone loss. Repositioning of IAN is
one of the alternative methods in the literature.

Case Report: Full-mouth fixed mandibular prosthetic rehabilitation with dental
implants was planned to a
62-year-old male patient in another clinic. However in the left mandibular
posterior region, placed implants were failed twice. In radiographic
examinations approximately 5 mm vertical height was determined in the posterior
region. According to current clinical conditions, all available treatment
options were discussed with the patient and dental implant placement with nerve
transposition technique was decided. Under local anesthesia IAN was
repositioned by implementing piezosurgery and dental implants were placed
successfully. After one year follow-up there was no complaint or sensory loss.

Conclusion: At the right indications, IAN
repositioning techniques are useful surgical procedures that can be used for
the rehabilitation of the atrophic posterior mandible with dental implants.

Keywords: dental implant, nerve reposition, nerve transposition, nerve
lateralization, inferior alveolar nerve

INFERIOR ALVEOLAR SİNİR TRANSPOZİSYONU
İLE BİRLİKTE GERÇEKLEŞTİRİLEN DENTAL IMPLANT UYGULAMASI

ÖZ

Giriş: Posterior
mandibulada, dental implant uygulamaları genellikle sabit protezleri
desteklemek amacıyla uygulanmaktadır. Ancak birçok vakada bölgede yaşanan diş
kayıpları sonrasında oluşan ciddi rezorpsiyonlar nedeniyle özellikle inferior
alveolar sinirin (IAS) vertikal boyut kısıtlamaları da eklenince uygun
boyutlarda implant uygulamaları yapabilmek oldukça zor hale gelmektedir.
Literatürde bu tip aşırı kemik rezorpsiyonu bulunan durumlarda dental implant
uygulanabilmesine olanak sağlayacak çeşitli rejeneratif veya rekonstrüktif
teknikler önerilmiştir. IAS’ın yeniden konumlandırılması teknikleri de
literatürde geçen alternatif tekniklerden biridir.

Olgu Sunumu: 62 yaşında erkek
hastaya dış merkezde implant destekli tüm çene mandibular sabit protetik
rehabilitasyon planlanmıştır. Ancak sol mandibula bölgeye yerleştirilen
implantlar 2 defa tekrarlanmış ancak başarısız olmuştur. Tarafımızdan yapılan
radyolojik muayenede bölgede 5 mm kemik yüksekliği tespit edilmiştir. Mevcut
şartlar dahilinde hastaya uygulanabilecek tedavi alternatifleri açıklanmış ve
nihayetinde sinir transpozisyon tekniği ile birlikte dental implant uygulanması
kararlaştırılmıştır. Lokal anestezi altında piezocerrahi yardımıyla sinir
repozisyonu uygulanmış ve bölgeye implant uygulamaları başarıyla yapılmıştır. 1
yıllık takibin ardından hastada herhangi bir şikayet bulunmazken, duyusal bir
kayıp tespit edilmemiştir.

Sonuç: Doğru
endikasyonlarda sinir rezpozisyon teknikleri, atrofik posterior mandibular
bölgelerin dental implantlarla rehabilitasyonuna olanak sağlayan kullanışlı
tedavi seçenekleridir.

 

Anahtar
Kelimeler: dental
implant, sinir repozisyonu, sinir transpozisyonu, sinir lateralizasyonu,
inferior alveolar sinir

Keywords

dental implant, nerve reposition, nerve transposition, nerve lateralization

References

• 1. Jensen OT. Alveolar segmental "sandwich" osteotomies for posterior edentulous mandibular sites for dental implants. J Oral Maxillofac Surg. 2006;64:471-5.
• 2. Rachmiel A, Emodi O, Aizenbud D. [Reconstruction of the alveolar ridge by osteodistraction for implant placement]. Refu'at ha-peh veha-shinayim. 2011;28:30-6
• 3. Morrison A, Chiarot M, Kirby S. Mental nerve function after inferior alveolar nerve transposition for placement of dental implants. J Can Dent Assoc. 2002;68:46-50.
• 4. Jensen J, Reiche-Fischel O, Sindet-Pedersen S. Nerve transposition and implant placement in the atrophic posterior mandibular alveolar ridge. J Oral Maxillofac Surg. 1994;52:662-8
• 5. Felice P, Corinaldesi G, Lizio G, Piattelli A, Iezzi G, Marchetti C. Implant prosthetic rehabilitation of posterior mandible after tumor ablation with inferior alveolar nerve mobilization and inlay bone grafting: a case report. J Oral Maxillofac Surg. 2009;67:1104-12.
• 6. Felice P, Iezzi G, Lizio G, Piattelli A, Marchetti C. Reconstruction of atrophied posterior mandible with inlay technique and mandibular ramus block graft for implant prosthetic rehabilitation. J Oral Maxillofac Surg. 2009;67:372-80.
• 7. Smiler DG. Repositioning the inferior alveolar nerve for placement of endosseous implants: technical note. Int J Oral Maxillofac Implants. 1993;8:145-50.
• 8. Khajehahmadi S, Rahpeyma A, Bidar M, Jafarzadeh H. Vitality of intact teeth anterior to the mental foramen after inferior alveolar nerve repositioning: nerve transpositioning versus nerve lateralization. Int J Oral Maxillofac Surg. 2013;42:1073-8.
• 9. Alling CC. Lateral repositioning of inferior alveolar neurovascular bundle. J Oral Surg. 1977;35:419.
• 10. Jensen O, Nock D. Inferior alveolar nerve repositioning in conjunction with placement of osseointegrated implants: a case report. Oral Surg Oral Med Oral Pathol 1987;63:263-8.
• 21. Dario LJ, English R, Jr. Achieving implant reconstruction through bilateral mandibular nerve repositioning. J Am Dent Assoc. 1994;125:305-9.
• 22. Yoshimoto M, Konig BJ, Coelho PG, Allegrini SJ, Luiz FF. A light and scanning electron microscopy study of bone healing following inferior alveolar nerve lateralization: an experimental study in rabbits. Int J Oral Maxillofac Implants. 2008;23:457-62.
• 23. Hirsch JM, Branemark PI. Fixture stability and nerve function after transposition and lateralization of the inferior alveolar nerve and fixture installation. Br J Oral Maxillofac Surg. 1995;33:276-81.
• 24. Walter JM, Jr., Gregg JM. Analysis of postsurgical neurologic alteration in the trigeminal nerve. J Oral Surg. 1979;37:410-4.
• 25. Nocini PF, De Santis D, Fracasso E, Zanette G. Clinical and electrophysiological assessment of inferior alveolar nerve function after lateral nerve transposition. Clin Oral Implants Res. 1999;10:120-30.
• 26. Babbush CA. Transpositioning and repositioning the inferior alveolar and mental nerves in conjunction with endosteal implant reconstruction. Periodontol 2000. 1998;17:183-90.
• 27. Sandstedt P, Sorensen S. Neurosensory disturbances of the trigeminal nerve: a long-term follow-up of traumatic injuries. J Maxillofac Oral Surg. 1995;53:498-505.
• 28. Fernandez Diaz JO, Naval Gias L. Rehabilitation of edentulous posterior atrophic mandible: inferior alveolar nerve lateralization by piezotome and immediate implant placement. Int J Oral Maxillofac Surg. 2013;42:521-6.
• 29. Hashemi HM. Neurosensory function following mandibular nerve lateralization for placement of implants. Int J Oral Maxillofac Surg. 2010;39:452-6.
• 30. Sakkas N, Otten JE, Gutwald R, Schmelzeisen R. Transposition of the mental nerve by piezosurgery followed by postoperative neurosensory control: a case report. Br J Oral Maxillofac Surg. 2008;46:270-1.