Nerve Repositioning - A Solution for Challenging Implants

In dentistry, severe jawbone resorption often makes implant placement challenging. The nerve repositioning technique is an effective solution that creates a safe space, protects the nerve, and enhances the success of implant placement. This method is commonly used in cases with limited jawbone density, allowing patients to receive stable and long-lasting implants. Let’s explore this technique in detail with The East Rose Dental Clinic!

What Is Nerve Repositioning in Implant Placement?

Nerve repositioning is a surgical technique used for patients with insufficient bone density for implant placement, particularly in the lower jaw, where the inferior alveolar nerve (IAN) is located. When the lower jaw lacks the necessary height or volume for implant placement, the surgeon repositions the nerve to create a safe space for the procedure.

Studies indicate that this technique's success rate ranges from 87% to 95%. However, there is a 10% to 30% risk of temporary or permanent numbness in the lower lip and chin. Due to these risks, this technique is typically considered only when alternative solutions, such as bone grafting or sinus augmentation, are not viable.

Indications for the Nerve Repositioning Technique

Nerve repositioning is not a routine procedure in implant placement, but in certain specific cases, it serves as the best option to ensure safety and effectiveness. Below are the situations where this technique may be required.

Thin Lower Jawbone with Insufficient Clearance from the Nerve

In patients with severe jawbone resorption, the inferior alveolar nerve lies too close to the bone surface, making implant placement highly risky. Without nerve repositioning, there is a significant risk of nerve compression, which can result in numbness in the lower lip and chin. In such cases, the nerve repositioning technique helps create the necessary space for implant placement while preventing nerve damage.

Long-Term Tooth Loss and Severe Jawbone Resorption

Long-term tooth loss results in natural bone resorption, particularly in the lower jaw. When bone loss becomes severe, the distance between the bone surface and the nerve is too small, making safe implant placement unfeasible. Nerve repositioning allows for the relocation of the inferior alveolar nerve, facilitating implant restoration while preserving sensory nerve function.

Full-Arch Implant Restoration in the Lower Jaw

Patients requiring full-arch implant restoration (All-on-4, All-on-6) in the lower jaw often encounter challenges due to insufficient bone volume. If the inferior alveolar nerve is too close to the bone surface, placing multiple implants may increase the risk of nerve damage. Nerve repositioning allows for the creation of adequate space for implant placement, ensuring precise restoration while minimising complications, such as sensory loss.

Abnormal Lower Jaw Structure

In some cases, the lower jawbone has unique anatomical features, such as the inferior alveolar nerve running closer to the surface than usual or an asymmetrical jaw structure, making implant placement more challenging. Without nerve repositioning, the risk of nerve-related complications is significantly higher. This technique provides surgeons with additional space to work, ensuring safer and more effective implant placement.

Special Indications When Bone Grafting Is Not an Option

Typically, when bone volume is insufficient, bone grafting is the primary approach to regenerate bone tissue before implant placement. However, some patients may not be suitable candidates for bone grafting due to factors such as poor healing capacity, underlying medical conditions, or time constraints. In such cases, nerve repositioning serves as an alternative solution, enabling patients to receive dental implants without undergoing a prolonged bone grafting procedure.

What to Do After Treatment?

The recovery period after nerve repositioning surgery typically ranges from 3 to 6 months. During this time, patients may experience mild numbness in the lower lip and chin, which gradually subsides. Osseointegration takes approximately 4 to 6 months before the final prosthetic restoration can be placed.

In the first 24 hours, applying cold compresses can help reduce swelling, and patients should take prescribed pain relievers and anti-inflammatory medications as directed. During the first two weeks, it is essential to consume soft foods, avoid spicy, hot, or hard foods, and refrain from brushing directly over the surgical site. Using a saline solution or antiseptic mouthwash and incorporating vitamin C and protein into the diet can support the healing process.

Additionally, patients should avoid strenuous activities, bending over, or lifting heavy objects during the initial two weeks. Regular follow-up visits are crucial to monitor recovery, and any persistent pain, excessive swelling, or prolonged numbness should be reported to the dentist immediately.

Nerve repositioning is an advanced technique that significantly improves the success rate of dental implant placement in complex cases. However, due to its complexity, this procedure requires a highly skilled and experienced specialist to achieve the best possible outcomes. We hope this article from The East Rose Dental Clinic has provided you with valuable insights into this modern dental solution!