Mobilization of the inferior alveolar nerve with simultaneous implant insertion: a new technique. Case report

For reconstruction of an atrophied posterior mandible, different therapeutic options have been proposed, such as autologous bone grafting, guided bone regeneration for vertical ridge augmentation, and inferior alveolar nerve (IAN) mobilization with simultaneous implant placement. The possible dehiscence of soft tissues covering the surgical zone makes the first and second techniques unpredictable. Moreover, two surgical sites are necessary and a long treatment time is required (about 12 months). With IAN mobilization, only one surgical intervention is required and the total treatment time is shorter (about 6 months). However, this technique risks irreversible damage to the IAN, with consequent functional alterations. Current studies have shown extreme variability in the examination of functionality of the neurovascular bundle after its mobilization. This variability can be attributed both to the methodology used for the tests, which evoke subjective answers from the patient, and to the surgical procedure, which is highly dependent on operator technique. Nerve damage can be the result of an overstretched mucoperiosteal flap in the premolar area to achieve optimal visibility of the surgical zone. This article reports a case in which a new surgical approach to IAN mobilization is performed using a specifically engineered device for simplified bone surgery (Mectron Piezosurgery). This device enables the surgeon to cut hard tissue without injuring the soft tissues. Therefore, there is a lower risk of damaging the IAN, and it is possible to reduce overstretching of the mental nerve by creating a smaller bone window and using an apicocoronal inclination of instruments to capture the neurovascular bundle.