A Proposed Parameter-Based Planning Framework for Inferior Alveolar Nerve Repositioning

Background: Rehabilitation of the severely atrophic posterior mandible remains challenging when the residual bone height above the inferior alveolar nerve (IAN) is insufficient for conventional implant placement. In such cases, IAN lateralization or transposition may facilitate placement of longer implants and support fixed prosthetic rehabilitation. However, these procedures require careful case selection because of their technical complexity and the risk of neurosensory complications. Objective: This narrative review presents a literature-informed, expert-derived, parameter-based clinical decision framework for preoperative planning of IAN lateralization and transposition in the severely atrophic posterior mandible. Methods: A focused appraisal of the literature was performed to identify anatomical, prosthodontic, and surgical parameters relevant to IAN repositioning. Parameters were selected according to their recurrent relevance to surgical feasibility, implant positioning, procedural safety, and restorative planning, and were integrated with the authors' clinical experience to develop a structured decision-making framework. No formal risk-of-bias or certainty-of-evidence assessment was performed. Each parameter was assigned an evidence-source category and a threshold status to make its evidentiary basis explicit. Results: The proposed framework organizes treatment planning into three domains: bone-related, prosthodontic, and surgical considerations. Key parameters include residual bone height above the IAN canal, global mandibular height, ridge width, bone density, crown-to-implant ratio, intermaxillary space, ridge angulation, buccal cortical plate thickness, and the three-dimensional course of the IAN. Additional parameters include interforaminal dentition, implant trajectory, canal diameter, bifid canal anatomy, and ridge contour. Collectively, these variables are integrated into a stepwise decision pathway to help determine whether IAN repositioning is appropriate, whether lateralization or transposition is preferable, and when alternative approaches, such as short implants, ridge splitting, or vertical augmentation, may be more suitable. The framework links restorative feasibility and surgical risk to the choice of technique within a single sequential pathway, and reports the evidence basis of each decision point. Conclusions: The proposed framework should not be regarded as a validated clinical decision tool; prospective clinical validation and consensus-based refinement are required before routine clinical implementation. The framework is intended to structure and guide multidisciplinary assessment and discussion of cases; it should not independently determine treatment selection or replace individualized clinical judgment.