Oral Territorial Neurovascular Considerations in Implant Surgery

Abstract

The anatomy of the intrabony course of the inferior alveolar nerve (IAN) is very important for dentists, neurologist, radiologists and pathologists to aid in diagnosis, treatment, planning surgery, and the application of local anesthesia (Polland et al., 2001). IAN damage negatively affects the quality of facial sensibility and the patient’s ability to translate patterns of altered nerve activity into functionally meaningful motor behaviors. The sensory alteration can be attributed to anatomical or functional changes within the nerve after resolution of inflammation and edema in and surrounding the nerve (Essick, 2004; Becerra et al., 2006). Standardization of assessment methods would facilitate the identification of diagnostic criteria for different types of neurosensory impairment. Assessment of sensory changes can be evaluated using three types of measures: (i) objective electrophysiological measures of nerve conduction, (ii) sensory testing measures and (iii) patient report (Takazakura et al., 2007). The request of replacing missing teeth with dental implants is increasing, and as a result, incidence of postoperative complications is increasing concomitantly (Kim et al., 2009). When the height of bone between alveolar crest and inferior alveolar canal is insufficient, implant placement in the posterior mandible is limited. One of the most difficult surgical challenges to the implant surgery is severe resorption of the posterior mandible processes (Ardekian et al., 2001). Understanding of the intrabony distribution of the IAN is important in the accurate preoperative planning for the placement of mandibular implants (Kieser et al., 2002). There are several treatment options for patients with inadequate bone height superior to the inferior alveolar canal. There are lots of alternative reconstruction methods of atrophic dental arch: use of autogenous bone grafting, allografts, xenogenic, or alloplastic materials with or without guided bone regeneration, distraction osteogenesis, IAN lateralization (McAllister & Haghighat 2007; Hashemi 2010). Placing the implants to the buccal side of the IAN or lateralization of it are the two of them (Misch & Resnik 2010). An ideal alveolar ridge with adequate bone height and width is essential for a successful dental rehabilitation (McAllister & Haghighat, 2007). The placement of dental implants to the posterior mandible with severe resorption can cause damage to the IAN. The technique of nerve repositioning has been used to create the