Inferior Alveolar Nerve Lateralization Research Articles

Inferior alveolar nerve repositioning surgical techniques and outcomes – a systematic review

Inferior alveolar nerve (IAN) lateralization (IANL) or transposition (IANT) are both techniques allowing for dental implant placement in posterior atrophic mandibles. The aim of this study was to systematically review the implant survival rate and the complications associated with IAN reposition techniques with simultaneous implant placement in atrophic posterior mandibles.This systematic review was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic review and Meta-Analysis). The review was designed to answer the following PICO question: Is IAN repositioning (I) a safe and efficient technique (O) to treat patient looking for fixed dental rehabilitation of an atrophic posterior mandible (P).Thirty-three articles were reviewed, including a total of 899 patients, and approximately 950 IAN repositioning procedures. Dental implant survival rate ranged between 86.95% and 100% with a mean dental survival rate of 90.16%. Among the 269 patients who underwent IANT, there were 93% immediate neurosensory disturbance, and 15% persistent neurosensory disturbance. Among the 350 patients who underwent IANL, there were 93% immediate neurosensory disturbance, and 6% persistent neurosensory disturbance.IANT and IANL are reliable techniques allowing safe dental implant placement in atrophic posterior mandible with high patient satisfaction. IANL seems to cause less persistent neurosensory disturbances compared to IANT. The level of evidence is poor due to the high number of bias present in the included studies. IAN neurosensory disturbance assessment should be better homogenized in order to increase comparability.

Inferior alveolar nerve lateralization with simultaneous implant placement: A case report and review of literature comparing three different techniques

Implant placement is a challenge in atrophic posterior mandibular region. Inferior alveolar nerve lateralization (IANL) is a preferred procedure in such cases as it allows longer implant placement. Neurosensory deficit is the most common postoperative complication of this procedure. There are various strategies, which reduce the potential nerve damage involved in IANL. The use of piezoelectric device over rotary device minimizes accidental injury to neurovascular bundle. The repositioning of nerve after implant placement involves a technique of barrier placement between the IANL and the implant in the form of collagen membrane or bone graft. This case report aims to describe IANL technique using piezoelectric device with simultaneous dental implant placement and bone graft as barrier for posterior rehabilitation of an atrophic mandible. This article also compares the three different techniques of nerve repositioning and barrier placement.

Piezosurgery versus conventional rotary instrument for Inferior Alveolar Nerve lateralization prior to implant placement: (Comparative Clinical Study)

Aim of the study: Evaluation of the inferior alveolar nerve (IAN) neurosensory function, postoperative pain and edema following the placement of an implant with inferior alveolar nerve lateralization using piezo-surgery versus conventional rotary instruments. Materials and methods: Twenty four partially edentulous patients were selected for this study. Twelve patients underwent inferior alveolar nerve lateralization for Implants placement using Piezosurgery device (Group A), while the other twelve patients underwent inferior alveolar nerve lateralization for implant placement using conventional rotary surgical bur (Group B). Operation duration, postoperative pain, edema, and patient satisfaction were primary assessed and compared between the two groups at 2, 5 and 7days postoperatively, also inferior alveolar nerve affection as a secondary outcome was assessed subjectively and objectively and compared between the two groups throughout the follow up intervals occurred at 2, 8 & 24 weeks postoperatively. Results: There was a statistical significant difference in all of the primary and secondary assessments between the two groups in favor of group A at all of the follow up intervals, except at the operation duration assessment where piezosurgey ( Group A) had statistically significant higher operation duration than group B. Conclusion: The inferior alveolar nerve lateralization (IANL) technique using conventional surgical burs has a higher initial rate of sensory dysfunction, postoperative pain and edema than with using Piezosurgery. The somatosensory evoked potential method is considered more informative, reliable and diagnostic parameter than other subjective and conventional clinical methods.

Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances

BackgroundThe purpose of this study was to analyze medium-to-long-term implant success and survival rates, and lower lip sensory disturbance after placement of dental implants with simultaneous inferior alveolar nerve (IAN) repositioning.MethodsFifteen patients (3 men, 12 women) treated in two centers were included in this retrospective study. The ages of the participants ranged from 19 to 68. A total of 48 dental implants were placed in 23 posterior mandibular segments simultaneously with IAN transposition or lateralization. The residual bone above the IAN ranged from 0.5 to 7.0 mm. Crestal bone changes were measured using cone beam computed tomography (CBCT) images. Disturbance of the IAN was evaluated subjectively using a modified questionnaire.ResultsThe healing process was uneventful in fourteen patients. In one patient, spontaneous fracture of the operated mandible occurred on tenth day after the surgery. The implant in the fracture line was removed at the time of open reduction and fixation. One more implant was lost after 5 years of loading. Therefore, the overall dental implant survival rate was 95.8%, whereas all implants in function were judged as successful after a follow-up period of 1 to 10 years. Transient neurosensory disturbances (ND) were observed in all patients who underwent IAN lateralization and IAN transposition. At follow-up times of 3 years, 5 years, and 10 years, weak hypoesthesia remained in two subjects treated with IAN transposition. None of the patients developed neuropathic pain after the procedure.ConclusionsWithin the limitations of this study, we conclude that reconstruction of severely resorbed mandibles with dental implants in conjunction with IAN repositioning is an effective and reliable technique. Although neurosensory disturbances are the most common complication after surgery, they tend to resolve over time. Advanced surgical skills are required to perform this technique.

Evaluation of the effect of the lateralized inferior alveolar nerve isolation and bone grafting on the nerve function and implant stability. (Randomized Clinical Trial).

The inferior alveolar nerve lateralization (IANL), although allows for an implant full-length mandibular height engagement, coincides with depleting the buccal bone support and sensory deficits. This study aims to assess whether interposing a bone graft coupled with securing a collagen membrane separation between the inferior alveolar nerve (IAN) and the underlying dental implants would preserve the nerve function, enhance the implant stability, and minimize the radiographic marginal bone loss. Eighteen patients with 30 atrophic mandibular edentulous ridges were subjected to IANL after being randomly assigned to two treatment modalities which consisted of 15 patients each. The (control group) utilized conventional IANL in direct contact with 20 implants. The (test group) implemented the IAN collagen-membrane wrapping and interposing bone graft to overlay 23 implants. The neural function, the radiographic marginal bone loss, and the implant stability quotient were assessed and compared 6 months postoperatively. All the patients regained their full neurosensory function after 6 months, with statistically nonsignificant differences between both groups throughout the follow-up period. The mean marginal bone loss in the test group was (0.42 ± 0.09) mm versus (0.38 ± 0.14) mm for the control group, which was statistically similar (P= 0.401). The 6-month postoperative mean implant stability quotient values of the test group recorded (74.73 ± 2.68) versus (74.73 ± 1.79) for the control group, which was statistically nonsignificant with a value of P= 0.626. The interposed bone graft, coupled with the collagen membrane isolation, neither subsided the neural disturbances nor enhanced the secondary implant stability and marginal bone loss.

Evaluation of the Effect of Platelet Rich Fibrin Membrane on the Neurosensory Function Following Inferior Alveolar Nerve Lateralization for Implant Placement

Aim: The aim of this study was to evaluate the effect of PRF membrane on the neurosensory disturbance ofthe inferior alveolar nerve following IAN lateralization surgery for immediate implant placement.Methodology: The study was conducted on six patients underwent IAN lateralization surgery for immediateimplant placement and the nerve was surrounded by PRF membrane. The neurosensory disturbance wasevaluated using visual analogue scale preoperatively and postoperative at 1 week, 2 weeks,1 month,3 monthand 6 month.Results: At 1 week post-operative 100% of the patients had recorded complete absence of sensations in thelip and chin region. At 6 month post-operative (66.6%) of the patients has recorded score 4 and (33.3 %) ofthe patients have recorded score 5.The mean and median value significantly decreased at one week post-operatively, then gradually increased inthe subsequent observations. Friedman test revealed a significant difference between observations (p=0.00).Conclusions: The PRF membrane resulted in no immediate postoperative improvement of the neurosensorydisturbance of the inferior alveolar nerve following IAN lateralization surgery for immediate implantplacement and the nerve recovery followed the normal course.

Evaluation of Neurosensory Deficits Following the Use of Computer Assisted Surgical Guide for Inferior Alveolar Nerve Bypass versus Inferior Alveolar Nerve Lateralization (Randomized Controlled Trial)

Objective : To evaluate the neurosensory function of inferior alveolar nerve following the placement of animplant with Bypassing versus lateralization method. Methods : Twenty six partially edentulous patientswere selected and equally grouped into 2 groups. In 1st group: implants placed by inferior alveolar nervelateralization with Piezosurgery, while in 2nd group implants placed by computer guided surgical stentto bypass the inferior alveolar nerve. Then the neurosensory deficits are evaluated by subjectively andobjectively tests. Assessment occurred at period intervals 2 ,8 & 24 weeks postoperatively. Results: therewas statistically significant difference between the IANL & IANB especially at the early post-operativefollow up, but with time there was no statistically significant difference. Conclusion: The inferior alveolarnerve lateralization technique has a higher initial rate of sensory dysfunction than the nerve bypassingtechnique with the aid of computer guided stent.

In-Block Lateralization as a New Technique for Mobilization of the Inferior Alveolar Nerve: A Technique Case Series.

The edentulous atrophic posterior mandible is often a great challenge for implant rehabilitation. Although a number of treatment options have been proposed, including the use of short implants and surgical grafting techniques, in cases of severe bone atrophy, techniques for mobilization of the inferior alveolar nerve (IAN) have been shown to be efficient, with good results. Four female patients underwent IAN lateralization for prosthetic rehabilitation of the posterior mandible from 2013 to 2019, with 3 years to 5 years and 3 months of follow-up. This case series describes a new technique for mobilization of the IAN, named in-block lateralization, to facilitate access to the IAN and to reduce nerve manipulation. The implant is immediately installed (allowing nerve lateralization in unitary spaces), and the original mandibular anatomy is restored with autogenous bone from the original bed during the same surgical procedure. When well indicated and well performed, this new approach provides better and easier visualization of the IAN and safer manipulation aiming to achieve good results for implant stability and minimal risk of neurosensory disturbances, allowing rehabilitation even in unitary spaces.

Dental Implants Installation Laterally to the Inferior Alveolar Nerve Canal Guided Tomography: A Case Report

When severe atrophy in posterior portion of the mandible is present, lateralization of the alveolar nerve might be an option that allows implant installation in the area. However, this technique is complex and can produce some sequelae to patient, as paresthesia. Planning the implant installation using Cone-Beam Computed Tomography (CBCT)-guided surgery might prevent inferior alveolar nerve lateralization. The current report presents a clinical case of implants placement in posterior mandible area with severe alveolar ridge atrophy using CBCT-guide. The reported clinical case refers to a patient (female; 65 years old), partially edentulous, who sought dental rehabilitation complaining lack of efficiency of the removable inferior prosthesis. Clinically, it was observed that the remaining inferior teeth included 34, 33, 32, 31, 41, 42 and 43, and two dental implants in 35 and 44 positions. Moreover, severe bilateral alveolar ridge atrophy was noted. However, tomographic exams revealed bilateral proximity to inferior alveolar nerve canal where further implants should be placed. In order to avoid complications, a CBCT with surgical guide was obtained. At surgery with the surgical guide, 2 Cone Morse 3.5 × 10 mm dental implants were installed in the position of teeth 36 and 46. After implants placement, a new tomographic exam was performed. It was possible to verify the correct positioning to the implants laterally to the inferior alveolar nerve canal. Through the technique employed, it was possible to avoid manipulation of the inferior alveolar nerve bilaterally.

Complications associated with inferior alveolar nerve reposition technique for simultaneous implant-based rehabilitation of atrophic mandibles. A systematic literature review

IntroductionSurgical inferior alveolar nerve (IAN) reposition techniques offer an alternative approach to implant-based rehabilitation in patients with severe mandibular atrophy The aim of this systematic review, was to determine the complications associated with the technique and to determine which of two variants (lateralization or transposition) is less invasive. Materials and methodsAn electronic search was conducted in databases complimented by a manual search to identify clinical studies investigating complications derived from these surgical techniques. Only studies of adult humans, published in English during the last seven years were included. The initial search located 78 articles, of which seven were included in analysis on the basis of the following characteristics: four investigated inferior alveolar nerve lateralization (IANL), one inferior alveolar nerve transposition (IANT), and two investigated both reposition techniques. ResultsThis review included data from 289 patients who were recruited for lateralization (N=319) or transposition surgery (N=33) making a total of 352 reposition procedures. Five patients (1.73%) suffered persistent damage to the IAN at the end of the follow-up periods. The overall implant survival rate was 99.26% of a total of 817 implants. The most common complications were neurosensory problems, mandibular fracture, infection, implant loss, and insufficient anatomical reconstruction of the atrophic mandible; neurosensory complications (hypoesthesia, paraesthesia, and hyperesthesia caused by traumatic damage to the nerve) were the most prevalent. ConclusionsLateralization of the inferior alveolar nerve would appear to be less invasive as it produces lower percentages of persistent neurosensory disorders (1.56%) than transposition (12.12%). Nevertheless, both techniques offer a viable approach to implant placement in edentulous atrophic mandibles, obtaining predictable clinical and radiological results after 5 years implant loading.

Does the Length of Dental Implants Inserted in Areas of Inferior Alveolar Nerve Lateralization Interfere on Mandibular Resistance to Fracture?

The aim of this study was to compare, in vitro, the mechanical resistance to vertical displacement of the mandible after osteotomy for lateralization of the inferior alveolar nerve and installation of dental implants. One hundred eighty polyurethane mandibles were equally divided into 6 groups: G1-intact hemi-mandibles (control group), G2-hemi-mandibles after osteotomy for lateralization of the inferior alveolar nerve, G3-hemi-mandibles with installation of 3 bicortical dental implants (3.75 × 13 mm), G4-hemi-mandibles with installation of 3 dental implants that did not reach the basal cortical bone (3.75 × 11 mm), G5-hemi-mandibles after osteotomy for lateralization of the inferior alveolar nerve and installation of 3 bicortical dental implants (3.75 × 13 mm) and G6-hemi-mandibles after osteotomy for lateralization of the inferior alveolar nerve and installation of 3 dental implants that did not reach the basal cortical bone (3.75 × 11 mm). The specimens were subjected to linear loading tests. The highest mean value of maximum load was found in G1 (412.36N ± 11.99), followed by G2 (396.87N ± 23.94), G3 (319.63N ± 57.28), G4 (303.34N ± 18.25), G5 (231.75N ± 63.64) and G6 (228.13N ± 20.75). Based on this data, it can be concluded that the bicorticalization (or not) of the implants was not a statistically significant risk factor for the vertical displacement of polyurethane hemi-mandibles.

Evaluation of Neurosensory Function Following Inferior Alveolar Nerve Lateralization for Implant Placement

BackgroundAdequate bone height and width is the most important parameter for success of implants. Prolonged edentulous area in mandibular posterior region is often associated with atrophy precluding the use of dental implants. Inferior alveolar nerve (IAN) lateralization is a challenging surgical procedure as it involves the exposure of the neurovascular bundle from its compact bony compartment and adequate retraction while immediate placement of implant.AimEvaluation of neurosensory disturbances related to IAN lateralization for implant placement in the posterior atrophic edentulous mandible.Materials and MethodsTen patients above the age of 18 years with an edentulous span in mandibular posterior region showing distance from alveolar crest to IAN ≤ 8 mm (CBCT) were included in the study. The postoperative analysis of NDs was done using Semmes–Weinstein Monofilaments (SWM). Readings were made on the 1st and 7th postoperative day and every month thereafter until the neural sensations were restored.ResultsAll patients reported neurosensory disturbance on post-op day 1. None of the patients responded to SWM lesser than 4.56 on first postoperative day, which indicated 100% incidence of neurosensory disturbances. The minimum time required for complete recovery was 2.0 months, and maximum was 4.0 months.ConclusionIAN lateralization is a useful method for managing the atrophic posterior mandible with dental implants. If done precisely with experienced personnel, it can provide a worthy option for surgical restoration of atrophic mandible with minimal temporary NDs.

Computer-Guided Inferior Alveolar Nerve Lateralization With Simultaneous Implant Placement: A Preliminary Report.

Placement of dental implants in the posterior mandibular alveolar ridges may become a challenging procedure because of limited bone height between the crest of the ridge and the inferior alveolar canal. The aim of this study was to introduce an innovative, less invasive, highly accurate, and easy surgical technique of inferior alveolar nerve lateralization in the posterior deficient mandible using a special customized 3-dimensional-printed surgical guide to enhance the bone height for implant placement. This case series study included 7 patients with unilateral edentulous mandibular alveolar ridges. Customized surgical guides were manufactured using fused deposition modeling technology to accurately place a rectangular window to uncover the canal and also for immediate placement of dental implants in all cases. The results of this limited study provided information on an innovative technique that decreased intraoperative time and demonstrated decreased risks for (1) inferior alveolar nerve injury and (2) postoperative nerve dysfunction.

The effect of a platelet-rich fibrin conduit on neurosensory recovery following inferior alveolar nerve lateralization: a preliminary clinical study

This retrospective study aimed to assess the recovery of neurosensory dysfunction following modified inferior alveolar nerve (IAN) lateralization surgery compared to the conventional approach. Data from two groups of patients who underwent IAN lateralization in 2014 were included in this study. In one group, platelet-rich fibrin was placed over the IAN and this was protected with a collagen membrane conduit; the other group underwent the conventional IAN lateralization procedure. Implants were placed immediately. Neurosensory dysfunction was evaluated at 3, 6, and 12 months post-surgery. Demographic, neurosensory disturbance (NSD), subjective two-point discrimination test (TPD), and static light touch test (SLT) data were obtained. Twenty-three IAN lateralization procedures with the placement of 51 implants were performed in 14 patients. At the 6-month follow-up, the number of patients experiencing normal sensation was greater in the modified surgery group, but the 12-month follow-up results were the same in the two groups. More precise sensation was observed with the TPD in the modified group at 6 months, and the modified group demonstrated better SLT scores at 6 months. Although the two groups had comparable results at the 12-month follow-up, it was observed that the modified technique accelerated neural healing within 6 months and reduced the length of the discomfort period.

Clinical and radiographic evaluation of implants placed by means of inferior alveolar nerve lateralization: a 5-year follow-up study.

To evaluate clinical and radiological responses of implants placed in combination with inferior alveolar nerve lateralization, analyzing survival and success rates over 5years functional loading. This prospective, longitudinal, single-center study recruited 40 patients with mandibular atrophy in the posterior sectors, who underwent lateralization of the inferior alveolar nerve. Three months after surgery and implant placement, the implants were loaded by means of screw-retained implant-supported partial prostheses or fixed complete prostheses. Clinical and radiographic examinations were performed immediately after implant placement and at 12, 24, 36, 48 and 60-month follow-up visits. The 40 patients received a total of 129 implants (Phibo TSA™ , Phibo Dental Solutions, Sentmenat, Barcelona, Spain). Two implants were lost in the first month after surgery, generating an implant cumulative survival rate (CSR) of 98.44%. The success rate after 5years of loading was 98.44%. No intra-operative or postoperative soft tissue or prosthetic complications occurred during the 5-year follow-up. Inferior alveolar nerve lateralization performed to allow placement of (Phibo TSA™ ) implants in patients with mandibular atrophy obtained predictable clinical and radiological results over five years of functional loading.

The use of piezoelectric surgery to lateralize the inferior alveolar nerve with simultaneous implant placement and immediate buccal cortical bone repositioning: a prospective clinical study

A prospective study was conducted to assess a variation of inferior alveolar nerve (IAN) lateralization. This study included 13 patients. An osteotomy was made with a piezoelectric device, and the IAN bundle was moved buccally. Dental implants were then inserted medial to the nerve bundle, and the inner surface of the buccal cortical bone plate was shaped to reduce its thickness. Finally, the bone plate was repositioned to restore the original shape and contour of the mandible. Neurosensory examinations of the lower lip and chin were performed using three tests: light touch, pain, and two-point discrimination. Three months after surgery, the function of the IAN was judged to be completely restored at 11 of the 13 surgical sites. Differences in the tests comparing the operated and non-operated sides were not significant. No implants were lost, and all patients were satisfied with the result. Although IAN lateralization in conjunction with dental implant placement is rarely indicated, the use of a piezoelectric device to perform a buccal osteotomy with final repositioning of the buccal cortical plate over the bony defect contributes to the recovery of the contour and shape of the mandible, without impairment of IAN function.

Implant survival and complications in cases of inferior alveolar nerve lateralization and atrophied mandibles with 5-year follow-up

The objectives of this study were to evaluate the survival after 5 years of implants placed using inferior alveolar nerve (IAN) lateralization in cases of mandibular atrophy and to determine the incidence of complications. Twenty-seven patients received 74 implants by means of the IAN lateralization technique. Implant survival after 5 years of loading was 98.6%. Eighteen months after surgery, the recovery of sensitivity was complete in 26 cases. Implant placement with IAN lateralization was seen to be a satisfactory and predictable technique. IAN lateralization requires a high level of technical skill, and strict criteria should be applied when prescribing this treatment.

Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: a systematic review of surgical techniques.

ABSTRACTObjectivesThe purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible.Material and MethodsA comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up.ResultsA total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented.ConclusionsInferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications.

ABSTRACTObjectivesThis article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible.Material and MethodsA comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN) repositioning, with minimum 6 months of follow-up, were included.ResultsA total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378]) for 1 to 6 months. In total, 0.53% (2/378) of procedures the disturbances were permanent.ConclusionsInferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.

Vertical splitting of the mandibular body as an alternative to inferior alveolar nerve lateralization

The aim of this study was to present and evaluate a modified technique to inferior alveolar nerve lateralization (IANL) that allows the placement of longer implants in the posterior mandibular region. One hundred and forty-three consecutive patients were enrolled in this study; these patients had between 1.8 and 8mm residual crestal height above the mandibular canal. Vertical splitting of the mandibular body was performed using piezoelectric surgery followed by bone expansion and insertion of special conical implants of 10 and/or 12mm in length. Two hundred and sixty-nine osteotomies were performed and 636 implants were inserted, with a survival rate of 99% at the end of 12 months. Immediately postoperative there was an alteration of sensation in the lip/chin area in 8.5% of cases; 4.1% regained full sensation within 10–14 days, 2.6% after 8 weeks, and 0.7% had persistent paresthesia that did not affect their daily activities. Progressively increasing pain and numbness was present in 1.1%; the implants were removed 6 months postoperatively. This is a relatively simple procedure that has no limitations in clinical situations with minimal bone height. It allows for greater implant stability, and the risk of neurological disturbance is minimal.