Nerve Repositioning

When the molars and/or second premolars in the lower jaw are missing, the treatment that will most closely replicate natural teeth, is the placement of dental implants. A very consequential nerve runs through the back of the lower jaw, however, and in some patients, its location may interfere with the proper placement of implants. This major nerve, called the inferior alveolar nerve, gives sensation (feeling) to the lower lip and chin. In some circumstances, it may be prudent to reposition this nerve in order to make room for the proper placement of dental implants in the lower jaw. This procedure is considered to be fairly aggressive, as there is almost always some postoperative numbness of the lower lip and jaw area.  Although this may dissipate slowly and resolve, these effects may also be permanent. Generally, less aggressive options than a nerve repositioning procedure are considered first, such as placement of particularly shaped implants, such as blade implants.

The nerve repositioning procedure itself, involves accessing the back of the lower jaw bone to expose the inferior alveolar nerve and vessel canal. The nerve and vessel bundle are isolated in that area and very slightly relocated while the implants are properly placed. The neuro-vascular bundle is then released and placed back over the implants. The surgical access is subsequently filled with bone graft material of the surgeon’s choice, and the area is then sutured closed.

Depending upon the bone graft material and treatment chosen, these procedures may be performed within one surgery, or may involve two surgeries. This decision is determined by one’s health as well as a number of other factors. As is noted in the procedural description “About Bone Grafting”, there are several areas of the body that are suitable for obtaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth in the area of the chin or lower third molar region, or in the upper jaw behind the last molar. In more extensive situations, a greater quantity of bone may be harvested from the hip or the outer aspect of the tibia (below the knee). The best results are generally achieved when a patient’s own bone is used for repairs or additions.

As noted previously, allograft materials may also be considered when a bone grafting procedure is indicated prior to dental implant placement. This sterilized bone is prepared from cadavers, and it is also a safe and effective material that encourages a patient’s own bone to grow within the repair site. Synthetic materials can also be used to stimulate bone formation. Factors from one’s own blood may also be used to accelerate and promote bone formation in graft areas.

These surgeries are generally performed in-office in our surgical suite under intravenous sedation. Following discharge, bed rest is recommended for one day, as well as limited physical activity for one week. A longer period of recovery is indicated if one is undergoing a surgical procedure to harvest bone from a secondary site, in which case this surgery would be completed in hospital under general anesthesia.