Nerve Repositioning: Moving the Nerve in the Lower Jaw
Nerve repositioning or nerve lateralisation is used in cases when a patient needs to have a number of missing lower back teeth replaced, but the patient’s bone mass is not tall enough for dental implants to be placed successfully.
Nerve repositioning or nerve lateralization involves the repositioning of the inferior alveolar nerve, which is the nerve that supplies feeling to a patient’s chin and lower lip areas. The placement of dental implants in patients who have experienced significant bone loss in the lower jaw area may not be possible without damaging the inferior alveolar nerve – which is why the movement or repositioning of this nerve is needed. This technique allows the whole height of the lower jaw to be made available for the placement of longer dental implants.
Nerve repositioning is a dental procedure used in cases when the patient has missing teeth in the back end of his lower jaw area, and requires a dental implant to be placed in this particular area. A nerve repositioning technique is needed when the patient does not have sufficient bone height in the lower jaw area to support the placement of a dental implant, or if the quality of the bone mass in the affected area is not strong enough to hold the dental implants firmly in place. The lower jaw houses the inferior alveolar nerve, which gives feeling to the lower lip and chin areas; this nerve needs to be moved or repositioned so that the dental implant can successfully be placed without the risk of harming the nerve.
A dental surgeon starts the nerve repositioning procedure by making an incision into the lower jaw bone, to get to the inferior alveolar nerve; the nerve is then repositioned carefully outwards. The dental surgeon may place the implant at this stage or at a later surgery. A surgical pad or collatape is placed between the inferior alveolar nerve and the dental implant to provide additional cushioning and support. The nerve canal is filled with particulate bone to add further cushioning and support. A healing period of three months follows – allowing the dental implant to integrate with the surrounding tissue – after which a dental crown or a dental bridge is attached to the dental implant.
This technique provides an alternative to the need for an onlay bone grafting technique. This is an advanced technique and does carry a risk of nerve damage which may leave a patient with an altered sensation or numbness of the lower lip on surgical side. This may be transient or permanent and patients should not undergo this technique without being prepared for this outcome.
Nerve Repositioning Procedure
1. The dentist or dental surgeon makes an incision on the patient’s gums and lower jaw bone.
2. The inferior alveolar nerve is very carefully repositioned sideways out of its canal. The surgical site may be left to heal or the implants placed immediately. the dental implant is carefully but securely screwed into place – into the lower jaw bone. The dental implant is provided with more support with the placement of irradiated bone around it.
3. Collatape or a surgical pad is placed between the inferior alveolar nerve and the dental implant, to provide additional support and cushioning for the nerve.
4. The nerve repositioning procedure is completed with the addition of more irradiated bone, to provide even more support for the dental implant. The implant (and the irradiated bone) will need two to three months of healing time, to ensure that proper integration with surrounding tissues has been completed.
5. After the healing period has passed, dental bridges or dental crowns can be fixed and attached over the dental implant.