Nerve Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for the placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and may be indicated when teeth are missing in the area of the two back molars and/or second premolars. This procedure is considered an aggressive approach since there is almost always some postoperative numbness of the lower lip and jaw area, which typically resolves over several months to a year, but rarely may be permanent. Usually other, less aggressive options are considered first, such as placement of short implants or bone grafting to increase the height of the posterior mandible. Generally, onlay bone grafts of this nature need to be from the patients own bone. There are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth. In more extensive situations a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee.

If the decision is made to reposition the nerve, Dr. Freimuth will remove a section of the cortical bone of the lower jaw bone in order to expose the nerve and vessel canal. He then will isolate the nerve and vessel bundle in that area and slightly move it laterally to allow space to place the implants while holding the neuro-vascular bundle. After the implants are placed, the nerve is released and placed back to it’s original position with gel foam between the nerve and the implants. The surgical access is bone grafted with the bone that was removed and the area is closed.

These surgeries are performed in the office surgical suite under IV sedation. After discharge, bed rest is recommended for one day, as well as limited physical activity for one week.