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 placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar. This procedure is a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which disappears only very slowly, if ever). Usually other, less aggressive options, such as bone grafting, are considered first.

Typically we remove an outer section of the cheek side of the lower jawbone in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area, and slightly pull it out to the side. As the implants are place, we keep the bundle out to the side and protected. Then the bundle is released and placed back over the implants. The surgical access area is refilled with bone graft material of the surgeon’s choice and the area is sutured closed.

These procedures may be performed separately or together depending upon the individual’s condition. As stated earlier, 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 outer aspect of the tibia at the knee or the hip. When we use the patient’s own bone for repairs or addition, we generally get the best results.

In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to get the patient’s own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.

These surgeries are performed in the surgical center or hospital under general or IV sedation anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.