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, when it is desirable to place dental implants. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever). Usually other, less aggressive options are considered first. 

Typically when this procedure is performed, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve and vessel canal. Then the nerve and vessel bundle in that area is isolated and gently moved out to the side. At the same time, with the nerve bundle protected and under direct surgical vision, dental implants are placed. The surgical access opening in the jaw is refilled with the bone graft material of the surgeon’s choice, and the nerve bundle is released and allowed to lie alongside the implants within the newly grafted bone.

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 hip or the outer aspect of the tibia at the knee. 

In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is generally processed bone mineral granules or synthetic bone that is used to stimulate the patient’s own bone to grow into the repair site. It is quite effective and very safe. Factors from the patient’s own blood can even be prepared to accelerate and promote bone formation in graft areas.

These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, rest at home is recommended for the first day and only light physical activity for the first week.