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Allavéna J, Nicot R, Majoufre C, Schlund M. Inferior alveolar nerve repositioning surgical techniques and outcomes - a systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101631. [PMID: 37689139 DOI: 10.1016/j.jormas.2023.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023]
Abstract
Inferior alveolar nerve (IAN) lateralization (IANL) or transposition (IANT) are both techniques allowing for dental implant placement in posterior atrophic mandibles. The aim of this study was to systematically review the implant survival rate and the complications associated with IAN reposition techniques with simultaneous implant placement in atrophic posterior mandibles. This systematic review was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic review and Meta-Analysis). The review was designed to answer the following PICO question: Is IAN repositioning (I) a safe and efficient technique (O) to treat patient looking for fixed dental rehabilitation of an atrophic posterior mandible (P). Thirty-three articles were reviewed, including a total of 899 patients, and approximately 950 IAN repositioning procedures. Dental implant survival rate ranged between 86.95% and 100% with a mean dental survival rate of 90.16%. Among the 269 patients who underwent IANT, there were 93% immediate neurosensory disturbance, and 15% persistent neurosensory disturbance. Among the 350 patients who underwent IANL, there were 93% immediate neurosensory disturbance, and 6% persistent neurosensory disturbance. IANT and IANL are reliable techniques allowing safe dental implant placement in atrophic posterior mandible with high patient satisfaction. IANL seems to cause less persistent neurosensory disturbances compared to IANT. The level of evidence is poor due to the high number of bias present in the included studies. IAN neurosensory disturbance assessment should be better homogenized in order to increase comparability.
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Affiliation(s)
- Julie Allavéna
- Univ. Bordeaux, CHU Bordeaux, Service de Chirurgie Maxillo-Faciale et Stomatologie, Bordeaux 33000, France.
| | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Advanced Drug Delivery Systems, Lille 59000, France
| | - Claire Majoufre
- Univ. Bordeaux, CHU Bordeaux, Service de Chirurgie Maxillo-Faciale et Stomatologie, Bordeaux 33000, France
| | - Matthias Schlund
- Univ. Bordeaux, CHU Bordeaux, Service de Chirurgie Maxillo-Faciale et Stomatologie, Bordeaux 33000, France; Univ. Bordeaux, CHU Bordeaux, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1026 - Bioengineering of Tissues, Bordeaux 33000, France
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Tomazi MA, da Silveira Gerzson A, Neto AM, da Costa ALP. In-Block Lateralization as a New Technique for Mobilization of the Inferior Alveolar Nerve: A Technique Case Series. J ORAL IMPLANTOL 2021; 47:333-341. [PMID: 32838423 DOI: 10.1563/aaid-joi-d-20-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The edentulous atrophic posterior mandible is often a great challenge for implant rehabilitation. Although a number of treatment options have been proposed, including the use of short implants and surgical grafting techniques, in cases of severe bone atrophy, techniques for mobilization of the inferior alveolar nerve (IAN) have been shown to be efficient, with good results. Four female patients underwent IAN lateralization for prosthetic rehabilitation of the posterior mandible from 2013 to 2019, with 3 years to 5 years and 3 months of follow-up. This case series describes a new technique for mobilization of the IAN, named in-block lateralization, to facilitate access to the IAN and to reduce nerve manipulation. The implant is immediately installed (allowing nerve lateralization in unitary spaces), and the original mandibular anatomy is restored with autogenous bone from the original bed during the same surgical procedure. When well indicated and well performed, this new approach provides better and easier visualization of the IAN and safer manipulation aiming to achieve good results for implant stability and minimal risk of neurosensory disturbances, allowing rehabilitation even in unitary spaces.
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Affiliation(s)
- Marcos Augusto Tomazi
- Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alexandre da Silveira Gerzson
- Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; Implantology and Periodontology of the Dental Institute of the Americas, Porto Alegre, RS, Brazil
| | - Angelo Menuci Neto
- Postgraduate Program in Periodontology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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The Impact of Dental Implant Length on Failure Rates: A Systematic Review and Meta-Analysis. MATERIALS 2021; 14:ma14143972. [PMID: 34300891 PMCID: PMC8307721 DOI: 10.3390/ma14143972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.
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Deryabin G, Grybauskas S. Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances. Int J Implant Dent 2021; 7:44. [PMID: 34105021 PMCID: PMC8187674 DOI: 10.1186/s40729-021-00334-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to analyze medium-to-long-term implant success and survival rates, and lower lip sensory disturbance after placement of dental implants with simultaneous inferior alveolar nerve (IAN) repositioning. Methods Fifteen patients (3 men, 12 women) treated in two centers were included in this retrospective study. The ages of the participants ranged from 19 to 68. A total of 48 dental implants were placed in 23 posterior mandibular segments simultaneously with IAN transposition or lateralization. The residual bone above the IAN ranged from 0.5 to 7.0 mm. Crestal bone changes were measured using cone beam computed tomography (CBCT) images. Disturbance of the IAN was evaluated subjectively using a modified questionnaire. Results The healing process was uneventful in fourteen patients. In one patient, spontaneous fracture of the operated mandible occurred on tenth day after the surgery. The implant in the fracture line was removed at the time of open reduction and fixation. One more implant was lost after 5 years of loading. Therefore, the overall dental implant survival rate was 95.8%, whereas all implants in function were judged as successful after a follow-up period of 1 to 10 years. Transient neurosensory disturbances (ND) were observed in all patients who underwent IAN lateralization and IAN transposition. At follow-up times of 3 years, 5 years, and 10 years, weak hypoesthesia remained in two subjects treated with IAN transposition. None of the patients developed neuropathic pain after the procedure. Conclusions Within the limitations of this study, we conclude that reconstruction of severely resorbed mandibles with dental implants in conjunction with IAN repositioning is an effective and reliable technique. Although neurosensory disturbances are the most common complication after surgery, they tend to resolve over time. Advanced surgical skills are required to perform this technique.
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Abstract
The purpose of this article is not to discuss the success of short dental implants versus standard/long dental implants, but to compare short dental implants with standard/long dental implants in areas that necessitated adjunctive bone grafting or augmentation procedures and as a way to avoid the need for advanced surgical procedures and their associated risks. It can be concluded that short dental implants are a viable alternative in sites that would have required additional complex and costly augmentation procedures. Short dental implants resulted in comparable survival and success rates with faster, less expensive treatment with fewer surgical complications and morbidity.
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Affiliation(s)
- Steven R Schwartz
- Private Practice: NY Oral & Maxillofacial Surgeon, PC, 2844 Ocean Parkway, Brooklyn, NY 11235, USA; Department of Oral & Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway 2c320, Brooklyn, NY 11206, USA.
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Palacio García-Ochoa A, Pérez-González F, Negrillo Moreno A, Sánchez-Labrador L, Cortés-Bretón Brinkmann J, Martínez-González JM, López-Quiles Martínez J. Complications associated with inferior alveolar nerve reposition technique for simultaneous implant-based rehabilitation of atrophic mandibles. A systematic literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:390-396. [PMID: 31904530 DOI: 10.1016/j.jormas.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgical inferior alveolar nerve (IAN) reposition techniques offer an alternative approach to implant-based rehabilitation in patients with severe mandibular atrophy The aim of this systematic review, was to determine the complications associated with the technique and to determine which of two variants (lateralization or transposition) is less invasive. MATERIALS AND METHODS An electronic search was conducted in databases complimented by a manual search to identify clinical studies investigating complications derived from these surgical techniques. Only studies of adult humans, published in English during the last seven years were included. The initial search located 78 articles, of which seven were included in analysis on the basis of the following characteristics: four investigated inferior alveolar nerve lateralization (IANL), one inferior alveolar nerve transposition (IANT), and two investigated both reposition techniques. RESULTS This review included data from 289 patients who were recruited for lateralization (N=319) or transposition surgery (N=33) making a total of 352 reposition procedures. Five patients (1.73%) suffered persistent damage to the IAN at the end of the follow-up periods. The overall implant survival rate was 99.26% of a total of 817 implants. The most common complications were neurosensory problems, mandibular fracture, infection, implant loss, and insufficient anatomical reconstruction of the atrophic mandible; neurosensory complications (hypoesthesia, paraesthesia, and hyperesthesia caused by traumatic damage to the nerve) were the most prevalent. CONCLUSIONS Lateralization of the inferior alveolar nerve would appear to be less invasive as it produces lower percentages of persistent neurosensory disorders (1.56%) than transposition (12.12%). Nevertheless, both techniques offer a viable approach to implant placement in edentulous atrophic mandibles, obtaining predictable clinical and radiological results after 5 years implant loading.
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Affiliation(s)
- A Palacio García-Ochoa
- Department of dental Clinical Specialties Faculty of dentistry, Complutense University of Madrid, Madrid, Spain
| | - F Pérez-González
- Department of dental Clinical Specialties Faculty of dentistry, Complutense University of Madrid, Madrid, Spain
| | - A Negrillo Moreno
- Department of dental Clinical Specialties Faculty of dentistry, Complutense University of Madrid, Madrid, Spain
| | - L Sánchez-Labrador
- Department of dental Clinical Specialties Faculty of dentistry, Complutense University of Madrid, Madrid, Spain
| | - J Cortés-Bretón Brinkmann
- Department of dental Clinical Specialties Faculty of dentistry, Complutense University of Madrid, Madrid, Spain.
| | - J M Martínez-González
- Department of dental Clinical Specialties Faculty of dentistry, Complutense University of Madrid, Madrid, Spain
| | - J López-Quiles Martínez
- Department of dental Clinical Specialties Faculty of dentistry, Complutense University of Madrid, Madrid, Spain
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Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS. Anatomical study: the potential movability of the inferior alveolar nerve. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:353-356. [PMID: 31227458 DOI: 10.1016/j.oooo.2019.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Nerve repair and repositioning are procedures for treating and avoiding injury to the inferior alveolar nerve during oral and maxillofacial surgery. The present study aimed to examine how the mobility of the inferior alveolar neurovascular bundle (IAB) changes with or without removing the bone around the mental foramen (MF). STUDY DESIGN Six fresh-frozen cadavers (11 sides) were dissected in this study. Osteotomy in the buccal cortical bone was performed from 5 mm posterior to the MF to the distal edge of the second molar with a high-speed drill and osteotome. Next, the distance from the lateral surface of the buccal cortical bone to the retracted IAB was measured with and without removing the bone around the MF. RESULTS The distance from the lateral surface of the buccal cortical bone to the retracted IAB without removing the bone around the MF was 0 mm on all sides. After removing the bone, the mean distance changed by 4.71 ± 1.41 mm (range 2.83-7.90). There was no statistically significant difference between the right and left sides. CONCLUSIONS The results of this study support removing the bone around the MF for increased mobility of the IAB.
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Affiliation(s)
- Shogo Kikuta
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Seattle Science Foundation, Seattle, WA, USA
| | - Joe Iwanaga
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Seattle Science Foundation, Seattle, WA, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Hamada M, Shimizu H, Takasu A, Nishiyama K, Yura Y. Piezosurgery for Intraosseous Venous Malformation of the Mandible. Ann Maxillofac Surg 2019; 8:333-336. [PMID: 30693258 PMCID: PMC6327793 DOI: 10.4103/ams.ams_189_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intraosseous venous malformation of the mandible is rare. A 59-year-old woman was referred to our hospital for evaluation of a radiolucent lesion in the left body of the mandible that had been detected on a routine radiologic dental checkup. The patient wished for follow-up rather than operation. After 2 years’ follow-up, the radiolucent lesion had slowly grown, and the patient decided to have an operation. The lesion was removed surgically using the piezosurgery system, and conservation of the inferior alveolar nerve was achieved under general anesthesia. After operation, she reported an initial change in sensation (paresthesia). The sensitivity was recovered after 6 months. Patient prognosis has been good to date, with no symptoms indicating recurrence. We used to treat intraosseous venous malformations using the piezosurgery system. The present report describes a patient with intraosseous venous malformation of the mandible by complete excision and conservation of the nerve. It was useful to use piezosurgery for conservation of inferior alveolar nerve.
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Affiliation(s)
- Masakazu Hamada
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Hidetaka Shimizu
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Ayako Takasu
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Kyoko Nishiyama
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Yoshiaki Yura
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Piezoelectric Surgery in the Inferior Alveolar Nerve Lateralization With Simultaneous Implant Placement: A Case Report. IMPLANT DENT 2019; 28:86-90. [PMID: 30624393 DOI: 10.1097/id.0000000000000855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this case report was to describe the inferior alveolar nerve (IAN) lateralization technique using the piezoelectric device for the posterior rehabilitation of an atrophic mandible with implants. The patient presented the absence of elements 35 and 36 associated with a vertical defect impairing the adequate dental implant placement without IAN damage. A full-thickness mucoperiosteal flap was raised, and a bone window was made with a piezoelectric device centralized on the IAN canal position. After dissection, the IAN was moved buccally with a sterile elastic strip. Morse cone 4.0 × 1.5-mm implants were inserted while the IAN remained retracted. At the 4-month follow-up, the screw-retained prosthesis was installed guaranteeing the recovering masticatory function. In conclusion, the case report showed that the IAN lateralization performed with an adequate surgical technique can be successfully indicated for longer implant placement in edentulous atrophic posterior mandible with no permanent neural damage.
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Inferior Alveolar Nerve Mobilization Using Ultrasonic Surgery With Crestal Approach Technique, Followed by Immediate Implant Insertion: Evaluation of Neurosensory Disturbance. J Craniofac Surg 2017; 27:1209-11. [PMID: 27380570 DOI: 10.1097/scs.0000000000002755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Many techniques are described for atrophied mandibles rehabilitation. This article reports on 12 clinical patients of severely atrophied posterior mandibles. In all the patients, a cone beam is performed before the crestal surgical approach to inferior alveolar nerve (IAN) mobilization. For the realization of this technique the piezosurgery device was used to minimize IAN injuries. With the help of this device the selective cutting of the bone has been possible until IAN exposure, in the implant placement site. At the same time, the authors performed the implant osteotomy and implant placement. After 4 months of healing, all implants were osseointegrated and the implant-supported bridges were done.Evaluation by means of neurosurgery function test over a 36-months period found that all patients had a return to normal sensation, after a brief period of neurosensory disturbance.
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Guillaume B. Filling bone defects with β-TCP in maxillofacial surgery: A review. Morphologie 2017; 101:113-119. [PMID: 28571762 DOI: 10.1016/j.morpho.2017.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 11/18/2022]
Abstract
Reconstruction of bone defects prior to implant placement now involves synthetic substitutes such as β-TCP because of its ability to promote bone remodeling. Its capacity to be progressively substituted by the patient's bone allows to regenerate a dense bone volume. In addition, its availability in large quantities, avoiding the morbidity observed with harvesting autogenous bone, widens the operative indications. In this paper, the main indications of β-TCP in maxillofacial surgery (dentistry, parodontology and dental implant surgery) are reviewed. They include periodontal bone disease, bone disjunction, pre-implant surgery (sinus floor elevation and lateralization of the inferior alveolar nerve).
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Affiliation(s)
- B Guillaume
- Collège Français d'Implantologie (CFI), 6, rue de Rome, 75005 Paris, France; Groupe Études Remodelage Osseux et bioMatériaux (GEROM), Institut de Biologie en Santé (IRIS-IBS), LUNAM Université, CHU d'Angers, 49933 Angers cedex, France.
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Domingues EP, Ribeiro RF, Horta MCR, Manzi FR, Côsso MG, Zenóbio EG. Vertical augmentation of the posterior atrophic mandible by interpositional grafts in a split-mouth design: a human tomography evaluation pilot study. Clin Oral Implants Res 2016; 28:e193-e200. [PMID: 27704640 DOI: 10.1111/clr.12985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Using computed tomography, to compare vertical and volumetric bone augmentation after interposition grafting with bovine bone mineral matrix (GEISTLICH BIO-OSS® ) or hydroxyapatite/tricalcium phosphate (STRAUMANN® BONECERAMIC) for atrophic posterior mandible reconstruction through segmental osteotomy. MATERIAL AND METHODS Seven patients received interposition grafts in the posterior mandible for implant rehabilitation. The computed tomography cone beam images were analysed with OsiriX Imaging Software 6.5 (Pixmeo Geneva, Switzerland) in the pre-surgical period (T0), at 15 days post-surgery (T1) and at 180 days post-surgery (T2). The tomographic analysis was performed by a single trained and calibrated radiologist. Descriptive statistics and nonparametric methods were used to analyse the data. RESULTS There was a significant difference in vertical and volume augmentation with both biomaterials using the technique (P < 0.05). There were no significant differences (P > 0.05) in volume change of the graft, bone volume augmentation, or augmentation of the maximum linear vertical distance between the two analysed biomaterials. CONCLUSIONS The GEISTLICH BIO-OSS® and STRAUMANN® BONECERAMIC interposition grafts exhibited similar and sufficient dimensional stability and volume gain for short implants in the atrophic posterior mandible.
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Affiliation(s)
- Eduardo Pinheiro Domingues
- Dentistry Department, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael Fernandes Ribeiro
- Dentistry Department, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Flávio Ricardo Manzi
- Dentistry Department, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maurício Greco Côsso
- Dentistry Department, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Elton Gonçalves Zenóbio
- Dentistry Department, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Lateralization Technique and Inferior Alveolar Nerve Transposition. Case Rep Dent 2016; 2016:4802637. [PMID: 27433360 PMCID: PMC4940526 DOI: 10.1155/2016/4802637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/16/2016] [Indexed: 11/18/2022] Open
Abstract
Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics.
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de Vicente J, Peña I, Braña P, Hernández-Vallejo G. The use of piezoelectric surgery to lateralize the inferior alveolar nerve with simultaneous implant placement and immediate buccal cortical bone repositioning: a prospective clinical study. Int J Oral Maxillofac Surg 2016; 45:851-7. [DOI: 10.1016/j.ijom.2016.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/20/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
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Nishimaki F, Kurita H, Tozawa S, Teramoto Y, Nishizawa R, Yamada SI. Subjective and qualitative assessment of neural disturbance after inferior alveolar nerve transposition for dental implant placement. Int J Implant Dent 2016; 2:14. [PMID: 27747706 PMCID: PMC5005664 DOI: 10.1186/s40729-016-0047-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this retrospective study was to accumulate data regarding the quality of postoperative neurosensory function after inferior alveolar nerve (IAN) transposition for dental implant placement. METHODS The study included seven consecutive patients who underwent IAN transposition surgery for the insertion of a dental implant into the atrophic posterior mandible. Of these, six patients (seven sides) were available for long-term assessment of postoperative IAN function. Neurosensory disturbance of the IAN was assessed objectively using the modified SW perception test reported by Semmes and Weinstein. In addition, the quality of nerve paralysis was assessed according to the criteria reported by Highet. RESULTS The median follow-up time was 49 months (range 12-105 months). No implant loss was observed during the follow-up. All patients experienced numbness immediately and the days after surgery. Complete recovery of neural function was observed on two sides; weak hypoesthesia was observed on two sides, moderate hypoesthesia on two sides, and severe hypoesthesia on one side. However, only one patient expressed concern about IAN function. CONCLUSIONS IAN transposition is a useful method for placing implants in the atrophic posterior mandible. However, the procedure is complicated, with the possibility of some degree of neurosensory disturbance, although in most of our cases, it resolved within a clinically acceptable period.
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Affiliation(s)
- Fumihiro Nishimaki
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-3-1, Asahi, Matsumoto-shi, Nagano, 390-0804, Japan.
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-3-1, Asahi, Matsumoto-shi, Nagano, 390-0804, Japan
| | - Shinya Tozawa
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-3-1, Asahi, Matsumoto-shi, Nagano, 390-0804, Japan
| | - Yuji Teramoto
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-3-1, Asahi, Matsumoto-shi, Nagano, 390-0804, Japan
| | - Rishiho Nishizawa
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-3-1, Asahi, Matsumoto-shi, Nagano, 390-0804, Japan
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-3-1, Asahi, Matsumoto-shi, Nagano, 390-0804, Japan
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Martínez-Rodríguez N, Barona-Dorado C, Cortés-Breton Brinkmann J, Martín Ares M, Calvo-Guirado JL, Martínez-González JM. Clinical and radiographic evaluation of implants placed by means of inferior alveolar nerve lateralization: a 5-year follow-up study. Clin Oral Implants Res 2016; 29:779-784. [DOI: 10.1111/clr.12857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Natalia Martínez-Rodríguez
- Department of Medicine and Buccofacial Surgery; Faculty of Dentistry; The Complutense University of Madrid; Madrid Spain
| | - Cristina Barona-Dorado
- Department of Medicine and Buccofacial Surgery; Faculty of Dentistry; The Complutense University of Madrid; Madrid Spain
| | - Jorge Cortés-Breton Brinkmann
- Department of Medicine and Buccofacial Surgery; Faculty of Dentistry; The Complutense University of Madrid; Madrid Spain
| | - María Martín Ares
- Department of Medicine and Buccofacial Surgery; Faculty of Dentistry; The Complutense University of Madrid; Madrid Spain
| | - José Luis Calvo-Guirado
- International Dentistry Research Cathedra; Universidad Católica San Antonio de Murcia (UCAM); Murcia Spain
| | - José María Martínez-González
- Department of Medicine and Buccofacial Surgery; Faculty of Dentistry; The Complutense University of Madrid; Madrid Spain
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Hassani A, Saadat S, Moshiri R, Shahmirzad S, Hassani A. Nerve Retraction During Inferior Alveolar Nerve Repositioning Procedure: A New Simple Method and Review of the Literature. J ORAL IMPLANTOL 2015; 41 Spec No:391-4. [DOI: 10.1563/aaid-joi-d-13-00108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nerve repositioning surgery is one of the treatments chosen for the patients with edentulous posterior atrophic mandible. Like any other treatments, this therapy has its advantages and disadvantages, indications and contraindications. The most important complication of this procedure is neurosensory disturbance. This problem may occur at different stages of the treatment. One common time when nerve damage happens is when the nerve is located outside the canal and drilling and insertion of the implant are performed. Accordingly, this report describes a simple and feasible method to retract and protect nerves outside the canal during the treatment of nerve transposition. This will reduce the risk of nerve damage.
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Affiliation(s)
- Ali Hassani
- Department of Oral and Maxillofacial Surgery, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Sarang Saadat
- Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Amin Hassani
- Sharif University of Technology, School of Mechanical Engineering, Tehran, Iran
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Khojasteh A, Hassani A, Motamedian SR, Saadat S, Alikhasi M. Cortical Bone Augmentation Versus Nerve Lateralization for Treatment of Atrophic Posterior Mandible: A Retrospective Study and Review of Literature. Clin Implant Dent Relat Res 2015; 18:342-59. [PMID: 26082191 DOI: 10.1111/cid.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We sought to assess implant success/survival/failure rate following cortical autogenous tenting technique (CATT) versus inferior alveolar nerve transposition (IANT) in the posterior mandible. MATERIALS AND METHODS Patients who underwent these two procedures between 2007 and 2011 were analyzed. CATT was performed using lateral ramus block graft and implants were inserted simultaneously or after 4 to 6 months. In IANT, implants were placed simultaneously after nerve transposition with or without mental foramen involvement. Data regarding marginal bone level (MBL), pus discharge (PD), neurosensory dysfunction (NSD), implant mobility, and failure were collected. Success rate was measured based on Pisa Consensus. Independent sample t-test with a significance level of 0.05 was used to compare implant dimensions and MBL changes between the two techniques. RESULTS A total of 118 patients with a mean age of 54.85 years were included. The mean follow-up after CATT and IANT was 37.97 and 18.51 months, respectively. The overall survival and success rates of dental implants in the CATT group were 98.73% and 71.52%, respectively. The corresponding values for IANT subjects were 98.74% and 94.56%, respectively. Implant length and diameter in IANT group were significantly longer and wider than implants used after CATT (p value < .001). MBL changes in both techniques were less than 1 mm (p value = .79). Two cases of NSD, seven PD, and two implant failures were found in the CATT group. For IANT patients, seven permanent NSD, two PD, two implant failures, and one mandibular fracture were documented. CONCLUSION Both techniques had implant survival rates similar to implants placed in unaltered bone. A higher implant success rate, albeit with higher incidence of long-lasting nerve damage, was observed in the IANT group.
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Affiliation(s)
- Arash Khojasteh
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Dental Research Center, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hassani
- Department of Oral and Maxillofacial Surgery, Azad University of Medical Sciences Dental Branch, Tehran, Iran
| | - Saeed Reza Motamedian
- Dental Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Marzieh Alikhasi
- Department of Prosthodontics and Dental Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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19
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Abayev B, Juodzbalys G. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2015; 6:e3. [PMID: 25937874 PMCID: PMC4414234 DOI: 10.5037/jomr.2014.6103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/21/2015] [Indexed: 11/27/2022]
Abstract
Objectives This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible. Material and Methods A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN) repositioning, with minimum 6 months of follow-up, were included. Results A total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378]) for 1 to 6 months. In total, 0.53% (2/378) of procedures the disturbances were permanent. Conclusions Inferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.
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Affiliation(s)
- Boris Abayev
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
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20
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Abayev B, Juodzbalys G. Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: a systematic review of surgical techniques. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2015; 6:e2. [PMID: 25937873 PMCID: PMC4414233 DOI: 10.5037/jomr.2014.6102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/27/2015] [Indexed: 11/25/2022]
Abstract
Objectives The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. Results A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.
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Affiliation(s)
- Boris Abayev
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
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21
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Vetromilla B, Moura L, Sonego C, Torriani M, Chagas O. Complications associated with inferior alveolar nerve repositioning for dental implant placement: a systematic review. Int J Oral Maxillofac Surg 2014; 43:1360-6. [DOI: 10.1016/j.ijom.2014.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/31/2022]
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Chrcanovic BR, Albrektsson T, Wennerberg A. Tilted versus axially placed dental implants: a meta-analysis. J Dent 2014; 43:149-70. [PMID: 25239770 DOI: 10.1016/j.jdent.2014.09.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The purpose of the present review was to test the null hypothesis of no difference in the implant failure rate, marginal bone loss, and postoperative infection for patients being rehabilitated by tilted or by axially placed dental implants, against the alternative hypothesis of a difference. METHODS An electronic search without time or language restrictions was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational. The estimates of an intervention were expressed in risk ratio (RR) and mean difference (MD) in millimetres. RESULTS The search strategy resulted in 44 publications. A total of 5029 dental implants were tilted (82 failures; 1.63%), and 5732 implants were axially placed (104 failures; 1.81%). The difference between the procedures did not significantly affect the implant failure rates (P=0.40), with a RR of 1.14 (95% CI 0.84-1.56). A statistically significant difference was found for implant failures when studies evaluating implants inserted in maxillae only were pooled (RR 1.70, 95% CI 1.05-2.74; P=0.03), the same not happening for the mandible (RR 0.77, 95% CI 0.39-1.52; P=0.45). There were no apparent significant effects of tilted dental implants on the occurrence of marginal bone loss (MD 0.03, 95% CI -0.03 to 0.08; P=0.32). Due to lack of satisfactory information, meta-analysis for the outcome 'postoperative infection' was not performed. CONCLUSIONS It is suggested that the differences in angulation of dental implants might not affect the implant survival or the marginal bone loss. The reliability and validity of the data collected and the potential for biases and confounding factors are some of the shortcomings of the present study. CLINICAL SIGNIFICANCE The question whether tilted implants are more at risk for failure than axially placed implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.
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Affiliation(s)
| | - Tomas Albrektsson
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Biomaterials, Göteborg University, Göteborg, Sweden
| | - Ann Wennerberg
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Long term follow-up in inferior alveolar nerve transposition: our experience. BIOMED RESEARCH INTERNATIONAL 2014; 2014:170602. [PMID: 24949422 PMCID: PMC4052621 DOI: 10.1155/2014/170602] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/07/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022]
Abstract
Introduction. Inferior alveolar nerve transposition (IANT) is a surgical technique used in implantoprosthetic rehabilitation of the atrophic lower jaw which has not been well embraced because of the high risk of damage to the inferior alveolar nerve (IAN). There are cases in which this method is essential to obtain good morphologic and functional rebalancing of the jaw. In this paper, the authors present their experience with IANT, analyzing the various situations in which IANT is the only surgical preprosthetic option. Methods. Between 2003 and 2011, 35 patients underwent surgical IANT at our center. Thermal and physical sensitivity were evaluated in each patient during follow-up. The follow-up ranged from 14 to 101 months.
Results and Conclusion. Based on our experience, absolute indications of IANT are as follows: (1) class IV, V, or VI of Cawood and Howell with extrusion of the antagonist tooth and reduced prosthetic free space; (2) class V or VI of Cawood and Howell with presence of interforaminal teeth; (3) class V or VI of Cawood and Howell if patient desires fast implantoprosthetic rehabilitation with predictable outcomes; (4) class VI of Cawood and Howell when mandibular height increase with inlay grafts is advisable.
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Amet EM, Uehlein C. Alveolar nerve repositioning with rescue implants for management of previous treatment. A clinical report. J Prosthodont 2013; 22:633-40. [PMID: 23924033 DOI: 10.1111/jopr.12068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 11/30/2022] Open
Abstract
The goal of modern implant dentistry is to return patients to oral health in a rapid and predictable fashion, following a diagnostically driven treatment plan. If only a limited number of implants can be placed, or some fail and the prosthetic phase of implant dentistry is chosen to complete the patient's treatment, the final outcome may result in partial patient satisfaction and is commonly referred to as a "compromise." Previous All-on-4 implant treatment for the patient presented here resulted in a compromise, with an inadequate support system for the mandibular prosthesis and a maxillary complete denture with poor esthetics. The patient was unable to function adequately and also was disappointed with the resulting appearance. Correction of the compromised treatment consisted of bilateral inferior alveolar nerve elevation and repositioning without bone removal for lateral transposition, to gain room for rescue implants for a totally implant-supported and stabilized prosthesis. Treatment time to return the patient to satisfactory comfort, function, facial esthetics, and speech was approximately 2 weeks. The definitive mandibular prosthesis was designed for total implant support and stability with patient retrievability. Adequate space between the mandibular bar system and the soft tissue created a high water bridge effect for self-cleansing. Following a short interim mandibular healing period, the maxillary sinuses were bilaterally grafted to compensate for bone inadequacies and deficiencies for future maxillary implant reconstruction.
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Affiliation(s)
- Edward M Amet
- Director, Reconstructive & Implant Dental Center, Overland Park, KS
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25
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Lorean A, Kablan F, Mazor Z, Mijiritsky E, Russe P, Barbu H, Levin L. Inferior alveolar nerve transposition and reposition for dental implant placement in edentulous or partially edentulous mandibles: a multicenter retrospective study. Int J Oral Maxillofac Surg 2013; 42:656-9. [DOI: 10.1016/j.ijom.2013.01.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 01/09/2013] [Accepted: 01/31/2013] [Indexed: 11/30/2022]
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Mangano FG, Shibli JA, Sammons RL, Iaculli F, Piattelli A, Mangano C. Short (8-mm) locking-taper implants supporting single crowns in posterior region: a prospective clinical study with 1-to 10-years of follow-up. Clin Oral Implants Res 2013; 25:933-40. [DOI: 10.1111/clr.12181] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jamil Awad Shibli
- Oral Implantology Clinic; Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos Sao Paulo Brazil
| | | | - Flavia Iaculli
- Dental School; University of Chieti-Pescara; Chieti Italy
| | - Adriano Piattelli
- Department of Medical; Oral and Biotechnological Sciences; Dental School; University of Chieti-Pescara; Chieti Italy
| | - Carlo Mangano
- Oral Surgery Unit; Department of Surgical and Morphological Science; Dental School; University of Insubria; Varese Italy
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Taschieri S, Corbella S, Molinari R, Saita M, Del Fabbro M. Short implants in maxillary and mandibular rehabilitations: interim results (6 to 42 months) of a prospective study. J ORAL IMPLANTOL 2013; 41:50-5. [PMID: 23413769 DOI: 10.1563/aaid-joi-d-12-00206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this single-cohort study was to evaluate clinical survival and success of partial rehabilitation supported by reduced-length implants in maxilla and mandible. Data from 53 short implants placed in 41 patients are presented. Before surgery mean residual bone height was 6.21 ± 1.05 mm in the upper jaw and 10.73 ± 1.63 mm in the mandible. None of the implants failed, and the cumulative survival rate was 100% at 1 year after prosthetic loading. Mean peri-implant bone loss was 0.69 ± 0.24 mm for maxillary implants and 0.73 ± 0.23 mm for mandibular implants, and there was no significant difference between the 2 jaws. No complications were recorded. Despite the limitations of this study concerning study design and sample size, short implants may be considered effective in supporting partial rehabilitation in both maxilla and mandible. More well-designed studies with a larger sample size and longer follow-up are needed to validate the use of short implants.
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Affiliation(s)
- Silvio Taschieri
- 1 Università degli Studi di Milano, Department of Clinical Surgical and Dental Sciences, Research Centre in Oral Health, IRCCS Istituto Ortopedico Galeazzi, Dental Clinic, Milan, Italy
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