Immediate implant loading in conjunction with CBCT guided implant placement, alongside the inferior alveolar nerve as an alternative to nerve transposition. In cases with extreme mandibular atrophy, Inferior Alveolar Nerve (IAN) transposition may be the only option to treat a posterior edentulous mandible with an implant-supported fixed prosthesis. When the available bone above the nerve is less than 5mm, short implants for example, can’t be an option (3). An additional scenario is when the nerve is located at a central location inside the bone, prohibiting placement of implants buccally or lingually to the nerve using a CT guide.
This technique offers several advantages including reduced treatment time, and eliminating the need for bone grafting with immediate insertion of dental implants at the same surgery, bicortical implants anchorage, and favorable corono-radicular relationship. However the conflicting results from studies that have determined the incidence of IAN dysesthesia with this procedure have created debate as to its appropriate use.
According to the IAN location bucco-lingually, several modifications have been reporting attempts not to disturb the nerve, including bone expansion combined with immediate loading of one-piece implants, vertical splitting of the mandibular body, and the repositioning of the buccal cortex laterally by greenstick fractures with simultaneous implants placement. Additional option in use by the author ( Fares Kablan), includes vertical osteotomy of the buccal cortex to enhance visualization of the IAN, placing the dental implants buccally and repositioning of the buccal cortex and fixation. In recent years, the timing implant loading has been challenging, and numerous practitioners now advocate immediate loading of the implants. Immediate loading requires shorter periods and allows immediate recovery of function and esthetics with reports of high success rates. The availability of virtual reality technologies, and the advent of radiographic and CBCT Guided Surgery help the practitioners to insert dental implants alongside the IAN even at the borderline bone dimensions. The technology may reduce the indication for IAN transposition surgery in atrophic mandibles, saving the integrity of the mandibular body, reducing nerve disturbance, enabling placiement of longer dental implants, and enhancing the immediate loading procedure of the dental implants.