Alveolar Nerve Lateralization + Horizontal Augmentation

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Posted on By Jose Luis Dominguez Mompell In Bone Grafting

Hi to all friends of the DentalXp Family!
Today we want to share a case where two apparently opposed techniques merge to try to achieve a better result! Bone Block and Alveolar nerve Lateralization.
Sometimes when the alveolar nerve is very high and the interioclusal space is correct, and alveolar nerve lateralization has to be considered. But, what if the remanent bone at that site is also very thin? An horizontal augmentation procedure has to be done. In this case we did the latelaralization and we used the lateral window made to access the nerve to perform the lateral augmentation. This window was splitted and one bone blade was used to restore the missing buccal wall (Khoury's technique or Split Bone Block Technique SBBT) and the other was repositioned in its original place to cover the nerve.

Any consideration is more than welcome, hope you find in interesting!!

Hope to meet some of you soon!!

Jose L. Mompell
Juan Lara Chao

IntraOral Photo
CBCT Scan

Bone window to access the nerve
After Window removal. Nerve in place


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8 Comments

Last two pictures of the Lateral augmentation using one of the thin bone blocks obtained after splitting the bone window.

Horizontal Augmentation
Filling the gap with autogenous bone chips


Reply

What a nice pic! What a superb treatment! Love the idea and the execution!
Just a question, why don´t add a third implant on the middle? Just in case the devil make his duty...
Regards
Jorge


Reply

Hi my friend! Hahaha! I didn't know the expression "In case the devil makes his duty"
We placed just to implants (Dentsply Xive 3.4mm) because If 3 were placed IMHO the space between them could have been compromised... I prefer bone to titanium!
See you soon!


Reply

Incredible work my friend. What is the percentage of post op parathesia, dysthesia etc. Can you explain when you decide on nerve lateralization vs.
nerve transposition vs. Vertical augmentation. Thanks Maurice


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What other methods would one consider here?


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Hi Maurice! Thanks for taking your time in commenting the post, We really appreciate it.
Sensitive alterations are always observed when performing these techniques. But, fortunately, all of them have been temporal paresthesias. After 1 week 70-80% recovery, being complete at 4 months when second stage surgery.
One important thing that we always do is to place bone in between implant and the new position of the nerve, avoiding implant-nerve contact.
When do we perform nerve lateralization or vertical augmentation?
What a good question! I usually go vertical when No short implants can be placed. And "interproximal" (Bone peaks) adjacent to the defect play a key roll. I rather a deep but short defect than a long but very flat one.
We indicate nerve lateralization when short implants can't be inserted and the prosthetic space is correct (Is not augmented) This usually happens when, due to anatomical reasons, we find an alveolar nerve with a very high location in the mandible. That is pretty much one of the very few reasons for us to indicate a nerve lateralization.

And last, lateralization or reposition? If patient was canine and lower incisors I rather do a lateralization and leave intact the incisive nerve. If you want to do a reposition, the incisive nerve has to be sectioned and this may cause some permanent sensibility alterations.

Once again thanks for always finding the time to share your thoughts with the dental XP family!

Hope to see you soon!

Jose L Mompell


Reply

Simply amazing! "Interesting" is no expression for this work.
Do you always perform soft tissue enhancement after grafting and implant placement or do you consider sometimes to improve the soft tissue before big hard tissue surgeries?
Thank you for sharing your excellent work!
Cheers
Snjezana


Reply

Hi Master! What a pity the World Cup!!
France won the cup, but Croacia won many of our hearts" Hehehe
Answering to your 2 questions;

1- YES! Soft tissue is a must! Not only in bone augmentation procedures but in more simple Implantology. I always say in our lectures that soft tissue is our "Implant Seat Belt"
If you have an accident but you are wearing your seat belt you may have problems but this problems would be much bigger if you have the same accident and you are not wearing them. So, soft tissue yes! And it should be like the seat belt... mandatory! Hehehe

2- Soft tissue before big augmentation procedures? Very good question. Yes, if the biotype is very thin is a very good option, but be careful if you are going to perform a tunnel approach (Like we do many times) and you try to have a better soft tissue before doing the augmentation, you may find that performing the tunnel is much more difficult due to the density of the soft tissue. So, if performing a tunnel approach We don't do soft tissue augmentation prior to the reconstruction unless the tissue is ver very thin.

See you soon!!

Jose L Mompell (Pepo)


Reply


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