Anterior Mandible Implants and Incisive Nerve

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Posted on By Ernest Agajanyan In Anterior/Esthetic

Thank you in advance for helping me with this anterior mandible implant placement case. Please review the images provided of the mandible. Upon evaluation of the mental nerve, specifically how it continues anteriorly and turns into incisive nerve as well as the location of the planned implant sites, one can observe that the mandibular incisive nerve/branch will in fact will be damaged by placement of the implants. I was wondering if someone could tell me if my patient is in danger of having implants placed in area 28 or give me some insights on what to expect besides what could occur with perforation of the lingual plate. I once read that neuropathic pain may occur after implant placement in the interforaminal region due to the perforation of the incisive canal and nerve. I was wondering if someone who performs All-on-4 or someone who has expertise could help me with this case as this is my first case of placing implants in the anterior mandible. I am planning to use a tooth supported surgical guide made by Anatomage. This case will involve placement two implants one in area 28 and the other in area 26. Then sometime after that patient will undergo implant placement in area #21 and 23 for all on 4 supported prosthesis. Implant will be utilized in area 28 would be 4.3x 11.5 Nobel CC replaced tapered and in area 26 would be 3.5x11.5.

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I have seen this before and it is not uncommon. I explain that some neurological alterations in proprioception may occur but it is rarely an issue.
From anatomical perspective; The inferior alveolar nerve is a branch of the mandibular nerve. After branching from the mandibular nerve, the inferior alveolar nerve travels behind the lateral pterygoid muscle. It gives off a branch, the mylohyoid nerve, and then enters the mandibular foramen.

While in the mandibular canal within the mandible, it supplies the lower teeth (molars and second premolar) with sensory branches that form into the inferior dental plexus and give off small gingival and dental nerves to the teeth.

Anteriorly, the nerve gives off the mental nerve at about the level of the mandibular 2nd premolars, which exits the mandible via the mental foramen and supplies sensory branches to the chin and lower lip.

The inferior alveolar nerve continues anteriorly as the mandibular incisive nerve to innervate the mandibular canines and incisors.


The Inferior Alveolar Nerve always extends to the mid line through the mandibular incisive canal, some call that portion of the nerve the Mandibular Incisive Nerve. This portion of the nerve enervates the Canine, Lateral and Central Incisors, it has nothing to do with the innervation of the lip or any other soft tissue. BUT, you must define the ANTERIOR LOOP (typically 3mm anterior to mental foramen) of the mandibular nerve from the extension which is the Inferior Alveolar Nerve.

good luck Dr. Salama


Interesting case! I absolutely agree with Maurice, the “incisive nerve” is for Inerveting canine and mandíbula incisors, No soft tissue (lower lip or chin) So, if you are planning to do an overdenture, I don’t think you’ll have any problem. Be very careful with the VERY crestal position of the mental foramen. Yo could damage it with your incision.
Pay special attention to soft tissue management, and everything should be ok!
Keep us posted!
José Mompell


I would like to thank all of you here in this forum for all the help and guidance that you have provided to me for this case. I was able to deliver two anterior mandibular implants for my patient today as part of the treatment which eventually would include all on four procedure. After surgery I took a small field CT Scan of the area to verify if there were any perforation of the lingual plate, everything looked great just like planned on surgical guide. I also followed up with patient for possible sublingual hematoma or mental nerve damage, patient is doing just fine. Thank you once more and your help is greatly appreciated and you guys are true scholars.