Dental Alveolar Nerve Lateralization for implants placement

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Posted on By Vladimir García Lozada In Implants

Dear Friends,
This is a case of Alveolar Nerve Lateralization in conjunction with placement of 2 dental implants. thanks
thoughts?
regards
Vladimir García Lozada

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28 Comments

Vladimir

For me, excellent exposure and soft touch surgical procedure. I have done several lateralization procedures for non implant reasons. I usually protect or wrap the nerve with a soft membrane, then particulate, and final membrane(sandwich) In your experience no need? Any temporary nerve neuritis?

Beautiful

Rocco




Reply

Hello Rocco, first at all thank you for your comment and kind words, im glad you like that surgery. About your questions, yes i inserted particulate autologous bone graft between the implant surface and the dental alveolar nerve without membrane, sorry is not appreciated in the video because the blood, and only is appreciate in the outside buccal surface!!
For me is important avoid the direct contact between the implant and the nerve to protect it, that is why the sandwich technique as you comment i think is more safetely and predictable.
About sensorial disturb, in this case at 2 weeks the patient did not report any discomfort for paresthesia and total sensorial activity without pain, i recommend for this surgery, ever work with piezosurgery, be kind with the tissues, and VIT "B" complex.
best regards and thank you
Vladimir Garcia Lozada


Reply

Vladimir. I wish to personally thank you for sharing your wonderful work. In addition to this video, I also admire and appreciate your zygomatic cases. Your are a gifted surgeon! It is nice to know there are individuals such as yourself who possess DIAGNOSTIC AND CLINICAL CAPABILITIES necessary to perform these extraordinary surgeries. Perhaps you make it look too easy? Maybe you could comment on some of the risk factors and complications that are possible along with the knowledge and skills necessary to deal with potential unintended outcomes. Best regards. Chuck


Reply

Chuck,
I don´t know how to thank your very kind comments, they are the things that inspire and appreciate to continue realizing and sharing with everyone about our very dear profession. Thank you my friend!!
Ill be lucky to haved good teaching and friends that care me about how to do as well as possible some treatments, everyone can do it with good mentors and cases!! moreover its very true than the possible complication they are and if you do some kind of treatment is very important how to solve them, upload possible complications and there resolution its important i agree with you, i take note of it.
Thank you so much
best regards
Vladimir García Lozada


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You show incredible advanced surgery, one after the other!
Literature says that transient and permanent sensibility disturbances are very often, what is your experience?
What magnification do you use?
Thank you for sharing your magnificent work!
Best regards
Snjezana


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Snjezana,
thank you so much for your beautiful words!!
The literature is quite extensive in regard to this type of treatment, but we must remember that the same from the beginning were performed only with round burs rotatory apparatology and now increasingly appear scientific evidence by doing only with piezosurgery which according to the results regarding possible paresthesias, have decreased and even eradicated in the postoperative period. Select the case as at all is mandatory. My experience has been good in that sense, in some cases some transient paraesthesia for a period of 1 month and a half thanks God, is what I have had, that performing controls, sensory mapping, use of vitamin B complex, including infrared laser therapy in case that it takes more time to recover the sensitivity to 100%.
At the moment I do not use magnification but I would love you can recommend me someone to use.
a big hug!!
greetings
Vladimir


Reply

Vladimir, do you give courses, workshops to the topics zygoma implants and nerve lateralization? My students start asking me...
Normally I use loupes with 4,0 or 5,0 magnification, but we have also a microscope in our clinic. Surgical skills plus knowledge plus piezo plus microscope?
Happy New Year
Snjezana


Reply

Snejezana, thank you for your recommendation about the magnification loupes!! any particulate brand you like?
yes i can give courses, workshops and lectures for zygomatic implants, nerve lateralization and other topics! :)
Fantastic that you have a microscope, when you want it if you think it's okay we can see it and plan things for your students.
Happy New Year
Vladimir


Reply

Vladimir García Leonardo Lozada,
again, your name is a poetry and I just have to write it completely.
Great, great!! I`ll contact you soon. And regarding the loupes - I prefer the loupes with headband and light. It`s less pressure on the nose and assistance loves it - less work with the lamp:))
Best wishes and happy happy
Snjezana


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Snejezana,
Thank you!! :)
Vladimir


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Great video...can you explain "how you dissect the nerve out without injury and how much tension can you place on nerve with rubber before injury? Great video and skill. Thanks for sharing. Dr. Salama


Reply

Dr. Salama,
Thank you so much for your compliments! As I said earlier I am delighted to collaborate with dentalXP.
Its a great website to learn and share with the other kind doctors.
i have the explained video just waiting for tyler response, your questions are primordial, because its one of the important point to avoid transient paraesthesia.
After perform the buccal window with the saw piece of the piezosurgery, and access to the marrow bone area where the nerve is located, i use the diamond round bur of the piezosurgery, to released softly and with patience the nerve of the bone marrow. Once located the mandibular canal with the nerve, I used the sinus lift curettes because they have different angulations and also do not have sharp edges, to lateralize it in a more secure way.
i lateralized the nerve with a sterile dam or with a vessel loop, you have different colors like yellow or blue and for documented with photos or videos is clearly more beautiful.
As for how much to pull the nerve, this is related to how large the window is made, since as it becomes smaller, greater tension will receive the nerve and of course greater possibility of paresthesia, that is why the design of the window and approach is very important to just avoid pulling too much of the nerve. If I observe that lateralization would create a lot of tension to the nerve, I prefer or enlarge the window or better perform a transposition of the nerve, which is when the mental nerve is released as well, which allows a greater range of stretching over the nerve. I only lateralize the nerve as it allows me to drill for the implant, I do not pull more than necessary to avoid complications.
thank you
Have a happy holidays!!
Vladimir


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Exceptional skill displayed here. Thank you for posting such cases. As mentioned above, what kind of sensory disturbances do you see commonly after these procedures from the manipulation of neurovascular bundle with instruments as well as rubber band?
Great case !! Regards, Naheed


Reply

Dear Naheed,
i very appreciate your words, Thank you!!
The sensorial disturb more common in this kind of treatment that you can see its transient paraesthesia, but it quickly recovers the sensitivity about 2 months, less or possible more time. Then what we do not want to have like a permanent paraesthesia that it been occur, but now a day we have the necessary instrumental and apparatology to avoid it.
and i read in the literature that its very uncommon complication like a mandibular fracture in the window area, but it can be solved with plates and screws.
thank you
Best regards
Vladimir


Reply

Vlad,

Nice work, Clean as always- Can you share your diagnostic planning prior to surgery, radiographic tools, - depth to nerve, what is your minimum bone height in deciding on lateralization and how do manage when you encounter nerve bifurcation

Happy New Year,

Cheers,

Richard


Reply

Dear Richard, thank you my friend for your compliments!!
Look for orthopantomography and TC to show it.
I prefer to do it in cases of 6 and 7 mm of minimum height taking as reference the upper cortical of the mandibular canal and the alveolar crest.
And if a bifurcation of the nerve is encounter without having previously diagnosed it on the TC, need more patience my friend and sweat a little more :)

Happy New Year!!
Cheers,
Vladimir

P.D: i have the photo before and after of the buccal fat pad removal video but when i can reply only permit comments and not photo. Can you tell me how to do? thank you


Reply

Hi, Vladimir !

Very nice, clean surgery and beautiful documentation ! You are very talented.

I have a few questions regarding this case.
Have you tried to internal contour and to put back the bone plate taken from the window ?
How much height of bone was present in this case ? Have you considered short implants to avoid this surgery? What implant height have you utilized here ?

Thank you !
I wish you all the best !


Reply

Hi Cristian, thank you very much for your kind compliments im glad you like it :)
about tour questions:

1- I used the same bone autologous plate taken from the window but previously passed by the bone grinder, transforming it into particulate bone, I always like to do it in that way, you see that color of bone in the video because the bone is cortical.

2- In this case the patient come to me, because previously they made short implants, and then tried a bone regeneration, I don't know why are the motives, because don't work the previously treatments, but i offer to him another option and he accepted that option.
i think the implants height used was 13 and 15 mm

i sent the panoramic Xray
wish al the best too!!
Happy New Year
Vladimir


panoramic Xray


Reply

Hi Cristian, thank you very much for your kind compliments im glad you like it :)
about tour questions:

1- I used the same bone autologous plate taken from the window but previously passed by the bone grinder, transforming it into particulate bone, I always like to do it in that way, you see that color of bone in the video because the bone is cortical.

2- In this case the patient come to me, because previously they made short implants, and then tried a bone regeneration, I don't know why are the motives, because don't work the previously treatments, but i offer to him another option and he accepted that option.
i think the implants height used was 13 and 15 mm

i sent the panoramic Xray
wish al the best too!!
Happy New Year
Vladimir


panoramic Xray


Reply

Vladimir...you ask and we listen...you can now post image followups on your video posts!!!
Just like standard posts....
Dr. Salama


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Dr. Salama thank you very much for your quickly reply, and congrats for your great effort and dedication and also the team XP to make possible this kind site of learning and sharing!!
Happy New Year
Vladimir


Reply

Dr. Salama it works very well thank you, i upload the photos pre and post surgery of the video buccal fat pad removal for a facial aesthetics!
best regards


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Thank you my friend....we hope to see you soon at one of our Global symposia. regards and HNY. Dr. Salama


Reply

Dr. Salama,
Thank you, i hope too. I will organized me to be able too attend some symposium XP, i know in february its in Vegas there any one else these year please?
best regards
Vladimir


Reply

Vladimir; When do you decide nerve lateralization vs. vertical bone grafting?? Dr. S


Reply

Hello Dr. Salama
basically i decide if the patient comes with any previous failed treatment of bone regeneration or short implants, and if the aesthetic conditions are favorable as well as also that the dental crown / implant proportion is not very disproportionate and also has strong bruxism.
If the space to be rehabilitated with implants is very short bone regeneration could be better option, and with the lateralization option the waiting time of the patient is lower for the final result.
regards
Vladimir


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Thank you


Reply

You´re welcome, any other question or thoughts welcome are!
regards
Vladimir


Reply


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