Nerve Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for the placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and may be indicated when teeth are missing in the area of the two back molars and/or second premolars. This procedure is considered a very aggressive approach since there is almost always some postoperative numbness of the lower lip and jaw area, which typically dissipates very slowly, but may be permanent. Usually other, less aggressive options are considered first.

Typically, we remove an outer section of bone on the outer side of the lower jaw bone in order to expose the nerve and vessel canal. We then isolate the nerve and vessel bundle in that area and slightly pull it out to the side. We then place the implants while protecting the nerve and blood vessels. Then the nerve and blood vessels are placed back over the implants. The surgical access is refilled with bone graft material and the area is closed.

These procedures may be performed separately or together depending upon the individual’s condition. There are several areas of the body that are suitable for attaining bone grafts. In the facial region bone grafts can be taken from inside the mouth. This includes the area of the chin, the third molar region, or in the upper jaw behind the last tooth. In more extensive situations a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. We can also obtain excellent results using an allograft (bone bank) material. It is quite effective and very safe. 

These surgeries are performed in the office surgical suite under IV anesthesia.