Abstract
Inferior alveolar nerve (IAN) repositioning has been used widely in recent years as an alternative approach for dental implant placement in the atrophic posterior mandible. The aim of this study was to answer the question: What are the complications associated with IAN repositioning? A systematic literature review performed in accordance with the PRISMA statement, using the PubMed (MEDLINE), Cochrane Library, and Scopus databases, identified a total of 116 articles related to this technique. Of those articles, 24 were included in the final review. Lateralization was the chosen technique in seven studies, transposition in 15 studies, and two studies reported both techniques. The longest follow-up period was 49.1 months and the shortest 6 months. Of the patients who underwent lateralization, 95.9% initially showed a neurosensory disturbance, and the condition remained at the end of the study for 3.4% of those patients. With regard to the patients who underwent transposition, neurosensory alterations were observed in 58.9% of patients initially, and the condition remained for 22.1% of those affected at the end of the study. Only one study found no neurosensory disturbance at any time. More data consolidation is necessary to determine scientifically if, which, and when the IAN repositioning technique can be recommended.
For the last two decades, dental implant placement has been a popular option for the treatment of the edentulous mandible. In such cases, where there is insufficient height for implant placement, there are a few options available for rehabilitation, including short implants, bone graft, and inferior alveolar nerve (IAN) repositioning. Repositioning is performed via one of two surgical techniques, lateralization or transposition, with lateralization yielding lower degrees of nerve deficiency. In lateralization, the IAN is exposed and retracted laterally, held in this position during implant placement, then released to rest against the implants. In the transposition technique, first described in 1977 and modified in 1987, the mental foramen is included in the osteotomy, to allow incisive branch excision, so that the IAN can be pulled into a new position, generally more posterior. Although both techniques have seen improvements since their introduction, reported data remain sparse.
The aim of the present study was to answer the question: What are the complications associated with IAN repositioning?
Materials and methods
Search strategy and selection criteria
An initial bibliographic search in the PubMed (MEDLINE), Cochrane Library, and Scopus databases was performed using three lines of search elements from a brief reading of the subject of interest: (1) ‘inferior’, ‘alveolar’, ‘nerve’, ‘lateralization’; (2) ‘inferior’, ‘alveolar’, ‘nerve’, ‘transposition’; and (3) ‘inferior’, ‘alveolar’, ‘nerve’, ‘translocation’, without time delimitations. The last search was performed on March 19, 2013.
For the initial selection, article titles and/or abstracts were analyzed by three independent reviewers (BMV, LBM, and OLCJr), and the following inclusion criteria were observed: studies published in English; no time delimitations; studies of human beings; specific studies using IAN repositioning for rehabilitation with osseointegrated implants; case report, case series, prospective and/or retrospective clinical study types.
Following initial selection, the three examiners (BMV, LBM, and OLCJr) read the previously selected articles in full, applying the selection criteria (see Table 1 ) to determine final inclusion or exclusion from the study. Disagreements among reviewers were settled by additional discussions. The authors established all selection criteria prior to commencement of this study.
