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Nerve Repositioning...the following images are very graphical
Below is a series of images of a typical Nerve Repositioning surgery.
Above to the left is a clinical image of the lower jaw with two molars missing on the patient’s left (right side on image). The right image shows the panographic x-ray. Notice that the neurovascular canal (outlined in red) is too high up towards the ridge for us to place rootform implants of proper length.
Above to the left is a clinical image of the bone exposed and the tissues reflected. Notice the Mental Foramen, where the nerve and vessel bundle (arrow) exit from inside the jaw. This same bundle is the one we will reposition. To the right you can see the initial outline of a window that will eventually be removed to gain access to the neurovascular bundle inside the jawbone (the arrow on the right shows the neurovascular bundle exiting through the foramen again).
On the left above you can see how we are beginning to remove the bony plate and on the right you can see the access window. At this point we remove some of the bone marrow to get to the neurovascular bundle and expose it.
The image on the left above shows the neurovascular bundle exposed and suspended by a vessel sling (arrow). At this point we keep traction on the bundle with the vessel slung and prepare the implant sites. On the right you can see how the bone is prepared for the implants, while the neurovascular bundle is kept out of the way..
Above on the left you can see the two dental implants inserted into the bone (arrows), while the neurovascular bundle is kept out of their path. Once placed, the bundle is released and the access site is refilled with bone graft material, as you can see on the right.
Please keep in mind that this is considered a very aggressive procedure due to the inherent danger of injuring this particular nerve and therefore not indicated very often. An alternative could have been to place a Blade Implant instead, and take into account some of the disadvantages that come with those types of implants.
Above on the left the post operative x-ray. Notice how we could take advantage of long implants due to the Nerve Repositioning procedure. The right image shows the surgical site two weeks post operatively with the sutures ready to be removed.
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