ISSN: 1859 - 2872
A review and update of inferior alveolar nerve repositioning techniques
Main Article Content
Keywords
Inferior alveolar nerve repositioning, piezosurgery, guided surgery, neurosensory disturbance.
Abstract
To synthesize and analyze inferior alveolar nerve (IAN) repositioning techniques reported in the literature; to compare the advantages, disadvantages, neurosensory disturbances of the lower lip–chin and mandibular fracture among techniques using rotary instruments, piezoelectric devices, and piezoelectric devices combined with a surgical guide; and to report illustrative clinical cases. Subject and method: A narrative review was conducted to provide an updated overview of IAN repositioning techniques, combined with the reporting of two clinical cases. One case was treated using piezosurgery, and the other using piezosurgery in combination with a surgical guide. Outcome variables included lower lip–chin neurosensory disturbance, duration of neurosensory recovery, mandibular fracture, and implant osseointegration. Result: Techniques using rotary instruments were associated with temporary neurosensory disturbances in approximately 25 - 40%, with recovery within 3 - 6 months; mandibular fracture incidence ranged from 1 - 2%, and increased to 6 - 7% in severe mandibular atrophy. In contrast, piezosurgery demonstrated lower rates of neurosensory complications 15 - 30%, shorter recovery times 2 - 3 months, and high implant success rates 92 - 100%, particularly when combined with a surgical guide. In the reported clinical cases, simultaneous implant placement after nerve repositioning resulted in uneventful healing, stable osseointegration, absence of mandibular fractures, and neurosensory disturbances were transient, with complete recovery observed within 2–3 months. Conclusion: IAN repositioning using piezosurgery, particularly when combined with a surgical guide, is a safe and feasible approach that enhances surgical accuracy and reduces the risk of neurosensory disturbances in implant rehabilitation of the severely atrophic posterior mandible.
Article Details
References
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15. Pogrel MA, Lee JS, Muff DF (2004) Inferior alveolar nerve transposition anatomic and neurosensory considerations. J Oral Maxillofac Surg 62(5): 529-534.
16. Eggers G, Klein J, Blank J, Hassfeld S (2004) Piezosurgery: an ultrasound device for cutting bone and its use and limitations in maxillofacial surgery. J Oral Maxillofac Surg 42(5):451-453.
17. Vicente JC, Peña I, Braña P, Hernández-Vallejo G (2016) The use of piezoelectric surgery to lateralize the inferior alveolar nerve with simultaneous implant placement and immediate buccal cortical bone repositioning: a prospective clinical study. Int J Oral Maxillofac Surg 45: 851-857.
18. Vercellotti T (2004) Technological characteristics and clinical indications of piezoelectric bone surgery. Minerva Stomatol 53(5): 207-214.
19. Kablan F (2025) A new classification of inferior alveolar nerve repositioning procedures for dental implant placement. Dent J 13(6): 267.
20. Vercellotti T (2020) Piezoelectric Bone Surgery: A New Paradigm. Batavia, IL: Quintessence Publishing Co, Inc.
21. Anesi A, Negrello S, Checchi M, Di Bartolomeo M, Salvatori R, Cavani F (2024) Piezosurgery versus reciprocating saw: Qualitative comparison of the morphology of cutting surfaces in ex vivo human bone. Appl Sci (Basel) 14(5): 2203.
22. Preti G, Martinasso G, Peirone B, Navone R, Manzella C, Muzio G, Russo C, Canuto RA, Schierano G (2007) Cytokines and growth factors involved in the osseointegration of oral titanium implants positioned using piezoelectric bone surgery versus a drill technique: a pilot study in minipigs. J Periodontol 78(4): 716-722.
23. Lundgren D, Sennerby L, Falk H (1999) Temperature increase during drilling for dental implants: An in vitro study. Clin Oral Implants Res 10(4): 309-316.
24. Deryabin G, Grybauskas S (2021) Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: A retrospective multicenter study of implant success and survival rates and lower lip sensory disturbances. Int J Implant Dent 7(1): 44.
25. Atef M, Mounir M (2018) Computer-guided inferior alveolar nerve lateralization with simultaneous implant placement: A preliminary report. J Oral Implantol. 2018;44(3):192-197.
26. Metawie, Dina & Prince, Nagy & Fahmy, Magued & Eldibany, Riham & Ibrahim, Ibrahim (2022) Computer guided inferior alveolar nerve larteralization after repositioning of the bone window versus sticky bone augmentation (a randomized clinical trial). Alex. Dent. J 47: 14-24.
27. Schneider D, Marquardt P, Zwahlen M, Jung RE (2009) A systematic review on the accuracy and clinical outcome of computer-guided implant dentistry. Clin Oral Implants Res 20(4): 73-86.
28. Payer M, Kirmeier R, Jakse N, Pertl C (2009) The clinical use of piezosurgery in lateralization of the inferior alveolar nerve and implant placement. Clin Oral Implants Res 20(6): 605-610.
29. Rullo R, Addabbo F, Papaccio G, D’Aquino R (2013) Neurosensory disturbance after inferior alveolar nerve repositioning for implant placement: A comparison between rotary instruments and piezosurgery. J Oral Maxillofac Surg 71(11): 1890-1897.
30. Greenstein G, Tarnow D (2006) The mental foramen and nerve: clinical and anatomical factors related to dental implant placement. J Periodontol 77(12): 1933-1943.
31. Rosenquist BE (1995) Implant placement in combination with nerve transpositioning: experiences with the first 100 cases. Implant Dent 4(4): 205-209.
32. Kablan F, Abu-Sobeh A, Lorean A, Levin L (2020) Spontaneous mandibular fracture as a complication of inferior alveolar nerve transposition and placement of endosseous dental implants in the atrophic mandible: A review of the literature and report of two cases with nonsurgical conservative management. Quintessence Int 51(3): 230-237.
33. Kan JY, Lozada JL, Boyne PJ (1997) Mandible fracture after endosseous implant placement in conjunction with inferior alveolar nerve transposition: a patient treatment report. Int J Oral Maxillofac Implants 12(5): 655-658.
34. Karlis V, Bae RD, Glickman RS (2003) Mandibular fracture as a complication of inferior alveolar nerve transposition and placement of endosseous implants: A case report. Implant Dent 12(3):211-216.
35. Li B, Sun Y, Fu L, Zhou Y (2025) Preoperative simulation with 3D-printed models for bilateral inferior alveolar nerve lateralization: A case report with 6.5-year follow-up and literature review. J Oral Implantol 51(3): 248-257.
2. Abayev B, Juodzbalys G (2015) Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: A systematic review of surgical techniques. J Oral Maxillofac Res 6(1): 2.
3. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P (2009) Interventions for replacing missing teeth: Vertical and horizontal bone augmentation techniques for dental implants. Cochrane Database Syst Rev (4): CD003607.
4. Cawood JI, Howell RA (1988) A classification of the edentulous jaws. Int J Oral Maxillofac Surg 17(4): 232-236.
5. Jensen J, Nock D (1987) Inferior alveolar nerve repositioning in conjunction with placement of osseointegrated implants: A case report. Oral Surg Oral Med Oral Pathol 63(3):263-268.
6. Vetromilla BM, Moura LB, Sonego CL, Torriani MA, Chagas OL (2014) Complications associated with inferior alveolar nerve repositioning for dental implant placement: A systematic review. J Oral Maxillofac Surg 43(11): 1360-1366.
7. Vinci R, Cosola S, Varkey MK, Gunasekaran S, George J, Covani U (2025) Neurosensory disturbances following inferior alveolar nerve relocation and implant placement: A systematic review and meta-analysis. J Clin Med 14(16):5741.
8. Vercellotti T (2000) Piezoelectric surgery in implantology: A case report–a new piezoelectric ridge expansion technique. Int J Periodontics Restorative Dent 20(4): 358-365.
9. Vercruyssen M, Laleman I, Jacobs R, Quirynen M (2015) Computer-supported implant planning and guided surgery: A narrative review. Clin Oral Implants Res 26(11): 69-76.
10. Chehata IM, Abdelmonim GM (2021) Piezosurgery versus conventional rotary instrument for inferior alveolar nerve lateralization prior to implant placement: Comparative clinical study. Egypt Dent J 67: 2061-2073.
11. Juodzbalys G, Wang HL, Sabalys G (2011) Injury of the inferior alveolar nerve during implant placement: A literature review. J Oral Maxillofac Res 2(1):1.
12. Jensen OT, Cottam JR, Ringeman JL, Adams MW (2002) Transposition of the inferior alveolar nerve for placement of endosseous implants. J Oral Maxillofac Surg 60(2): 172-178.
13. Lorean A, Kablan F, Mazor Z, Mijiritsky E (2013) Inferior alveolar nerve transposition and reposition for dental implant placement in edentulous or partially edentulous mandibles: a multicenter retrospective study. Int J Oral Maxillofac Surg 42: 656-659.
14. Palacio García-Ochoa A, Pérez-González F, Negrillo Moreno A (2020) Complications associated with inferior alveolar nerve reposition technique for simultaneous implant-based rehabilitation of atrophic mandibles: A systematic literature review. J Stomatol Oral Maxillofac Surg 121(4): 390-396.
15. Pogrel MA, Lee JS, Muff DF (2004) Inferior alveolar nerve transposition anatomic and neurosensory considerations. J Oral Maxillofac Surg 62(5): 529-534.
16. Eggers G, Klein J, Blank J, Hassfeld S (2004) Piezosurgery: an ultrasound device for cutting bone and its use and limitations in maxillofacial surgery. J Oral Maxillofac Surg 42(5):451-453.
17. Vicente JC, Peña I, Braña P, Hernández-Vallejo G (2016) The use of piezoelectric surgery to lateralize the inferior alveolar nerve with simultaneous implant placement and immediate buccal cortical bone repositioning: a prospective clinical study. Int J Oral Maxillofac Surg 45: 851-857.
18. Vercellotti T (2004) Technological characteristics and clinical indications of piezoelectric bone surgery. Minerva Stomatol 53(5): 207-214.
19. Kablan F (2025) A new classification of inferior alveolar nerve repositioning procedures for dental implant placement. Dent J 13(6): 267.
20. Vercellotti T (2020) Piezoelectric Bone Surgery: A New Paradigm. Batavia, IL: Quintessence Publishing Co, Inc.
21. Anesi A, Negrello S, Checchi M, Di Bartolomeo M, Salvatori R, Cavani F (2024) Piezosurgery versus reciprocating saw: Qualitative comparison of the morphology of cutting surfaces in ex vivo human bone. Appl Sci (Basel) 14(5): 2203.
22. Preti G, Martinasso G, Peirone B, Navone R, Manzella C, Muzio G, Russo C, Canuto RA, Schierano G (2007) Cytokines and growth factors involved in the osseointegration of oral titanium implants positioned using piezoelectric bone surgery versus a drill technique: a pilot study in minipigs. J Periodontol 78(4): 716-722.
23. Lundgren D, Sennerby L, Falk H (1999) Temperature increase during drilling for dental implants: An in vitro study. Clin Oral Implants Res 10(4): 309-316.
24. Deryabin G, Grybauskas S (2021) Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: A retrospective multicenter study of implant success and survival rates and lower lip sensory disturbances. Int J Implant Dent 7(1): 44.
25. Atef M, Mounir M (2018) Computer-guided inferior alveolar nerve lateralization with simultaneous implant placement: A preliminary report. J Oral Implantol. 2018;44(3):192-197.
26. Metawie, Dina & Prince, Nagy & Fahmy, Magued & Eldibany, Riham & Ibrahim, Ibrahim (2022) Computer guided inferior alveolar nerve larteralization after repositioning of the bone window versus sticky bone augmentation (a randomized clinical trial). Alex. Dent. J 47: 14-24.
27. Schneider D, Marquardt P, Zwahlen M, Jung RE (2009) A systematic review on the accuracy and clinical outcome of computer-guided implant dentistry. Clin Oral Implants Res 20(4): 73-86.
28. Payer M, Kirmeier R, Jakse N, Pertl C (2009) The clinical use of piezosurgery in lateralization of the inferior alveolar nerve and implant placement. Clin Oral Implants Res 20(6): 605-610.
29. Rullo R, Addabbo F, Papaccio G, D’Aquino R (2013) Neurosensory disturbance after inferior alveolar nerve repositioning for implant placement: A comparison between rotary instruments and piezosurgery. J Oral Maxillofac Surg 71(11): 1890-1897.
30. Greenstein G, Tarnow D (2006) The mental foramen and nerve: clinical and anatomical factors related to dental implant placement. J Periodontol 77(12): 1933-1943.
31. Rosenquist BE (1995) Implant placement in combination with nerve transpositioning: experiences with the first 100 cases. Implant Dent 4(4): 205-209.
32. Kablan F, Abu-Sobeh A, Lorean A, Levin L (2020) Spontaneous mandibular fracture as a complication of inferior alveolar nerve transposition and placement of endosseous dental implants in the atrophic mandible: A review of the literature and report of two cases with nonsurgical conservative management. Quintessence Int 51(3): 230-237.
33. Kan JY, Lozada JL, Boyne PJ (1997) Mandible fracture after endosseous implant placement in conjunction with inferior alveolar nerve transposition: a patient treatment report. Int J Oral Maxillofac Implants 12(5): 655-658.
34. Karlis V, Bae RD, Glickman RS (2003) Mandibular fracture as a complication of inferior alveolar nerve transposition and placement of endosseous implants: A case report. Implant Dent 12(3):211-216.
35. Li B, Sun Y, Fu L, Zhou Y (2025) Preoperative simulation with 3D-printed models for bilateral inferior alveolar nerve lateralization: A case report with 6.5-year follow-up and literature review. J Oral Implantol 51(3): 248-257.
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Published
Apr 24, 2026
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How to Cite
NhânV. V. (2026). A review and update of inferior alveolar nerve repositioning techniques. Tạp Chí Y Dược lâm sàng 108, 21(3). https://doi.org/10.52389/ydls.v21i3.2996