Dental Tribune United Kingdom

August 1-7, 2011United Kingdom Edition 10% OFF Our Dentist Range Online! Discount Code: NEWDNT* Quote NEWDNT when ordering to get 10% off your first order at www.alexandra.co.uk * Excluding contract pricing and special price agreements. Dentist advert_Layout 1 26/07/2011 13:14 Page 1 page 15DTß prepared in the cancellous bone. Usage of the diamond-coated part of the Piezo device is rec- ommended for this procedure. After preparation, the nerve will be encircled with ethiloop sili- cone slinga. The preparation of the nerve is followed by the insertion of the implant. In order to obtain suf- ficient primary stability, there must still remain enough bone in the buccal area after the prepa- ration of the cavity. If there is not enough bone left, the buccal bone lamella may break during insertion, which might endan- ger the primary stability of the implant. The preparation of the counter corticalis is also sug- gested, provided that the implant is long enough. A previously manufactured—by means of 3-D diagnosis—orientation template, can be used for the bucco-lingual and mesio-distal positioning of the implant. The nerve can be reposi- tioned directly on the implant (in this case a CAMLOG Srewline, 4,3 x 13mm, was used, Fig 10 and 11) without taking any further measures. Some authors (Rosen- quist11 , Friberg4 ) state that the contact with sharp thread edges often causes chronic irritation. Use of implants with a low inci- sive thread is therefore recom- mended in order to avoid nerve irritation. After repositioning the nerve the bone cavity will be filled with bone chips, which were ob- tained by grinding the buccal compact bone. Afterwards, the cavity will be covered with the collagen membraneb, which will be fixed with membrane nailsc. The wound is carefully closed with successive single inter- rupted suturesd. After a waiting period of three months, the fixed prosthetic restoration can be done. During this time the opera- tive site should not be irritated. Discussion The lateralisation of the inferior alveolar nerve offers patients the possibility of obtaining a fixed prosthesis in the mandible, pro- vided that they have a conserv- able anterior residual dentition and a free-end situation. This is sometimes the only feasible procedure to help pa- tients obtain a fixed prosthesis, especially in those cases where there is only very little residual bone height depth left due to the route of the inferior alveolar nerve rather than atrophy. Other advantages are the fixation in the pre-existing bone, and the one site surgery, which make aug- mentative procedures unneces- sary. This also avoids the disad- vantages of other procedures for example the risk of resorption. The evaluation values for im- plant survival rates are similar to those for standard implantations. However, there are two reasons that might advise against a later- alisation of the inferior alveolar nerve: (i) the complicated surgi- cal technique requires a skilled surgeon and (ii) the risk of nerve irritation. Patients have to consider six–eight weeks of lasting par- esthesia of the mental nerve, and the possibility of a perma- nent paresthesia cannot be ex- cluded. It is therefore of utmost importance to inform the patient in detail beforehand. A rather rarely-occurring complication is a mandibular fracture in the area of the bony window. In 10 of the 11 lateralisation surgeries car- ried out in the authors clinic, the function of the mental nerve was completely recovered within 6–8 weeks. In one case, one patient still suffers from permanent par- esthesia, though it does not dis- turb much. However, even this patient would again decide upon this surgery instead of choosing a removable mandibular pros- thesis as alternative solution. No case of implant loss can be re- ported. In all cases, the fixed im- plant supported prosthesis could be manufactured according to the previous planning. DT Editorial note: The literature list can be requested from the au- thor. About the author Dr Bernd Quantius MSc Giesenkirchener Str. 40 41238 Mönchengladbach, Germany E-mail: B.Quantius@drquantius.de _contact Fig 8 Fig 9 Fig 10 Fig 11 Fig 12 Fig 13 Fig 14