Transpositioning and repositioning the inferior alveolar and mental nerves in conjunction with endosteal implant reconstruction.

Without the benefit of the computed tomographic scan with three-dimensional reformatted imaging, this procedure would be difficult if not impossible to carry out. The end-point results would not be as valid. It is also not indicated to place any type of granular allograft and/or any one of the alloplast materials in this area, as it could prove to irritate the exposed neurovascular bundle. I have also found that, in most instances, the residual bone from the osteotomy site is not sufficient to replace at the termination of the procedure. However, if it is sufficient, then it would be necessary to thin down the medial aspect of the cortical plate in repositioning it, as it would then prevent excessive pressure or crushing of the nerve against the surface of the implant(s). Procedures such as onlay or saddle grafting can be offered to the patient as an alternative to these nerve procedures. However, a second surgical site is then required as well as, in some cases, staging of the procedure, thus increasing treatment time and the number of procedures for the patient. Lastly, adequate soft tissue coverage over the graft is often difficult, if not impossible to achieve.