EC Dental Science

Introduction: The atrophic posterior mandible poses a significant clinical challenge for oral rehabilitation through implant placement in the area. This mainly occurs due to anatomical limitations and poor bone vascularization, thus frequently preventing regenerative surgical techniques in height. A solution is often provided through an inferior alveolar nerve (IAN) lateralization or transposition, a surgical operation in which the inferior alveolar nerve is displaced vestibularly in order to accommodate the insertion of implants in the area. While the technique is far from experimental, we believe that the case report presented in this article will provide clinicians with useful variations of the procedure.

Case Report: In this case, an inferior alveolar and incisive nerves lateralization was performed on a 38-year-old female with a knife-edge hourglass form of posterior mandible with 3-4 mm height above the inferior alveolar nerve. She was administered intraoperatively with a combination of local Platelet Rich Fibrin plugs and membranes, one session of Low-Level Laser Therapy (also used post operatively) and systemic Vitamin B complex (for 2 months). We also used corticotherapy starting on the day of the surgery and extended by 6 days. The resulting neurological symptoms resolved in 45 days, a faster recovery rate than that previously reported in the literature.

Keywords: IAN; Lateralization; Posterior Mandible; Severe Atrophy; Dental Implants

1. Anders Juanita J., et al. “Low-level light/laser therapy versus photobiomodulation therapy”. Photomedicine and Laser Surgery4 (2015): 183-184.
2. Abayev B and G Juodzbalys. “Inferior alveolar nerve lateralization and transposition for dental implant placement. part i: a systematic review of surgical techniques”. Journal of Oral and Maxillofacial Research1 (2015): e2.
3. Abayev B and G Juodzbalys. “Inferior alveolar nerve lateralization and transposition for dental implant placement. Part II: A systematic review of neurosensory complications”. Journal of Oral and Maxillofacial Research1 (2015): e3.
4. Calderón-Ospina Carlos A and Mónica O Nava-Mesa. “B vitamins in the nervous system: current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin”. CNS Neuroscience and Therapeutics1 (2020): 5-13.
5. Castellano-Navarro JM., et al. “Neurosensory issues after lateralisation of the inferior alveolar nerve and simultaneous placement of osseointegrated implants”. British Journal of Oral and Maxillofacial Surgery3 (2019): 213-218.
6. Castro Pimentel Angélica, et al. “Lateralization technique and inferior alveolar nerve transposition”. Case Reports in Dentistry (2016): 4802637.
7. Cuyubamba O., et al. “The combination of neurotropic vitamins B1, B6, and B12 enhances neural cell maturation and connectivity superior to single B vitamins”. Cells7 (2025): 477.
8. de Vicente JC., et al. “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”. International Journal of Oral and Maxillofacial Surgery7 (2016): 851-857.
9. Dohan Ehrenfest David M., et al. “Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part II: platelet-related biologic features”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology3 (2006): e45-e50.
10. Dursun Erhan., et al. “Management of limited vertical bone height in the posterior mandible: short dental implants versus nerve lateralization with standard length implants”. Journal of Craniofacial Surgery3 (2016): 578-585.
11. Esposito Marco., et al. “The efficacy of vertical and horizontal bone augmentation procedures for dental implants: a cochrane systematic review”. European Journal of Oral Implantology3 (2009): 167-184.
12. Fernández Díaz JÓ and L Naval Gías. “Rehabilitation of edentulous posterior atrophic mandible: inferior alveolar nerve lateralization by piezotome and immediate implant placement”. International Journal of Oral and Maxillofacial Surgery 4 (2013): 521-526.
13. Garg AK and MJ Morales. “Lateralization of the inferior alveolar nerve with simultaneous implant placement: surgical techniques”. Practical Periodontics and Aesthetic Dentistry9 (1998): 1197-1204.
14. Ghatak RN., et al. “Anatomy, head and neck, mandibular nerve”. StatPearls, StatPearls Publishing (2026).
15. Hirsch JM and PI Brånemark. “Fixture stability and nerve function after transposition and lateralization of the inferior alveolar nerve and fixture installation”. British Journal of Oral and Maxillofacial Surgery5 (1995): 276-281.
16. Huang ML., et al. “Platelet-rich fibrin membrane nerve guidance conduit: a potentially promising method for peripheral nerve injuries”. Journal of Neural Engineering3 (2020): 036005.
17. Hwaiti Hisham Suliman, et al. “Inferior alveolar nerve relocation and immediate dental implant placement in severely resorbed mandibles: a prospective clinical case series”. BMC Oral Health 25 (2025): 92.
18. Jena S., et al. “Prevalence, patterns and variations of anterior loop of inferior alveolar nerve-a CBCT based retrospective study”. Indian Journal of Otolaryngology and Head and Neck Surgery3 (2022): 5424-5431.
19. Khojasteh A., et al. “The effect of a platelet-rich fibrin conduit on neurosensory recovery following inferior alveolar nerve lateralization: a preliminary clinical study”. International Journal of Oral and Maxillofacial Surgery 11 (2016): 1469-1477.
20. Muinelo-Lorenzo J., et al. “Detection of the accessory mental foramina on human mandibles using cone-beam computed tomography: a systematic review and meta-analysis”. Journal of Endodontics8 (2021): 1215-1228.
21. Naves Freire Alice Engel., et al. “Piezoelectric surgery in the inferior alveolar nerve lateralization with simultaneous implant placement: a case report”. Implant Dentistry1 (2019): 86-90.
22. Palacio García-Ochoa A., et al. “Complications associated with inferior alveolar nerve reposition technique for simultaneous implant-based rehabilitation of atrophic mandibles: a systematic literature review”. Journal of Stomatology, Oral and Maxillofacial Surgery4 (2020): 390-396.
23. Priyadarshini SR., et al. “Qualitative and morphological evaluation of the mandibular bone using computed tomography”. Indian Journal of Dental Research6 (2020): 899-903.
24. Rodriguez JG and RM Eldibany. “Vertical splitting of the mandibular body as an alternative to inferior alveolar nerve lateralization”. International Journal of Oral and Maxillofacial Surgery10 (2013): 1295-1302.
25. Suzuki Dalton., et al. “Inferior alveolar nerve lateralization and implant placement in atrophic posterior mandible”. Journal of Craniofacial Surgery4 (2012): e347-e349.
26. Turhani Dritan., et al. “Undesirable course of an oral implant rehabilitation in a patient with a long history of bulimia nervosa: case report and review of the literature”. Quintessence International7 (2019): 548-553.
27. Wang S., et al. “Evaluation of platelet-rich plasma therapy for peripheral nerve regeneration: a critical review of literature”. Frontiers in Bioengineering and Biotechnology 10 (2022): 808248.
28. Yang Yang., et al. “Diabetic neuropathy: cutting edge research and future directions”. Signal Transduction and Targeted Therapy 10 (2025): 132.