Dental Implants Installation Laterally to the Inferior Alveolar Nerve Canal Guided Tomography: A Case Report

When severe atrophy in posterior portion of the mandible is present, lateralization of the alveolar nerve might be an option that allows implant installation in the area. However, this technique is complex and can produce some sequelae to patient, as paresthesia. Planning the implant installation using Cone-Beam Computed Tomography (CBCT)-guided surgery might prevent inferior alveolar nerve lateralization. The current report presents a clinical case of implants placement in posterior mandible area with severe alveolar ridge atrophy using CBCT-guide. The reported clinical case refers to a patient (female; 65 years old), partially edentulous, who sought dental rehabilitation complaining lack of efficiency of the removable inferior prosthesis. Clinically, it was observed that the remaining inferior teeth included 34, 33, 32, 31, 41, 42 and 43, and two dental implants in 35 and 44 positions. Moreover, severe bilateral alveolar ridge atrophy was noted. However, tomographic exams revealed bilateral proximity to inferior alveolar nerve canal where further implants should be placed. In order to avoid complications, a CBCT with surgical guide was obtained. At surgery with the surgical guide, 2 Cone Morse 3.5 × 10 mm dental implants were installed in the position of teeth 36 and 46. After implants placement, a new tomographic exam was performed. It was possible to verify the correct positioning to the implants laterally to the inferior alveolar nerve canal. Through the technique employed, it was possible to avoid manipulation of the inferior alveolar nerve bilaterally.