Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 26 Jul 2022

Expanding the Surgeon's Armamentarium: Use of the Tubing Technique to Preserve the Inferior Alveolar Nerve During Transposition Procedure

DMD, BSc,
DMD,
DMD, MSc,
DMD, PhD, and
DMD, PhD
Page Range: 62 – 69
DOI: 10.1563/aaid-joi-D-20-00382
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Severe edentulous posterior mandible atrophy with inadequate bone height superior to the inferior alveolar canal may increase the risk of neurosensory impairment and other complications during inferior alveolar nerve (IAN) transposition (IANT) prior to dental implant insertion. The current report describes the tubing technique as a practical and feasible procedure that ensures IAN preservation during IANT. The technique involves wrapping a standard suction catheter around the exposed nerve to facilitate full coverage. This work presents a retrospective review of 31 patients undergoing IANT procedures followed by immediate placement of dental implants between January 2015 and January 2020. IANT was performed either unilaterally or bilaterally on all patients, followed by IAN tubing before implant placement. A total of 46 IANT procedures involving the tubing technique were performed. Overall, 149 dental implants were inserted during IANT surgeries, with a success rate of 98.6%. Sensory disturbance was documented in 47.8% of the treated sites (left/right mandible) at 1 month (22/46 sites), 21.7% at 3 months (10/46 sites), 6.5% at 6 months (3/46 sites), and 2.2% at 12 months (1/46 sites) postimplantation. In total, except for 1 case, sensory disturbance was fully resolved by the end of the 12-month follow-up period. Taken together, the tubing technique described herein is a practical and reproducible method for protecting the IAN during transposition.

Figure 1.
Figure 1.

Assessment of IAN position by cone-beam computed tomography (CBCT). Notice insufficient residual vertical bone height.


Figure 2.
Figure 2.

Osteotomy of the mental foramen with release of the inferior alveolar nerve (IAN) and mental nerve. The incisive nerve is sharply dissected about 4–5 mm anterior to the mental foramen (yellow arrow).


Figure 3.
Figure 3.

Exposed inferior alveolar nerve (IAN) in the mandibular canal.


Figure 4.
Figure 4.

Measurement of the exposed inferior alveolar nerve (IAN).


Figure 5.
Figure 5.

Measuring of the suction catheter.


Figure 6.
Figure 6.

(a) Opening the suction catheter along 1 side by scissors. (b) Suction catheter calibrated and ready to use.


Figure 7.
Figure 7.

Suction tube (yellow arrows) cautiously inserted around the exposed nerve until full coverage. Notice the onlay technique with mandibular ramous bone graft.


Figure 8.
Figure 8.

Tubing technique. (a) Inferior alveolar nerve (IAN) is protected throughout the surgery. No need for additional retraction while placing the implants. 3-0 silk suture (Mersilk, Ethicon) was added to secure the tube. (b) Illustration of the tubing technique.


Figure 9.
Figure 9.

Buccal fat pad free graft is used to cover the partly exposed IAN.


Figure 10.
Figure 10.

Primary tension-free sutures of the surgical wound.


Figure 11.
Figure 11.

Reported sensory disturbance following IAN transposition with tubing technique.


Contributor Notes

Corresponding author, e-mail: Dannyoren100@walla.co.il
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