Neurological Risks During Implant Placement in the Anterior Maxilla and Mandible: A Literature Review
The placement of implants in the anterior maxillary and mandibular region requires esthetic proficiency and surgical finesse. It is important to consider the esthetic outcome while avoiding any type of nerve injury for the patient. In this literature review, anatomical structures of the anterior jaw were reviewed from a gross anatomical and radiographic interpretation. A discussion on the frequency of neurosensory complications for patients as a result of nerve damage in this region was evaluated. The purpose of this literature review was to educate the dental surgeon to consider the anterior jaw’s neurological structures when performing procedures like implant surgery. The mandibular incisive canal (MIC) presents as an extension of the inferior alveolar canal that runs between the mental foramina. The MIC is a structure that is easily depicted in cone-beam computed tomography (CBCT) imaging and is present in most subjects in gross anatomical studies. The anterior loop of the mental nerve is another structure that is discussed in this paper. Although its structure is accurately depicted in CBCT images, its anatomical variations in patients can make implant treatment planning difficult. The maxilla contains 2 neurovascular structures that were discussed. First, the nasopalatine canal and its relation and impact on implant placement is evaluated. Case reports are reviewed that outline a prophylactic enucleation and bone grafting of the canal prior to implant placement. Second, the canalis sinuosus, which houses the anterior superior alveolar nerve, is of concern during implant placement in the lateral incisor region. Case reports involving nerve damage with follow-up are discussed.
A panoramic reconstruction depicting the inferior alveolar nerve canal outlined in green. The mandibular incisive canal is also outlined in green with its complete length measured by the red arrows bilaterally. The yellow line indicates the denervated midline band in the midsymphyseal region.
A graphically reconstructed mandible in a panoramic radiograph illustrating the mandibular canal and the MIC. The distance between the alveolar crest and the MIC (red lines) determines the position of future implants and this distance may challenge treatment planning.
A panoramic reconstruction depicts the inferior alveolar nerve canal outlined in green with the length of the anterior loop of the mental nerve measured by the red arrow.
CBCT imaging of the nasopalatine canal with an axial section labeling the width of the nasopalatine canal (red line) and the distance between the canal and the most anterior bony part of the buccal plate (yellow line).
CBCT imaging and 3D reconstructed image depicting the CS outlined in green. The anterior canal of the CS is an accessory canal that migrates closer to the alveolar crest (yellow star). The posterior canal is the main branch of the CS that houses the anterior superior alveolar nerve (red star).
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