Implants in Anterior mandible: concerns when perforate incisive canal?

My question relates to the placement of implants in the anterior mandible. Is there any concern for bleeding or neuropathic pain if we perforate the incisive canal (branch of the inferior dental nerve) in the lower mandible? I understand this nerve innervates lower incisors so it is not a concern for an edentulous patient. I have attached scans of the incisor and canine region with the planned placement of the implants. Comments?



5 Comments on Implants in Anterior mandible: concerns when perforate incisive canal?

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BFulk
2/28/2017
Better to avoid any anterior loop or branch of the IAN. Curious, what is your plan in this case? Is this going to be fixed or removable? I am guessing that you are think fixed based on the 6 implants you have planned. So, a couple of things to consider: 1) have you measured your clearance for the prosthesis ( minimum 15mm for a fixed hybrid, ~10-12mm for monolithis Zi,). If you have not determined this you need too! 2) Have you looked at the bone between the mental foramen and considered angled implants to avoid the nerve while gaining some posterior spread 3) If you are doing Fixed and you are placing implants posterior to the mental foramens have you considered Mandibular flexture? While this is a debated theory it is something to consider and avoid if possible. ( ie: another reason to place 4-5 implants between the mental foramen and cantilever back) 4) what is your arch shape? if you have a very square arch you may NOT get adequate A-P spread to cantilever as I have suggested and you could better justify going with shorter implants posterior to the mental foramen (and accept the small risk of mandibular flexture related symptoms) These are just a few things to think about as you plan. My guess is that once you factor in adequate clearance for your prosthesis you will not have as much room for your implants as you think. Plan your prosthesis and necessary clearance First...then look where to put your implants. Unless you are planning locators I don't think you have enough clearance for any full arch prosthesis with your current plan. Hope this is helpful.
Howard Steinberg DMD,MDS,
2/28/2017
I obviously agree with being careful of the anterior loop and for the last 31 years I try to stay at least 5 mms. anterior to the mental foramen which in my case I have never experienced a permanent paresthesia. Have I violated that rule...yes many times but that does make me sweat but once again never seen a permanent paresthesia. As to the anterior mandible, do not worry about any issues with the nerve at that point as that will not present you with any significant problems. Good luck. Howard Steinberg DMD,MDS,FAAMP TucsonSmile.com
Gary
3/5/2017
Yes we are looking to construct a bridge. She is currently wearing a denture on locators so adequate height. The anterior loop on both sides continue for another 4mm so angled implants will not work unless I angle more than 40-50 degrees. I am better off using short implants instead as I have enough space clearance above the nerve. Yes mandibular flexure has been considered, however is this not more mythical? Thank you for your comments.
Dr.bülent zeytinoğlu
3/1/2017
We usually name the branch of the IAN that leaves the mandıbla as nervus mentalis not nervus incisivus. nervus incisivus is the name of the nerve which is between two central teeth of maxilla.On the other hand IAN erters mandible throuhg foramen mandibula goes down along the ramus makes 150 digree angle goes forward till it reaches the foramen between the apices of two lover premolars there divides into two branches one of which goes on through the bone and makes anastomosis of the contralateral branch of the same nerve the other branch before leaving mandible goes 5 or 4 mm.anterior makes a loop turs back and then leaves the mandible and innervates the half of the lover lip and the surrounding soft tissues.The anastomotic part innervates the lower incisisiv theeth. So if mental nerve is damaged there will be hemorragi and paresthsia of the lover lip which may open big problems to the surgeon . I think it will be helpful if we before planning treatment to revise our basic knowledge of medicine.Good Luck
GBoralsurgeon
3/5/2017
Just to follow on from this thread incisive nerve is the nerve in question . We all know about mental nerve and handling it, safety margins etc. It appears the plan will be to extract remaining natural teeth and therefore even if you went through jncisive canal it shouldn't not make any difference . It is a different question if lower anteriors remain . In this scenario if you damage the incisive nerve patient will experience tingling or numbness of lower anteriors . Just to highlight I have done few nerve repositions and the cases where incisive nerve was sacrificed the lower anteriors felt tingling down the line but not a big problem as long as patient is informed . Hope it helps

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