Injury to the branches of the trigeminal (sensory) nerve can occur from a variety of mechanisms. These can include trauma, extraction of teeth, placement of dental implants, endodontic therapy, corrective jaw surgery, removal of tumors and even injection of local anesthesia.
The most commonly injured nerves are the inferior alveolar nerve, which gives feeling to the lower lip and chin, and the lingual nerve, which gives feeling and provides for taste sensation of the tongue.
These altered sensations and occasionally pain can cause undesirable changes in function and quality of life. In many situations the damaged nerve can be explored and repaired. The appropriate treatment is determined on a case-by-case basis and can include medical therapy, surgical exploration, release of scar tissue, nerve repair or nerve grafting.
In addition to nerve injury, if teeth have been absent for some time and there is loss of bone in the lower jaw, the inferior alveolar nerve may need to be moved in order to make room for placement. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar, with the above-mentioned bone loss. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other, less aggressive options are considered first.
Typically, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area and slightly pull it out to the side. At the same time, we will place the implants. Then the nerve bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeon’s choice and the area is closed.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.
These surgeries can be performed in our office surgical suite under IV sedation or general anesthesia but are most commonly performed in the hospital. After discharge, bed rest is recommended for one day and limited physical activity for one week.
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