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IM0310

18 I I report _ inferior alveolar nerve Fig.1_Crestal route of the inferior alveolar nerve. Fig. 2_OPG before surgery. Fig. 3_Evaluation with Med 3-D software. implants3_2010 _Depending on the anatomical situation, the lateralization of the inferior alveolar nerve may be one, or perhaps the only, solution to manufacture a fixed prosthesis for a patient with a free-end situa- tion.Thisarticledescribesthesurgicaltechniqueused to minimize probable risks. _Problems If a patient with conservable residual dentition in the anterior mandibular area with a free-end situa- tion requires an implant-supported restoration, problemsmayariseregardingtherouteoftheinferior alveolarnerve.Iftherouteofthenerverunstoofarto- ward the crestal bone, or if there are already signs of atrophy in the crestal part of the jaw, a restoration with a common implant may be difficult, or even im- possible. Here are several solutions for this problem. One solution is the use of short implants (<10mm). The minimum length of common implant systems is 7–9mm. Therefore, the bottom line for a conventional implant should be calculated with a safety margin of 2mm, provided that there are ap- proximately 9–11mm of crestal bone. As observed in themandible,thesurvivalratesof8mmlongimplants are similar to the survival rates of longer implants (Grant5 2009). Another alternative is a vertical augmentation with autologous bone or allogenic materials. With respect to resorption, the long-term prognosis is controversial. Schlegel13 states a resorption rate of approximately 30 % after five years. Moreover, this solution must be excluded for those cases in which atrophyofthejawboneisnotduetoinsufficientcre- stalbone,buttothecrestalrouteoftheinferioralve- olar nerve (Fig. 1). This method requires the usage of pelvic bone, which implies a second surgery site. Probable rates of long-term complaints in this area are partially stated as 11 % (Cricchio1 2003). Another option is the osteodistraction in the lat- eralmandibulararea.Inordertoplacethedistractor cranially to the nerve canal, a minimum of 8 mm residual bone substance is necessary for the appli- cation of this technique. Here, the resorption rate is lower than in cases of vertical augmentation (Esposito2 2009). Thus, the lateralization of the inferior alveolar nerve facilitates implantation in the lateral Lateralization of the inferior alveolar nerve Author_Dr Bernd Quantius, Germany Fig. 2 Fig. 3Fig. 1