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Surgical treatment (Cont.)
Inferior alveolar nerve transposition/lateralization
| 1) |
A sufficient size of lateral cortical window to avoid too much tension
of the inferior alveolar nerve during the procedure. |
| 2) |
In order to secure bicortical anchorage of implants the cortical window
must not include the inferior border of the mandible or the superior part of alveolar process. |
| 3) |
Facilitated by simultaneous mandibular ramus sagittal split osteotomy. |
Sinus floor augmentation
Bone grafting
On-lay-veneer grafting is seldom predictable. Pronounced resorption of the graft may occur and other procedures are therefore preferred.
Donor site: Recontouring of donorsite can be accomplished by allogenic deproteinized bone covered with resorbable membrane (BioGide ®)
Take advantage of possible alternative donorsites i.e. exostosis/mandibular tori
Implant placement
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Use no more implants than necessary.
Consider extension bridge from established implant supported crown instead of implant, when space between adjacent teeth is too small. |
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Avoid too short implants in heavily loaded areas (the premolar/molar regions), and use longer implants combined with inferior alveolar nerve transposition or sinus floor augmentation. |
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In general, implant placement should be postponed until retention of orthodontic treatment has been stabilized. |
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Vertical growth of alveolar process may proceed after skeletal growth has finished, resulting in infraposition of the implant/superstructure 15 |
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