Adjunct Professor, Nhan Tam Dental Clinic, Hong Bang International University, Ho Chi Minh City, Vietnam.
Fellow, Department of Periodontics, UCLA School of Dentistry, Los Angeles, CA.
J Oral Maxillofac Surg. 2021 Apr;79(4):813.e1-813.e11. doi: 10.1016/j.joms.2020.11.027. Epub 2020 Dec 2.
This case report describes an unusual case of implant treatment after contralateral inferior alveolar nerve transposition (IANT) on a unilateral reconstructed mandible due to gunshot trauma with a 7-year follow-up. The patient had an edentulous atrophic mandible and underwent large bone reconstruction on the left side. The irregular passage of the right inferior alveolar nerve was within 1-2 mm of the superior aspect of the mandible, passed through the midline, and was nearly exposed under the oral mucosa at the left anterior part of the mandible, which prevented the placement of conventional implants. Consequently, right IANT followed by iliac onlay bone grafting was undertaken under general anesthesia to create a sufficient bone volume for implant placement. Four implants were installed simultaneously on the augmented bone. After a 2-month waiting period, soft tissue graft placement and vestibuloplasty were performed. The patient was scheduled for a continuous follow-up for the next 7 years. After 3 years, the bar-retained supporting system was replaced with the new CAD/CAM milled bar system on the same 4 implants. The 4 implants presented good initial stability (>35 N/cm), and radiographic evaluation showed osseointegration around all 4 implants. The patient experienced lip numbness in the first 5 days postoperatively but recovered by 97% after 2 months. After a 7-year follow-up, the result remained satisfactory with no sign of bone loss around any of the 4 implants, and the prosthesis functioned well and was stable and esthetically satisfactory. In conclusion, an immediate implant placement procedure after a complex surgery involving unilateral IANT and iliac onlay bone grafting remains challenging, especially when the patient has extensive bone defects or an atrophic mandible. However, a successful long-term outcome can be achieved with appropriate perioperative and postoperative care.
本病例报告描述了一例因枪伤导致单侧重建下颌骨对侧下牙槽神经移位（IANTD）后进行种植治疗的罕见病例，随访时间为 7 年。患者下颌骨无牙且萎缩，左侧行大骨重建。右侧下牙槽神经不规则通过下颌骨上 1-2mm，穿过中线，几乎在左侧下颌骨前部的口腔黏膜下暴露，这使得常规种植体无法放置。因此，在全身麻醉下进行右侧 IANTD 及髂骨骨板移植术，以创造足够的骨量进行种植体植入。在增强的骨上同时植入了 4 颗种植体。经过 2 个月的等待期，进行了软组织移植和前庭成形术。患者计划在接下来的 7 年内进行连续随访。3 年后，在同一 4 个种植体上更换为新的 CAD/CAM 铣削杆系统，以取代杆式固位支撑系统。这 4 个种植体具有良好的初始稳定性（>35N/cm），影像学评估显示所有 4 个种植体周围均实现了骨整合。患者术后 5 天内出现唇部麻木，但在 2 个月后恢复了 97%。经过 7 年的随访，4 个种植体周围均无骨吸收迹象，修复体功能良好，稳定且美观满意度高，结果仍然令人满意。总之，在涉及单侧 IANTD 和髂骨骨板移植的复杂手术后立即进行种植体植入仍然具有挑战性，尤其是当患者存在广泛的骨缺损或下颌骨萎缩时。然而，通过适当的围手术期和术后护理，可以实现成功的长期效果。
