Srivastava Vandita, Bansal Rajesh, Chattopadhyay Kausik, Bansal Monika
Prosthodontics, Crown Bridge and Implantology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Centre of Advanced Study, Department of Metallurgical Engineering, Indian Institute of Technology (BHU), Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Natl J Maxillofac Surg. 2025 Jan-Apr;16(1):109-117. doi: 10.4103/njms.njms_49_24. Epub 2025 Apr 28.
Rehabilitation of the atrophic posterior mandible is very challenging because the distance between the crest of the ridge and the inferior alveolar canal (IAC) is very less. Inferior alveolar nerve bypass is a technique in which implants are placed bypassing the nerve, lingually or buccally. The objectives are to assess the bone around the mandibular canal on buccal and lingual sides and place implants in the posterior region of the atrophic mandible using the inferior alveolar nerve bypass technique.
The bone with respect to IAC in 60 sites from 10 patients was assessed on both sides of the atrophic mandible. Measurements were taken at 10 mm, 20 mm, and 30 mm from the mesial aspect of the retromolar pad. After assessment, 20 implants were placed bypassing IAC in five patients, and postoperatively, neurosensitivity test was performed. Descriptive analysis was used to compare the different measurements from the retromolar pad on the right and left sides. Unpaired 't' test was used. A value less than 0.05 was considered as statistically significant.
The distance of the bone relative to IAC was statistically insignificant on right and left sides. Neurosensitivity test was negative on the first postoperative day. However, after the first and third months, there was positive response on the right side in 80% subjects and 100% on the left side.
Dental implants were placed successfully in the atrophic mandible, bypassing the IAC. IAC is placed more lingually toward the medial border of the retromolar pad and then becomes buccally in the premolar region. Buccal bypass is safer and easier than lingual bypass due to the lingual position of IAC.
萎缩性下颌骨后部的修复极具挑战性，因为牙槽嵴顶与下牙槽神经管（IAC）之间的距离非常小。下牙槽神经旁路技术是一种将种植体放置在神经的舌侧或颊侧以绕过神经的技术。目的是评估下颌神经管颊侧和舌侧周围的骨量，并使用下牙槽神经旁路技术在萎缩性下颌骨后部植入种植体。
对10例患者60个部位萎缩性下颌骨两侧相对于下牙槽神经管的骨量进行评估。在磨牙后垫近中侧10mm、20mm和30mm处进行测量。评估后，在5例患者中绕过下牙槽神经管植入20枚种植体，术后进行神经敏感性测试。采用描述性分析比较磨牙后垫左右两侧的不同测量值。使用非配对“t”检验。P值小于0.05被认为具有统计学意义。
骨相对于下牙槽神经管的距离在左右两侧无统计学差异。术后第一天神经敏感性测试为阴性。然而，在第一个月和第三个月后，右侧80%的受试者有阳性反应，左侧为100%。
成功地在下颌骨萎缩部位绕过下牙槽神经管植入了牙种植体。下牙槽神经管更靠近舌侧，朝向磨牙后垫的内侧边缘，然后在前磨牙区变为颊侧。由于下牙槽神经管的舌侧位置，颊侧旁路比舌侧旁路更安全、更容易。
