Concerns about nerve damage and narrow bone width during implant placement

Last week, dental implants were placed in the lower right molar area of a 61-year-old female patient.

Due to the narrow bone width, especially in the premolar area, I recommended using a bone-level implant such as the Roxolid implant.

However, due to cost constraints, we decided to proceed with a tissue-level implant instead.

Taking into consideration the limited mouth opening of the patient, as well as the occlusion and the relationship with the inferior alveolar nerve, a mid-face X-ray was captured.

Subsequently, implants with a diameter of 3.5mm were placed in the area of tooth #45, while the rest were 4.0mm in diameter.

The implants had a tissue-level neck of 2.8mm and a length of 8.5mm. The implant placement was accompanied by guided bone regeneration (GBR) techniques.

However, there is a concern for potential nerve damage in the area of tooth #47, contrary to initial expectations.

Here is a post-operative photo. Fortunately, the area of tooth #47 was placed slightly towards the lingual side, avoiding any significant risk. Additionally, the implant in the other area is not perforating through the lingual cortical bone, which is a positive outcome.

Fortunately, the patient is experiencing no significant side effects and is progressing well without any sensory disturbances after the surgery.

When the mandibular posterior region is thin, as in this case, there is a risk of penetrating the cortical bone during implant placement, as demonstrated. Therefore, it is important to exercise caution and careful surgical planning in such situations to avoid potential complications.