Position of Mental Foramen Nerve and Vulnerability to Damage During Surgery?

Hi, This can certainly become an issue if the resorption is at an advanced stage. Please look at the series of images on the following link (www.robertgougaloff.com), which shows actual mandibles at different stages of resorption (you are welcome to download those images for patient education purposes): As for the incision design, I would recommend a slightly lingualized incision, but definitely conduct a positive identification the mental foramen carefully as you approach the area with blunt dissection instruments.

It is allmost a certainty that with advanced ressorbtion you will get a mental foramen on top of the ridge(it usually bothers a lot when compressed with a regular removable prosthesis). A ligualized approach with a blunt dissection to locate the foramen is the correct approach.

It is a frequent occurrence in patients who have been edentulous for extended periods of time to have coronally dehisced mental foramina. For that and other reasons, it is crucial to have accurate 3D diagnostic images. To obtain those, you must have a stable, radiographic template with a duplicate or modified version of the same stent utilized in surgery. For that, programs like EasyGuide are excellent, not very expensive, and quite accurate. For a great overview of radiographic anatomy, look in IJPRD in the near future for an article by Dr. Robert Miller. He'll show you the anatomy you are familiar with AND many neuro and vascular bundles that aren't familiar to most of us. It really opens your eyes as to the potentials for disaster without proper imaging.

Study the patients pano, study their mouth, palpate etc. Review the procedure for a mand sub to get the feel for this important issue.

Yes, the foramen do find themselves on top of the ridge- they're visible radiographically, and palpable with your finger-usually there is little keratinized tissue at these sites- there isnt enough bone height in these cases to put implants posterior to the foramen anyhow, my advice, plan your case between the foramina- there should be some bone there thats useable- and stay away from the mental nerve--dont even go there!

You need to gain experience with cases that are less difficult. Pre surgical preparation should give you the information you are looking for. If you do not know how to get that information, you need to take surgical classes to get knowledge up to speed for this kind of procedure.

I am not sure if this site can help me or recommend a site; however, in August I had dental implant surgery. The surgeon is highly rated; however I have had constant pain in the front lower mandible area since August. It feels as if the nerves are fighting the entire process, i.e. as if the implant work is screwed in to tightly. I can count my pulse via my gumline. Cannot sleep. Advice pls. There are a total of six implants in the bottom and four on the top.

dear doctors, 2 weeks ago ı had a bad experience with 68 female pat.left mental nerve was at the top of the alveolar crest.my panoromic was not clear.during surgery ı saw right mental foramen after elevation 2 or 3 mm above the crest near premolar region.but left nerve was near left canine.due to mandibular resorbtion.ı cut left mental nerve during initial incision.from now ı promised myself get ct with problematic cases.left lip totally no sensation.5 implant were inserted to interforaminal region. ı am waiting your discussion about treating if possible mental nerve.thanks .