Guided Inferior Alveolar Nerve Lateralization and Simultaneous Implant Placement Using a Tooth-Supported Surgical Guide: A Case Report and Literature Review

Guided Inferior Alveolar Nerve Lateralization and Simultaneous Implant Placement Using a Tooth-Supported Surgical Guide: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Guided Inferior Alveolar Nerve Lateralization and Simultaneous Implant Placement Using a Tooth-Supported Surgical Guide: A Case Report and Literature Review Touraj Vaezi, Ali Mirzaei, Alireza Ebrahimpour This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7447762/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Treating severe posterior mandibular bone resorption with dental implants is challenging due to the proximity of the inferior alveolar nerve (IAN). While IAN lateralization creates space for implants, it carries a high risk of nerve damage. This report introduces a novel approach: a single, digitally designed surgical guide that precisely facilitates both the IAN lateralization osteotomy and immediate implant placement, aiming to significantly reduce neurosensory complications and enhance procedural efficiency. Case Presentation This report details the case of a patient presenting severe vertical bone deficiency in the posterior mandible. Utilizing cone-beam computed tomography and digital scans, a custom tooth-supported surgical guide was fabricated. This guide facilitated a combined, precise procedure performed under local anesthesia: a guided osteotomy for IAN lateralization using a piezoelectric device, followed by the immediate placement of two dental implants while the nerve was protected. Subsequently, the IAN was carefully repositioned, and the surgical site was closed. The patient experienced uneventful healing with no permanent nerve injury. Conclusions This case demonstrates the successful and safe application of a novel, fully guided technique for simultaneous IAN lateralization and immediate implant placement. This precision-guided method offers unprecedented accuracy in osteotomy and implant positioning, potentially reducing operative time and minimizing IAN risk. It presents a superior alternative to traditional extensive bone grafting or short implants for severe mandibular atrophy, paving the way for safer and more predictable outcomes in complex cases. Clinical trial number: not applicable. Dental Implants Mandible Nerve Transfer Computer-Assisted Surgery Cone-Beam Computed Tomography Piezoelectric Surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Rehabilitation of the posterior mandible with dental implants can be challenging when advanced ridge resorption leaves minimal bone above the inferior alveolar canal [1]. In such cases, the risk of injuring the inferior alveolar nerve (IAN) during implant osteotomy is high [2]. Traditional solutions include vertical ridge augmentation or use of short implants [3], but each has limitations. Short implants can often achieve high survival rates in moderately atrophic jaws [4], yet they require sufficient residual bone and may compromise crown-root ratios. An alternative strategy involves repositioning the IAN to gain vertical bone height for standard-length implants [5]. Techniques such as IAN lateralization (IANL) and transposition (IANT) have been utilized for decades in these scenarios IANL involves careful lateral mobilization of the nerve bundle, whereas IANT requires nerve transposition, often including mental nerve release [5]. Although these procedures permit longer implant placement in native bone, they carry an inherent risk of neurosensory disturbance (e.g., numbness of the lower lip and chin) [6]. A recent systematic review confirmed high implant survival (mean ~90%) but frequent transient IAN neuropathy with nerve repositioning [5], Notably, permanent deficits were significantly lower with IANL (~6%) compared to IANT (up to 15%), establishing IANL as the preferred approach when feasible [5]. To mitigate the surgical risks associated with freehand nerve manipulation, computer-guided techniques offer enhanced precision [7]. Such precision is particularly valuable, as anthropometric studies have revealed marked variability in facial indices between ethnic groups [8] , and CBCT-based investigations have further demonstrated the ability to detect subtle maxillofacial bony variations and correlate them with clinical findings, underscoring the importance of region-specific anatomical considerations during digital planning [9]. Static guided surgery employs pre-fabricated stereolithographic guides to accurately transfer virtual plans to the surgical site [10]. Meta-analyses report mean implant placement deviations around 1–1.5 mm and angular errors of ~3° [11]. While clinically acceptable, a safety margin of ~2 mm from vital structures like the IAN remains advisable [11, 12]. Guided implantation yields survival rates comparable to conventional methods (91–100% after 1–5 years) [11], adding the benefit of predictable positioning and potentially reducing complications from improper angulation or nerve encroachment [13]. In partially edentulous situations, tooth-supported guides provide superior stability and accuracy compared to mucosa-supported guides, leveraging anchorage from remaining teeth [14]. Studies confirm higher placement precision with tooth-supported designs [14, 15]. Recent innovations integrate guided surgery with nerve lateralization [6]. Atef et al. [1] reported using a custom 3D-printed guide for precise lateral window osteotomy and simultaneous implant placement, noting reduced surgical time and nerve injury risk compared to traditional methods. Furthermore, piezoelectric surgery, utilizing ultrasonic micro-vibrations for precise osteotomies with minimal soft tissue trauma, has been advocated for safer IANL [16]. A prospective study employing piezoelectric IANL demonstrated complete sensory recovery in 85% of patients by 3 months with no implant failures [17]. These advances highlight the trend towards guided, minimally invasive nerve management. However, optimizing the seamless integration of guided IANL osteotomy and immediate guided implant placement using a single surgical template—particularly capitalizing on the stability of tooth-supported guides—represents an ongoing refinement. This report addresses this challenge by presenting a clinical case employing a single, tooth-supported static surgical guide meticulously designed to direct both the IAN lateralization osteotomy and subsequent immediate implant placement. While Atef et al. [1] also used a guide for both steps, the specific novelty here lies in harnessing the enhanced stability and predictable precision of tooth anchorage within one integrated template to guide this complex, combined procedure. This approach represents a refinement aimed at maximizing accuracy and safety during simultaneous IANL and implant placement, addressing the need for highly precise, integrated techniques, especially in partially edentulous scenarios. The patient’s clinical presentation, surgical technique, and outcomes are detailed and discussed within the context of current literature. Case Presentation A 60-year-old female patient presented with functional impairment due to missing teeth in the posterior right mandible, a region of long-term edentulism at tooth 46 and a periodontally compromised tooth 45. Clinical examination revealed a severely resorbed alveolar ridge in the area of the right mandibular second premolar and first molar (teeth 45 and 46). Tooth 45 was deemed hopeless and scheduled for extraction as part of the implant surgery. The overlying mucosa appeared intact and healthy, and the adjacent teeth were present and deemed suitable for supporting a surgical guide. The patient’s medical history was unremarkable, with no reported systemic conditions known to interfere with bone healing or the success of dental implants. Following a comprehensive discussion of all available treatment options, including guided bone regeneration techniques for ridge augmentation and the potential use of short dental implants, the patient ultimately opted for a surgical approach involving extraction of tooth 45 and IAN lateralization at site 46. This decision was primarily driven by the desire to receive standard-length dental implants, which were considered to offer a more predictable and durable long-term outcome in the context of the severely resorbed alveolar ridge. Prior to proceeding, thorough informed consent was obtained from the patient, ensuring she understood the details of the planned procedure, including the potential risks and benefits, with specific emphasis on the possibility of temporary or, in rare cases, permanent altered sensation in the distribution of the inferior alveolar nerve, affecting the lower lip and chin. Preoperative CBCT revealed severe vertical bone deficiency in the right posterior mandible: tooth 46 was missing with severe ridge atrophy, while tooth 45, though present, showed insufficient bone for predictable implant placement and was planned for extraction and immediate implant placement. Cross-sectional views showed approximately 5 mm of bone height from the crest to the superior border of the IAN canal at site 45, and about 6 mm at site 46. The IAN canal ran close to the alveolar crest, and the ridge width measured approximately 7 mm, which was adequate for standard-diameter implants if the nerve was lateralized at site 46 . (Figures 1 and 2) Written informed consent for publication of clinical details and images was obtained from the patient. Based on the detailed data obtained from the CBCT scan and the optical intraoral scan of the patient’s dental arch, a precise digital workflow was initiated. The DICOM and STL files were merged and processed using Mimics Innovation Suite 21 (Materialise NV, Leuven, Belgium) to map the three-dimensional course of the inferior alveolar nerve. The virtual implant positions were then planned using 3Shape Implant Studio (version 2021, 3Shape A/S, Copenhagen, Denmark), with two standard-diameter implants virtually planned: a Ø3.8 × 8.5 mm implant at site 45 and a Ø4.0 × 7 mm implant at site 46 (UF(II) Series, DIO, Busan, South Korea), ensuring parallelism and prosthetically driven angulation in relation to the mapped course of the nerve. The osteotomy outline for inferior alveolar nerve access was designed separately using Autodesk Freeform software (Autodesk Inc., USA), based on anatomical landmarks and nerve mapping. The final composite design, including both the implant guidance channels and lateral corticotomy outline, was exported into CHITUBOX V1.9.5 (CHITUBOX, China) for 3D print preparation. A single, tooth-supported surgical guide was fabricated using a Phrozen Sonic Mighty 8K 3D printer (Phrozen Inc., Hsinchu, Taiwan) with biocompatible Surgical Guide Resin (JamgHe, China). The guide was designed without metal sleeves; instead, the channels for the implant drills were digitally sculpted within the resin body itself, providing accurate trajectory control during osteotomy. (Figure 3a,b) Prior to the procedure, the patient was evaluated and cleared by an anesthesiologist following standard preoperative assessment. Routine preoperative laboratory tests, including complete blood count, coagulation profile, and metabolic panel, were obtained and confirmed to be within normal limits. The patient was admitted to the hospital and prepared in a sterile operating room setting. Standard aseptic protocols were followed, including skin disinfection and sterile draping of the surgical field. General anesthesia was administered by an anesthesiology team using a balanced anesthetic technique, and the patient was maintained under controlled ventilation throughout the procedure. Following induction, local infiltration with lidocaine 2% containing epinephrine 1:100,000 was performed at the surgical site to provide hemostasis and postoperative analgesia. After confirming profound anesthesia and hemostasis, a full thickness mucoperiosteal flap was raised in the right posterior mandible. A mid-crestal incision was made along the edentulous ridge, extending mesially with a vertical releasing incision from tooth 43 to allow adequate access to the buccal mandibular cortex. Flap elevation extended from the right canine to the retromolar area. During the flap reflection, the mental nerve was visualized, and meticulous care was taken to protect it throughout the surgical procedure. Tooth 45 was extracted, and then the tooth-supported surgical guide was carefully seated over the occlusal surfaces of tooth 44 and extended distally over the edentulous ridge. Its stability was confirmed by a precise passive fit, and due to adequate support on both the remaining tooth and the retromolar pad, no fixation screws were necessary. The guide incorporated a lateral rectangular opening designed to provide a visual outline of the planned osteotomy site for inferior alveolar nerve access. Unlike prefabricated bone windows, this design did not dictate a fixed corticotomy shape but instead served as a reference template for intraoperative execution. Using the visible borders of this outlined window as a guide, a piezoelectric bone surgery unit (Surgic Smart, Woodpecker, Guilin, China) equipped with a fine saw tip was applied directly to the buccal cortex. The osteotomy was performed by carefully tracing the piezoelectric tip along the borders defined by the guide opening, creating a precise rectangular corticotomy in situ. The superior and inferior horizontal cuts were planned to remain approximately 2 mm above and below the estimated position of the inferior alveolar nerve canal. The anterior and posterior vertical corticotomy cuts extended from the distal root region of tooth 44 to the mesial edge of the ascending ramus. Using the piezosurgery unit allowed precise cutting with diminished risk of accidental laceration of the nerve or its vessels, as the ultrasound-mediated cutting selectively affected mineralized tissue [16]. Once the cortical cuts were complete, a small straight chisel was used to gently wedge and detach the rectangular bone segment. The corticotomy piece was carefully removed, exposing the underlying IAN encased in a thin layer of spongy bone and canal lining. With the canal unroofed, the inferior alveolar neurovascular bundle was visible. The inferior alveolar nerve was then carefully lateralized. Under copious irrigation, the nerve bundle was gently freed from the bony canal using a small periosteal elevator, and a sterile elastic surgical tape (Silicone Nerve and Vessel Loops, Medline Industries, USA) was placed around the nerve to retract it laterally and create a safe corridor. With the nerve lateralized at site 46, the surgical guide was repositioned, and implant site preparation began. A sequential drilling protocol was performed through the guide’s integrated resin-formed channels to prepare osteotomies at sites 45 and 46. Profuse irrigation was applied throughout drilling to reduce thermal transfer to the retracted nerve. A Ø3.8 × 8.5 mm implant (UF(II) Series, DIO, South Korea) was inserted at site 45 (fresh extraction socket), and a Ø4.0 × 7 mm implant (UF(II) Series, DIO, South Korea) at site 46 with torque values under 15 Ncm, consistent with limited bone resistance in IAN lateralization cases. Although low, primary stability was deemed sufficient for submerged healing. [16]. A manual palpation confirmed the canal was clear of the planned drilling trajectory. Following implant insertion, particulate bone graft was placed around the implants and covered with a resorbable collagen membrane. The IAN was then carefully repositioned over the implants, and a second collagen membrane was applied above the nerve. Additional particulate bone graft was added, after which the cortical bone window was repositioned and stabilized. Finally, another collagen membrane was laid to cover the entire site. Tension-free closure was achieved by scoring the periosteum at the flap base and advancing the flap; The flap was secured using interrupted 4-0 braided polyglycolic acid (P.G.A.) absorbable sutures (PezeshkYaran, Iran). Postoperatively, the patient was prescribed antibiotics (amoxicillin 500 mg TDS for 7 days) and NSAIDs for pain control, along with oral corticosteroids (dexamethasone 4 mg for 2 days) and Vitamin B complex to support nerve recovery. Intraoperatively, after implant placement and nerve repositioning, a segment of harvested lingual cortical bone was adapted and grafted to the buccal aspect of the osteotomy site. This step was performed to help restore and preserve the transverse dimension of the ridge, ensuring sufficient buccolingual bone volume around the implants and enhancing long-term stability. The immediate postoperative course was uneventful. The patient reported mild numbness in the right lower lip and chin on the first postoperative day, consistent with neurapraxia from manipulation of the IAN. However, there were no signs of active nerve laceration (sharp pain or hematoma). By two weeks post-surgery, the patient noted significant improvement in sensation, and light-touch and pin-prick tests confirmed near-normal sensory response in the IAN distribution. At the 1-month follow-up, the patient’s inferior alveolar nerve function had fully returned to baseline (no residual paresthesia), indicating successful nerve preservation. The patient was advised to return for follow-up appointments, but due to personal circumstances, she did not attend further visits. Consequently, no post-operative clinical or radiographic images were obtained. However, based on intraoperative assessment and immediate postoperative recovery, the procedure was considered successful, with the patient reporting resolution of transient hypoesthesia and satisfactory oral function during remote follow-up communication. The case illustrates a successful outcome for digitally guided lateralization at site 46, with immediate and delayed implant placement, respectively, using a single tooth-supported guide to accomplish both aspects of the surgery. Systematic Literature Review A systematic search was conducted across four major electronic databases: PubMed, Cochrane Library, Web of Science, and Scopus up to July 2025, to identify clinical studies related to computer-guided inferior alveolar nerve (IAN) lateralization, repositioning, or transposition with simultaneous dental implant placement. The search strategy combined controlled vocabulary and free-text terms related to the inferior alveolar nerve, dental implants, and digital/computer-guided surgery. Search formulas specific to each database, inclusion & exclusion criteria are provided in Supplementary Files. Summary of the Included Studies: Atef and Mounir [1] introduced a computer-guided method for inferior alveolar nerve (IAN) lateralization with simultaneous implant placement. The study included seven patients who had less than 8 mm of bone height above the IAN in the posterior mandible. The surgeons used customized 3D-printed surgical guides based on CT scans to mark the buccal cut and to guide the placement of the implants. All patients recovered without complications. Any temporary neurosensory issues went away completely within three weeks, and no permanent IAN damage was reported. After six months, all implants were stable and had been successfully restored. The authors concluded that guided IAN lateralization is a feasible and safe option that improves surgical accuracy and reduces risks. Metawie et al. [16] conducted a randomized clinical trial on twenty patients with severely atrophic posterior mandibles. The patients were divided into two groups: one received computer-guided IAN lateralization with repositioning of the osteotomy window, while the other received the same procedure with "sticky bone" augmentation. In both groups, customized 3D-printed surgical guides were used for nerve window preparation and implant placement. All patients had temporary neurosensory disturbances after surgery, but fully recovered within six months. The implant survival rate was 100% in both groups, and improvements were seen in stability, bone density, and marginal bone levels. The authors concluded that both techniques are safe and effective, with comparable overall outcomes, though the sticky bone method led to a slightly faster neurosensory recovery. In a single case report, Li et al. [6] documented a case of bilateral inferior alveolar nerve (IAN) lateralization with simultaneous implant placement. The procedure integrated 3D-printed preoperative models for surgical simulation and the adjunctive use of concentrated growth factor (CGF) to promote nerve healing. The patient demonstrated complete neurological recovery within two months, and at a 6.5-year follow-up, stable implant osseointegration and regeneration of the IAN canal wall were observed. This case highlights the significant role of digital planning and biomaterial adjuncts in improving surgical precision and long-term neurosensory outcomes. Together, these studies emphasize that digital planning and computer-guided approaches for IAN lateralization are feasible and safe, with predictable implant survival and largely reversible neurosensory disturbances. They collectively support the use of guided nerve lateralization as a viable alternative to traditional freehand surgery for the rehabilitation of severely atrophic posterior mandibles. Discussion The management of severely resorbed posterior mandibles presents a significant challenge in implant dentistry, often requiring either extensive ridge augmentation procedures or alternative strategies to safely circumvent the inferior alveolar nerve. This case report details the successful implementation of inferior alveolar nerve lateralization concurrently with computer-guided implant placement, providing a single-stage solution for these challenging clinical situations. A pivotal element of this approach is the novel utilization of a singular, tooth-supported surgical guide to meticulously coordinate both the osteotomy for nerve lateralization and the subsequent implant insertion, thereby seeking to optimize precision and patient safety. Traditionally, managing an atrophic posterior mandible for implant placement often involves onlay bone grafts or interpositional grafting techniques, such as a "sandwich" osteotomy, to achieve adequate vertical bone height [ 18 ]. Alternatively, the use of shorter dental implants could be considered to avoid the nerve canal. However, bone augmentation procedures are associated with drawbacks including increased treatment duration, potential donor site morbidity, and unpredictable graft resorption rates. While less invasive, short implants may exhibit biomechanical limitations, particularly in the long term, and are frequently unsuitable for cases of extreme bone resorption, such as the less than 6 mm of vertical bone height observed in the presented case [ 4 ]. IAN lateralization provides a more immediate solution by strategically utilizing the native bone present below the nerve canal. The intentional displacement of the IAN to enable dental implant placement constitutes a recognized surgical procedure. Notably, Peleg et al. elucidated a sophisticated technique for IAN lateralization coupled with simultaneous implant insertion, thereby illustrating the practicability of placing implants in significantly atrophic ridges within a single surgical intervention alongside nerve relocation [ 19 ]. These findings, corroborated by subsequent investigations, demonstrate high implant success rates with this approach, despite the frequent occurrence of transient neurosensory deficits. Consistent with this evidence, the presented case incorporated simultaneous implant placement, thereby eliminating the necessity for a second surgical procedure and limiting nerve manipulation to a single episode. A significant advantage of immediate implant placement alongside nerve lateralization is the diminished duration of nerve retraction and the prevention of repeated retraction episodes. Following secure implant placement, the nerve can be meticulously repositioned, facilitating undisturbed healing. This strategy is substantiated by prior research indicating that a one-stage nerve lateralization procedure with concurrent implant placement can achieve dependable implant survival rates and high patient satisfaction [ 5 ]. In this case, the use of a stereolithographic surgical guide significantly enhanced accuracy and predictability, aspects that prove challenging to attain with conventional freehand methods. Performing IAN lateralization without a guide is a highly sensitive procedure, an incorrectly placed osteotomy risks either inadequate nerve exposure or, more severely, direct nerve trauma. Our approach involved meticulous preoperative planning of the osteotomy via CBCT imaging, followed by its precise execution using a computer-generated surgical guide and a piezoelectric device. This strategy was designed to ensure the created bone window was optimally aligned with the nerve canal, minimizing any deviation from the planned position. Atef and Mounir's preliminary investigation into computer-guided IAN lateralization similarly concluded that a 3D-printed surgical guide could precisely determine the lateral bone window's location, potentially reducing intraoperative time and nerve damage risk [ 1 ]. Our experience in this case strongly corroborates their findings. A key concern associated with surgical manipulation of the inferior alveolar nerve (IAN) is the potential for either temporary or permanent paresthesia in its distribution. Consistently, the available literature indicates that most patients undergoing IAN lateralization will experience some immediate postoperative numbness in the affected area [ 5 ]. Our patient did experience mild hypoesthesia of the right lower lip immediately following the surgical procedure. Nevertheless, this neurosensory deficit was temporary and fully resolved within a month of the operation. This positive neural outcome can likely be attributed to multiple contributing factors. Among these, the utilization of piezoelectric surgery for the corticotomy is recognized for its ability to reduce mechanical and thermal stress on nerves, a benefit derived from its highly precise, controlled, and vibration-limited cutting mechanism, in contrast to traditional rotary instruments. [ 16 ]. Moreover, our surgical approach in this instance involved inferior alveolar nerve (IAN) lateralization, a technique where the nerve is carefully shifted laterally within its canal. This was favored over IAN transposition, which would have required dislocating the nerve from the mental foramen or detaching the mental nerve. This procedural choice is clinically significant, as existing research indicates a greater propensity for persistent neuropathy following IAN transpositions when compared to lateralization procedures [ 5 ]. Our finding of full sensation recovery in this case corroborates other published reports that underscore the significance of precise surgical execution. For example, Freire et al. presented a case of IAN lateralization performed with piezosurgery where the nerve was meticulously retracted and then carefully released, resulting in no observed permanent nerve deficits [ 16 ]. In a larger case series by de Vicente et al. the majority of patients (11 out of 13 cases) experienced a complete return to normal sensation within 3 months postoperatively [ 17 ], suggesting that predictable nerve function recovery is possible when compression and traction on the nerve are minimized during surgery. Our findings highlight the critical necessity of precise surgical technique, specifically slow and controlled piezoelectric bone cuts, minimal nerve traction or compression, consistent nerve hydration during surgery, and timely release of nerve retraction post-implant insertion for achieving optimal neural recovery. This case report strengthens the existing literature by demonstrating that, despite the increased complexity posed by guided implant drilling after nerve lateralization, the nerve can be effectively safeguarded, resulting in successful and uneventful restoration of sensory function. A multicenter study by Deryabin et al. found ~ 98% implant survival at 5 years when implants were placed in conjunction with IAN repositioning, although one case of mandibular fracture was noted out of 15 patients [ 20 ]. In the presented patient, only a unilateral procedure was performed, and the residual bone after the lateral window remained sufficient to maintain mandibular integrity, thus minimizing the risk of pathological fracture. The primary novelty of this case lies in the seamless integration of inferior alveolar nerve lateralization and implant placement into a fully guided surgical workflow utilizing a single, tooth-supported surgical guide. While a few previous reports have described the use of custom-fabricated guides for IAN lateralization [ 1 ], our case further reinforces the feasibility and clinical applicability of this concept in a real-world setting. The tooth-supported surgical guide provided superior precision and confidence, ensuring accurate execution of both the nerve osteotomy and implant placement according to the digital plan. This method reduces surgical errors and decision-making demands, as the guide dictates bone window location and implant angulation. Its innovative dual function—guiding both nerve access and implant trajectories—enhances efficiency by eliminating multiple guide changes. This guided approach to IAN lateralization could expand its indications, making the procedure safer and more predictable for clinicians, especially in complex scenarios where anatomical landmarks are obscured or multiple implants are planned near the inferior alveolar nerve. Digital preplanning further enables surgeons to identify and mitigate potential challenges in advance. Despite the positive outcome, this single case report has limitations. A comparative study with a larger cohort would better assess the guided approach's true benefit over freehand nerve lateralization. Furthermore, custom guide fabrication demands specialized software and expertise, and the associated digital planning and 3D printing can increase treatment costs. However, as digital dentistry advances, these guides may become more accessible and cost-effective. It is crucial to note that the guide aids, but does not replace surgical skills, particularly in delicate nerve handling and managing unexpected intraoperative findings. While our small, tooth-supported guide provided adequate access, larger bone-supported guides in edentulous cases might present challenges with reduced visibility and access. In this case, the patient did not attend in-person follow-up visits and no post-operative clinical or radiographic images were obtained. The favorable prognosis was based on intraoperative findings, immediate postoperative recovery, and patient-reported functional satisfaction during remote communication. The patient reported satisfaction with the functional and sensory outcomes and appreciated that the procedure was completed in a single surgical stage. Conclusion Guided implant surgery with simultaneous nerve lateralization presents a promising solution for severely resorbed posterior mandibles. This case illustrates how a tooth-supported 3D-printed surgical guide facilitates precise IAN corticotomy and accurate implant placement in a single, efficient procedure. The technique demonstrated successful osseointegration and complete nerve recovery, highlighting its potential safety and efficacy. This innovative combined guide streamlines the workflow, reducing surgical time and uncertainty, and offers clinicians a valuable alternative to conventional methods. Emphasizing meticulous digital planning and careful nerve handling, guided IAN lateralization could significantly expand implant treatment boundaries in atrophic jaws, providing improved patient outcomes through a single-stage, precision-guided approach. Abbreviations CBCT: Cone-Beam Computed Tomography IAN: Inferior Alveolar Nerve IANL: Inferior Alveolar Nerve Lateralization IANT: Inferior Alveolar Nerve Transposition P.G.A.: Polyglycolic Acid Declarations Ethics approval and consent to participate This study reports a single patient case and did not require formal ethical approval according to the guidelines of the Ethics Committee of Mashhad University of Medical Sciences. Written informed consent to participate was obtained from the patient. No committee reference number was applicable. Clinical trial number: not applicable. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Availability of data and materials The datasets supporting the conclusions of this article are included within the article and its additional files. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Authors’ contributions TV: Surgical treatment and manuscript revision. AM: Literature review, drafting of the manuscript. AE: Surgical treatment, and corresponding author duties. All authors read and approved of the final manuscript. Acknowledgments The authors wish to thank the staff of the Department of Oral and Maxillofacial Surgery, Mashhad University of Medical Sciences, for their assistance. AI Use Declaration The authors declare that large language models (ChatGPT, GPT-5, OpenAI; Gemini, Google DeepMind) were used to assist with language refinement and paraphrasing during manuscript preparation. The authors reviewed, edited, and take full responsibility for the final content of this article. 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Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances. Int J Implant Dent. 2021;7(1):44. doi:10.1186/s40729-021-00334-x Additional Declarations No competing interests reported. Supplementary Files CARE.pdf Additionalfile1Surgicalguidedesignviews.stl.zip Additional file 1: Surgical guide design views (.stl) — lateral and occlusal renderings of the planned guide [related to Figure 3]. Additionalfile2PreoperativeCBCTDICOMdataset.zip Additional file 2: Preoperative CBCT DICOM dataset (.zip) — full pre-surgical scan used for digital planning. Additionalfile3SearchStrategiesforSystematicLiteratureReview.docx Additional file 3: Search Strategies for Systematic Literature Review Additionalfile4InclusionandExclusionCriteriaforSystematicLiteratureReview.docx Additional file 4: Inclusion and Exclusion Criteria for Systematic Literature Review Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7447762","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":522561476,"identity":"fa8924fd-f058-4a63-971b-3a49d0d36e48","order_by":0,"name":"Touraj Vaezi","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Touraj","middleName":"","lastName":"Vaezi","suffix":""},{"id":522561478,"identity":"9bc34685-24da-4eeb-aed6-60c6f000bf66","order_by":1,"name":"Ali Mirzaei","email":"","orcid":"","institution":"Mashhad University of Medical 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1","display":"","copyAsset":false,"role":"figure","size":1727885,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative panoramic radiograph demonstrating severe vertical bone loss in the right posterior mandible, with missing tooth 46 and compromised tooth 45.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/5150bd5e7cd36bace2df3692.png"},{"id":92680113,"identity":"c5e7fbeb-7fd1-4bfa-a93f-222def5cf76f","added_by":"auto","created_at":"2025-10-03 01:03:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":917100,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative cone-beam computed tomography (CBCT) images. Top: panoramic and axial reconstructions. Bottom: cross-sectional slices reveal limited bone height above the inferior alveolar nerve canal at sites 45 and 46.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/2076d095a596b28bfd47a475.png"},{"id":92680117,"identity":"51c8d173-6683-4bf0-bc61-1ec0ed8de200","added_by":"auto","created_at":"2025-10-03 01:03:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":403124,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Lateral view of the digital design for the tooth-supported surgical guide, showing the integrated osteotomy outline for inferior alveolar nerve access. (b) Occlusal view of the same guide, illustrating alignment over the arch and planned osteotomy/implant channels.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/0c398f1e3e2e5f2abe325625.png"},{"id":92680124,"identity":"1d48f0a0-99ad-4e61-ac3d-11904bef0f35","added_by":"auto","created_at":"2025-10-03 01:03:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":199354,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram of study selection, showing 39 records identified, 24 screened, and 3 study included.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/08641272b011e445e156d035.png"},{"id":92850111,"identity":"c66dc872-8824-41f7-828b-7bb4182ff05f","added_by":"auto","created_at":"2025-10-06 10:32:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4813243,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/00022fed-3584-4ce8-bc58-861b13b4e205.pdf"},{"id":92680115,"identity":"037c1574-3c57-483c-a3d6-21829eda28b0","added_by":"auto","created_at":"2025-10-03 01:03:00","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":585048,"visible":true,"origin":"","legend":"","description":"","filename":"CARE.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/ae8d7f46cb9be0c78c5edf20.pdf"},{"id":92680141,"identity":"5f9919f6-6cb1-415b-bc1d-4a6624f1a096","added_by":"auto","created_at":"2025-10-03 01:03:01","extension":"zip","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":34893404,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1: Surgical guide design views (.stl) — lateral and occlusal renderings of the planned guide [related to Figure 3].\u003c/p\u003e","description":"","filename":"Additionalfile1Surgicalguidedesignviews.stl.zip","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/70180fd2755558547f562cac.zip"},{"id":92680140,"identity":"a2bd5992-085e-47be-bd0a-4208a08a88ff","added_by":"auto","created_at":"2025-10-03 01:03:01","extension":"zip","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":17363296,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 2: Preoperative CBCT DICOM dataset (.zip) — full pre-surgical scan used for digital planning.\u003c/p\u003e","description":"","filename":"Additionalfile2PreoperativeCBCTDICOMdataset.zip","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/6c1494d8b558f024ae226ff1.zip"},{"id":92680130,"identity":"c8634a5e-ea85-4e92-b69a-1c2691a21dc1","added_by":"auto","created_at":"2025-10-03 01:03:00","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":27283,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 3: Search Strategies for Systematic Literature Review\u003c/p\u003e","description":"","filename":"Additionalfile3SearchStrategiesforSystematicLiteratureReview.docx","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/56d86eb645678d27cba685d8.docx"},{"id":92680119,"identity":"266cd041-b775-4a12-9143-f2f2a1969d8a","added_by":"auto","created_at":"2025-10-03 01:03:00","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":37237,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 4: Inclusion and Exclusion Criteria for Systematic Literature Review\u003c/p\u003e","description":"","filename":"Additionalfile4InclusionandExclusionCriteriaforSystematicLiteratureReview.docx","url":"https://assets-eu.researchsquare.com/files/rs-7447762/v1/7464cf332ee6435c46b22580.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Guided Inferior Alveolar Nerve Lateralization and Simultaneous Implant Placement Using a Tooth-Supported Surgical Guide: A Case Report and Literature Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRehabilitation of the posterior mandible with dental implants can be challenging when advanced ridge resorption leaves minimal bone above the inferior alveolar canal [1]. In such cases, the risk of injuring the inferior alveolar nerve (IAN) during implant osteotomy is high [2]. Traditional solutions include vertical ridge augmentation or use of short implants [3], but each has limitations. Short implants can often achieve high survival rates in moderately atrophic jaws [4], yet they require sufficient residual bone and may compromise crown-root ratios.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn alternative strategy involves repositioning the IAN to gain vertical bone height for standard-length implants [5]. Techniques such as IAN lateralization (IANL) and transposition (IANT) have been utilized for decades in these scenarios\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIANL involves careful lateral mobilization of the nerve bundle, whereas IANT requires nerve transposition, often including mental nerve release [5]. Although these procedures permit longer implant placement in native bone, they carry an inherent risk of neurosensory disturbance (e.g., numbness of the lower lip and chin) [6]. A recent systematic review confirmed high implant survival (mean ~90%) but frequent transient IAN neuropathy with nerve repositioning [5], Notably, permanent deficits were significantly lower with IANL (~6%) compared to IANT (up to 15%), establishing IANL as the preferred approach when feasible [5].\u003c/p\u003e\n\u003cp\u003eTo mitigate the surgical risks associated with freehand nerve manipulation, computer-guided techniques offer enhanced precision [7]. Such precision is particularly valuable, as anthropometric studies have revealed marked variability in facial indices between ethnic groups [8] , and CBCT-based investigations have further demonstrated the ability to detect subtle maxillofacial bony variations and correlate them with clinical findings, underscoring the importance of region-specific anatomical considerations during digital planning [9]. Static guided surgery employs pre-fabricated stereolithographic guides to accurately transfer virtual plans to the surgical site [10]. Meta-analyses report mean implant placement deviations around 1\u0026ndash;1.5 mm and angular errors of ~3\u0026deg; [11]. While clinically acceptable, a safety margin of ~2 mm from vital structures like the IAN remains advisable [11, 12]. Guided implantation yields survival rates comparable to conventional methods (91\u0026ndash;100% after 1\u0026ndash;5 years) [11], adding the benefit of predictable positioning and potentially reducing complications from improper angulation or nerve encroachment [13].\u003c/p\u003e\n\u003cp\u003eIn partially edentulous situations, tooth-supported guides provide superior stability and accuracy compared to mucosa-supported guides, leveraging anchorage from remaining teeth [14]. Studies confirm higher placement precision with tooth-supported designs [14, 15].\u003c/p\u003e\n\u003cp\u003eRecent innovations integrate guided surgery with nerve lateralization [6]. Atef et al. [1] reported using a custom 3D-printed guide for precise lateral window osteotomy and simultaneous implant placement, noting reduced surgical time and nerve injury risk compared to traditional methods. Furthermore, piezoelectric surgery, utilizing ultrasonic micro-vibrations for precise osteotomies with minimal soft tissue trauma, has been advocated for safer IANL [16]. A prospective study employing piezoelectric IANL demonstrated complete sensory recovery in 85% of patients by 3 months with no implant failures [17]. These advances highlight the trend towards guided, minimally invasive nerve management. However, optimizing the seamless integration of guided IANL osteotomy and immediate guided implant placement using a single surgical template\u0026mdash;particularly capitalizing on the stability of tooth-supported guides\u0026mdash;represents an ongoing refinement.\u003c/p\u003e\n\u003cp\u003eThis report addresses this challenge by presenting a clinical case employing a single, tooth-supported static surgical guide meticulously designed to direct both the IAN lateralization osteotomy and subsequent immediate implant placement. While Atef et al. [1] also used a guide for both steps, the specific novelty here lies in harnessing the enhanced stability and predictable precision of tooth anchorage within one integrated template to guide this complex, combined procedure. This approach represents a refinement aimed at maximizing accuracy and safety during simultaneous IANL and implant placement, addressing the need for highly precise, integrated techniques, especially in partially edentulous scenarios. The patient\u0026rsquo;s clinical presentation, surgical technique, and outcomes are detailed and discussed within the context of current literature.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 60-year-old female patient presented with functional impairment due to missing teeth in the posterior right mandible, a region of long-term edentulism at tooth 46 and a periodontally compromised tooth 45. Clinical examination revealed a severely resorbed alveolar ridge in the area of the right mandibular second premolar and first molar (teeth 45 and 46). Tooth 45 was deemed hopeless and scheduled for extraction as part of the implant surgery. The overlying mucosa appeared intact and healthy, and the adjacent teeth were present and deemed suitable for supporting a surgical guide. The patient\u0026rsquo;s medical history was unremarkable, with no reported systemic conditions known to interfere with bone healing or the success of dental implants. Following a comprehensive discussion of all available treatment options, including guided bone regeneration techniques for ridge augmentation and the potential use of short dental implants, the patient ultimately opted for a surgical approach involving extraction of tooth 45 and IAN lateralization at site 46. This decision was primarily driven by the desire to receive standard-length dental implants, which were considered to offer a more predictable and durable long-term outcome in the context of the severely resorbed alveolar ridge. Prior to proceeding, thorough informed consent was obtained from the patient, ensuring she understood the details of the planned procedure, including the potential risks and benefits, with specific emphasis on the possibility of temporary or, in rare cases, permanent altered sensation in the distribution of the inferior alveolar nerve, affecting the lower lip and chin.\u003c/p\u003e\n\u003cp\u003ePreoperative CBCT revealed severe vertical bone deficiency in the right posterior mandible: tooth 46 was missing with severe ridge atrophy, while tooth 45, though present, showed insufficient bone for predictable implant placement and was planned for extraction and immediate implant placement. Cross-sectional views showed approximately 5 mm of bone height from the crest to the superior border of the IAN canal at site 45, and about 6 mm at site 46. The IAN canal ran close to the alveolar crest, and the ridge width measured approximately 7 mm, which was adequate for standard-diameter implants if the nerve was lateralized at site 46 . (Figures 1 and 2)\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of clinical details and images was obtained from the patient.\u003c/p\u003e\n\u003cp\u003eBased on the detailed data obtained from the CBCT scan and the optical intraoral scan of the patient\u0026rsquo;s dental arch, a precise digital workflow was initiated. The DICOM and STL files were merged and processed using Mimics Innovation Suite 21 (Materialise NV, Leuven, Belgium) to map the three-dimensional course of the inferior alveolar nerve. The virtual implant positions were then planned using 3Shape Implant Studio (version 2021, 3Shape A/S, Copenhagen, Denmark), with two standard-diameter implants virtually planned: a \u0026Oslash;3.8 \u0026times; 8.5 mm implant at site 45 and a \u0026Oslash;4.0 \u0026times; 7 mm implant at site 46 (UF(II) Series, DIO, Busan, South Korea), ensuring parallelism and prosthetically driven angulation in relation to the mapped course of the nerve.\u003c/p\u003e\n\u003cp\u003eThe osteotomy outline for inferior alveolar nerve access was designed separately using Autodesk Freeform software (Autodesk Inc., USA), based on anatomical landmarks and nerve mapping. The final composite design, including both the implant guidance channels and lateral corticotomy outline, was exported into \u003cem\u003eCHITUBOX V1.9.5\u003c/em\u003e (CHITUBOX, China) for 3D print preparation. A single, tooth-supported surgical guide was fabricated using a Phrozen Sonic Mighty\u003cem\u003e\u0026nbsp;8K\u003c/em\u003e 3D printer (Phrozen Inc., Hsinchu, Taiwan) with biocompatible Surgical Guide Resin (JamgHe, China). The guide was designed without metal sleeves; instead, the channels for the implant drills were digitally sculpted within the resin body itself, providing \u0026nbsp; accurate trajectory control during osteotomy. (Figure 3a,b)\u003c/p\u003e\n\u003cp\u003ePrior to the procedure, the patient was evaluated and cleared by an anesthesiologist following standard preoperative assessment. Routine preoperative laboratory tests, including complete blood count, coagulation profile, and metabolic panel, were obtained and confirmed to be within normal limits. The patient was admitted to the hospital and prepared in a sterile operating room setting. Standard aseptic protocols were followed, including skin disinfection and sterile draping of the surgical field.\u003c/p\u003e\n\u003cp\u003eGeneral anesthesia was administered by an anesthesiology team using a balanced anesthetic technique, and the patient was maintained under controlled ventilation throughout the procedure. Following induction, local infiltration with lidocaine 2% containing epinephrine 1:100,000 was performed at the surgical site to provide hemostasis and postoperative analgesia.\u003c/p\u003e\n\u003cp\u003eAfter confirming profound anesthesia and hemostasis, a full thickness mucoperiosteal flap was raised in the right posterior mandible. A mid-crestal incision was made along the edentulous ridge, extending mesially with a vertical releasing incision from tooth 43 to allow adequate access to the buccal mandibular cortex. Flap elevation extended from the right canine to the retromolar area. During the flap reflection, the mental nerve was visualized, and meticulous care was taken to protect it throughout the surgical procedure.\u003c/p\u003e\n\u003cp\u003eTooth 45 was extracted, and then the tooth-supported surgical guide was carefully seated over the occlusal surfaces of tooth 44 and extended distally over the edentulous ridge. Its stability was confirmed by a precise passive fit, and due to adequate support on both the remaining tooth and the retromolar pad, no fixation screws were necessary. The guide incorporated a lateral rectangular opening designed to provide a visual outline of the planned osteotomy site for inferior alveolar nerve access. Unlike prefabricated bone windows, this design did not dictate a fixed corticotomy shape but instead served as a reference template for intraoperative execution.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eUsing the visible borders of this outlined window as a guide, a piezoelectric bone surgery unit (Surgic Smart, Woodpecker, Guilin, China) equipped with a fine saw tip was applied directly to the buccal cortex. The osteotomy was performed by carefully tracing the piezoelectric tip along the borders defined by the guide opening, creating a precise rectangular corticotomy in situ. The superior and inferior horizontal cuts were planned to remain approximately 2 mm above and below the estimated position of the inferior alveolar nerve canal. The anterior and posterior vertical corticotomy cuts extended from the distal root region of tooth 44 to the mesial edge of the ascending ramus. Using the piezosurgery unit allowed precise cutting with diminished risk of accidental laceration of the nerve or its vessels, as the ultrasound-mediated cutting selectively affected mineralized tissue [16]. Once the cortical cuts were complete, a small straight chisel was used to gently wedge and detach the rectangular bone segment. The corticotomy piece was carefully removed, exposing the underlying IAN encased in a thin layer of spongy bone and canal lining.\u003c/p\u003e\n\u003cp\u003eWith the canal unroofed, the inferior alveolar neurovascular bundle was visible. The inferior alveolar nerve was then carefully lateralized. Under copious irrigation, the nerve bundle was gently freed from the bony canal using a small periosteal elevator, and a sterile elastic surgical tape (Silicone Nerve and Vessel Loops, Medline Industries, USA) was placed around the nerve to retract it laterally and create a safe corridor. With the nerve lateralized at site 46, the surgical guide was repositioned, and implant site preparation began. A sequential drilling protocol was performed through the guide\u0026rsquo;s integrated resin-formed channels to prepare osteotomies at sites 45 and 46. Profuse irrigation was applied throughout drilling to reduce thermal transfer to the retracted nerve. A \u0026Oslash;3.8 \u0026times; 8.5 mm implant (UF(II) Series, DIO, South Korea) was inserted at site 45 (fresh extraction socket), and a \u0026Oslash;4.0 \u0026times; 7 mm implant (UF(II) Series, DIO, South Korea) at site 46 with torque values under 15 Ncm, consistent with limited bone resistance in IAN lateralization cases. Although low, primary stability was deemed sufficient for submerged healing. [16]. A manual palpation confirmed the canal was clear of the planned drilling trajectory.\u003c/p\u003e\n\u003cp\u003eFollowing implant insertion, particulate bone graft was placed around the implants and covered with a resorbable collagen membrane. The IAN was then carefully repositioned over the implants, and a second collagen membrane was applied above the nerve. Additional particulate bone graft was added, after which the cortical bone window was repositioned and stabilized. Finally, another collagen membrane was laid to cover the entire site. Tension-free closure was achieved by scoring the periosteum at the flap base and advancing the flap; The flap was secured using interrupted 4-0 braided polyglycolic acid (P.G.A.) absorbable sutures (PezeshkYaran, Iran).\u003c/p\u003e\n\u003cp\u003ePostoperatively, the patient was prescribed antibiotics (amoxicillin 500 mg TDS for 7 days) and NSAIDs for pain control, along with oral corticosteroids (dexamethasone 4\u0026nbsp;mg for 2\u0026nbsp;days) and Vitamin B complex to support nerve recovery. Intraoperatively, after implant placement and nerve repositioning, a segment of harvested lingual cortical bone was adapted and grafted to the buccal aspect of the osteotomy site. This step was performed to help restore and preserve the transverse dimension of the ridge, ensuring sufficient buccolingual bone volume around the implants and enhancing long-term stability. The immediate postoperative course was uneventful. The patient reported mild numbness in the right lower lip and chin on the first postoperative day, consistent with neurapraxia from manipulation of the IAN. However, there were no signs of active nerve laceration (sharp pain or hematoma). By two weeks post-surgery, the patient noted significant improvement in sensation, and light-touch and pin-prick tests confirmed near-normal sensory response in the IAN distribution. At the 1-month follow-up, the patient\u0026rsquo;s inferior alveolar nerve function had fully returned to baseline (no residual paresthesia), indicating successful nerve preservation.\u003c/p\u003e\n\u003cp\u003eThe patient was advised to return for follow-up appointments, but due to personal circumstances, she did not attend further visits. Consequently, no post-operative clinical or radiographic images were obtained. However, based on intraoperative assessment and immediate postoperative recovery, the procedure was considered successful, with the patient reporting resolution of transient hypoesthesia and satisfactory oral function during remote follow-up communication. The case illustrates a successful outcome for digitally guided lateralization at site 46, with immediate and delayed implant placement, respectively, using a single tooth-supported guide to accomplish both aspects of the surgery.\u003c/p\u003e"},{"header":"Systematic Literature Review","content":"\u003cp\u003eA systematic search was conducted across four major electronic databases: PubMed, Cochrane Library, Web of Science, and Scopus up to July 2025, to identify clinical studies related to computer-guided inferior alveolar nerve (IAN) lateralization, repositioning, or transposition with simultaneous dental implant placement.\u003c/p\u003e\n\u003cp\u003eThe search strategy combined controlled vocabulary and free-text terms related to the inferior alveolar nerve, dental implants, and digital/computer-guided surgery. Search formulas specific to each database, inclusion \u0026amp; exclusion criteria are provided in Supplementary Files.\u003c/p\u003e\n\u003ctable cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of the Included Studies:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAtef and Mounir [1] introduced a computer-guided method for inferior alveolar nerve (IAN) lateralization with simultaneous implant placement. The study included seven patients who had less than 8 mm of bone height above the IAN in the posterior mandible. The surgeons used customized 3D-printed surgical guides based on CT scans to mark the buccal cut and to guide the placement of the implants. All patients recovered without complications. Any temporary neurosensory issues went away completely within three weeks, and no permanent IAN damage was reported. After six months, all implants were stable and had been successfully restored. The authors concluded that guided IAN lateralization is a feasible and safe option that improves surgical accuracy and reduces risks.\u003c/p\u003e\n\u003cp\u003eMetawie et al. [16] conducted a randomized clinical trial on twenty patients with severely atrophic posterior mandibles. The patients were divided into two groups: one received computer-guided IAN lateralization with repositioning of the osteotomy window, while the other received the same procedure with \u0026quot;sticky bone\u0026quot; augmentation. In both groups, customized 3D-printed surgical guides were used for nerve window preparation and implant placement. All patients had temporary neurosensory disturbances after surgery, but fully recovered within six months. The implant survival rate was 100% in both groups, and improvements were seen in stability, bone density, and marginal bone levels. The authors concluded that both techniques are safe and effective, with comparable overall outcomes, though the sticky bone method led to a slightly faster neurosensory recovery.\u003c/p\u003e\n\u003cp\u003eIn a single case report, Li et al. [6] documented a case of bilateral inferior alveolar nerve (IAN) lateralization with simultaneous implant placement. The procedure integrated 3D-printed preoperative models for surgical simulation and the adjunctive use of concentrated growth factor (CGF) to promote nerve healing. The patient demonstrated complete neurological recovery within two months, and at a 6.5-year follow-up, stable implant osseointegration and regeneration of the IAN canal wall were observed. This case highlights the significant role of digital planning and biomaterial adjuncts in improving surgical precision and long-term neurosensory outcomes.\u003c/p\u003e\n\u003cp\u003eTogether, these studies emphasize that digital planning and computer-guided approaches for IAN lateralization are feasible and safe, with predictable implant survival and largely reversible neurosensory disturbances. They collectively support the use of guided nerve lateralization as a viable alternative to traditional freehand surgery for the rehabilitation of severely atrophic posterior mandibles.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe management of severely resorbed posterior mandibles presents a significant challenge in implant dentistry, often requiring either extensive ridge augmentation procedures or alternative strategies to safely circumvent the inferior alveolar nerve. This case report details the successful implementation of inferior alveolar nerve lateralization concurrently with computer-guided implant placement, providing a single-stage solution for these challenging clinical situations. A pivotal element of this approach is the novel utilization of a singular, tooth-supported surgical guide to meticulously coordinate both the osteotomy for nerve lateralization and the subsequent implant insertion, thereby seeking to optimize precision and patient safety.\u003c/p\u003e\u003cp\u003eTraditionally, managing an atrophic posterior mandible for implant placement often involves onlay bone grafts or interpositional grafting techniques, such as a \"sandwich\" osteotomy, to achieve adequate vertical bone height [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Alternatively, the use of shorter dental implants could be considered to avoid the nerve canal. However, bone augmentation procedures are associated with drawbacks including increased treatment duration, potential donor site morbidity, and unpredictable graft resorption rates. While less invasive, short implants may exhibit biomechanical limitations, particularly in the long term, and are frequently unsuitable for cases of extreme bone resorption, such as the less than 6 mm of vertical bone height observed in the presented case [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIAN lateralization provides a more immediate solution by strategically utilizing the native bone present below the nerve canal. The intentional displacement of the IAN to enable dental implant placement constitutes a recognized surgical procedure. Notably, Peleg et al. elucidated a sophisticated technique for IAN lateralization coupled with simultaneous implant insertion, thereby illustrating the practicability of placing implants in significantly atrophic ridges within a single surgical intervention alongside nerve relocation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These findings, corroborated by subsequent investigations, demonstrate high implant success rates with this approach, despite the frequent occurrence of transient neurosensory deficits. Consistent with this evidence, the presented case incorporated simultaneous implant placement, thereby eliminating the necessity for a second surgical procedure and limiting nerve manipulation to a single episode. A significant advantage of immediate implant placement alongside nerve lateralization is the diminished duration of nerve retraction and the prevention of repeated retraction episodes. Following secure implant placement, the nerve can be meticulously repositioned, facilitating undisturbed healing. This strategy is substantiated by prior research indicating that a one-stage nerve lateralization procedure with concurrent implant placement can achieve dependable implant survival rates and high patient satisfaction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this case, the use of a stereolithographic surgical guide significantly enhanced accuracy and predictability, aspects that prove challenging to attain with conventional freehand methods. Performing IAN lateralization without a guide is a highly sensitive procedure, an incorrectly placed osteotomy risks either inadequate nerve exposure or, more severely, direct nerve trauma. Our approach involved meticulous preoperative planning of the osteotomy via CBCT imaging, followed by its precise execution using a computer-generated surgical guide and a piezoelectric device. This strategy was designed to ensure the created bone window was optimally aligned with the nerve canal, minimizing any deviation from the planned position.\u003c/p\u003e\u003cp\u003eAtef and Mounir's preliminary investigation into computer-guided IAN lateralization similarly concluded that a 3D-printed surgical guide could precisely determine the lateral bone window's location, potentially reducing intraoperative time and nerve damage risk [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Our experience in this case strongly corroborates their findings.\u003c/p\u003e\u003cp\u003eA key concern associated with surgical manipulation of the inferior alveolar nerve (IAN) is the potential for either temporary or permanent paresthesia in its distribution. Consistently, the available literature indicates that most patients undergoing IAN lateralization will experience some immediate postoperative numbness in the affected area [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Our patient did experience mild hypoesthesia of the right lower lip immediately following the surgical procedure. Nevertheless, this neurosensory deficit was temporary and fully resolved within a month of the operation. This positive neural outcome can likely be attributed to multiple contributing factors. Among these, the utilization of piezoelectric surgery for the corticotomy is recognized for its ability to reduce mechanical and thermal stress on nerves, a benefit derived from its highly precise, controlled, and vibration-limited cutting mechanism, in contrast to traditional rotary instruments. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Moreover, our surgical approach in this instance involved inferior alveolar nerve (IAN) lateralization, a technique where the nerve is carefully shifted laterally within its canal. This was favored over IAN transposition, which would have required dislocating the nerve from the mental foramen or detaching the mental nerve. This procedural choice is clinically significant, as existing research indicates a greater propensity for persistent neuropathy following IAN transpositions when compared to lateralization procedures [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Our finding of full sensation recovery in this case corroborates other published reports that underscore the significance of precise surgical execution. For example, Freire et al. presented a case of IAN lateralization performed with piezosurgery where the nerve was meticulously retracted and then carefully released, resulting in no observed permanent nerve deficits [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In a larger case series by de Vicente et al. the majority of patients (11 out of 13 cases) experienced a complete return to normal sensation within 3 months postoperatively [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], suggesting that predictable nerve function recovery is possible when compression and traction on the nerve are minimized during surgery. Our findings highlight the critical necessity of precise surgical technique, specifically slow and controlled piezoelectric bone cuts, minimal nerve traction or compression, consistent nerve hydration during surgery, and timely release of nerve retraction post-implant insertion for achieving optimal neural recovery. This case report strengthens the existing literature by demonstrating that, despite the increased complexity posed by guided implant drilling after nerve lateralization, the nerve can be effectively safeguarded, resulting in successful and uneventful restoration of sensory function.\u003c/p\u003e\u003cp\u003eA multicenter study by Deryabin et al. found\u0026thinsp;~\u0026thinsp;98% implant survival at 5 years when implants were placed in conjunction with IAN repositioning, although one case of mandibular fracture was noted out of 15 patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In the presented patient, only a unilateral procedure was performed, and the residual bone after the lateral window remained sufficient to maintain mandibular integrity, thus minimizing the risk of pathological fracture.\u003c/p\u003e\u003cp\u003eThe primary novelty of this case lies in the seamless integration of inferior alveolar nerve lateralization and implant placement into a fully guided surgical workflow utilizing a single, tooth-supported surgical guide. While a few previous reports have described the use of custom-fabricated guides for IAN lateralization [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], our case further reinforces the feasibility and clinical applicability of this concept in a real-world setting. The tooth-supported surgical guide provided superior precision and confidence, ensuring accurate execution of both the nerve osteotomy and implant placement according to the digital plan. This method reduces surgical errors and decision-making demands, as the guide dictates bone window location and implant angulation. Its innovative dual function\u0026mdash;guiding both nerve access and implant trajectories\u0026mdash;enhances efficiency by eliminating multiple guide changes. This guided approach to IAN lateralization could expand its indications, making the procedure safer and more predictable for clinicians, especially in complex scenarios where anatomical landmarks are obscured or multiple implants are planned near the inferior alveolar nerve. Digital preplanning further enables surgeons to identify and mitigate potential challenges in advance.\u003c/p\u003e\u003cp\u003eDespite the positive outcome, this single case report has limitations. A comparative study with a larger cohort would better assess the guided approach's true benefit over freehand nerve lateralization. Furthermore, custom guide fabrication demands specialized software and expertise, and the associated digital planning and 3D printing can increase treatment costs. However, as digital dentistry advances, these guides may become more accessible and cost-effective. It is crucial to note that the guide aids, but does not replace surgical skills, particularly in delicate nerve handling and managing unexpected intraoperative findings. While our small, tooth-supported guide provided adequate access, larger bone-supported guides in edentulous cases might present challenges with reduced visibility and access.\u003c/p\u003e\u003cp\u003eIn this case, the patient did not attend in-person follow-up visits and no post-operative clinical or radiographic images were obtained. The favorable prognosis was based on intraoperative findings, immediate postoperative recovery, and patient-reported functional satisfaction during remote communication. The patient reported satisfaction with the functional and sensory outcomes and appreciated that the procedure was completed in a single surgical stage.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGuided implant surgery with simultaneous nerve lateralization presents a promising solution for severely resorbed posterior mandibles. This case illustrates how a tooth-supported 3D-printed surgical guide facilitates precise IAN corticotomy and accurate implant placement in a single, efficient procedure. The technique demonstrated successful osseointegration and complete nerve recovery, highlighting its potential safety and efficacy. This innovative combined guide streamlines the workflow, reducing surgical time and uncertainty, and offers clinicians a valuable alternative to conventional methods. Emphasizing meticulous digital planning and careful nerve handling, guided IAN lateralization could significantly expand implant treatment boundaries in atrophic jaws, providing improved patient outcomes through a single-stage, precision-guided approach.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBCT: Cone-Beam Computed Tomography \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIAN: Inferior Alveolar Nerve \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIANL: Inferior Alveolar Nerve Lateralization \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIANT: Inferior Alveolar Nerve Transposition \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP.G.A.: Polyglycolic Acid \u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study reports a single patient case and did not require formal ethical approval according to the guidelines of the Ethics Committee of Mashhad University of Medical Sciences. Written informed consent to participate was obtained from the patient. No committee reference number was applicable.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions of this article are included within the article and its additional files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTV: Surgical treatment and manuscript revision. AM: Literature review, drafting of the manuscript. AE: Surgical treatment, and corresponding author duties. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the staff of the Department of Oral and Maxillofacial Surgery, Mashhad University of Medical Sciences, for their assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAI Use Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that large language models (ChatGPT, GPT-5, OpenAI; Gemini, Google DeepMind) were used to assist with language refinement and paraphrasing during manuscript preparation. The authors reviewed, edited, and take full responsibility for the final content of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAtef M, Mounir M. Computer-Guided Inferior Alveolar Nerve Lateralization With Simultaneous Implant Placement: A Preliminary Report. Journal of Oral Implantology. 2018;44. doi:10.1563/aaid-joi-D-17-00141\u003c/li\u003e\n\u003cli\u003eSrivastava V, Bansal R, Chattopadhyay K, Bansal M. Implant placement in the atrophic mandibular posterior region using the inferior alveolar nerve bypass technique after assessing the bone relative to the mandibular canal: A prospective interventional pilot study. National Journal of Maxillofacial Surgery. 2025;16(1):109\u0026ndash;17. doi:10.4103/njms.njms_49_24\u003c/li\u003e\n\u003cli\u003eGreenberg D, Estrin N, Delgado-Ruiz R, Romanos G. Effect of Primary Stability on Short vs. Conventional -Implants with Reverse Concave Neck. Int J Oral Maxillofac Implants. 2025;0(0):1\u0026ndash;13. doi:10.11607/jomi.11263\u003c/li\u003e\n\u003cli\u003eCarosi P, Lorenzi C, Laureti M, Ferrigno N, Arcuri C. Short Dental Implants (\u0026le; 6 mm) to Rehabilitate Severe Mandibular Atrophy: A Systematic Review. Int J Oral Maxillofac Implants. 2021;36(1):30\u0026ndash;7. doi:10.11607/jomi.8510\u003c/li\u003e\n\u003cli\u003eAllav\u0026eacute;na J, Nicot R, Majoufre C, Schlund M. Inferior alveolar nerve repositioning surgical techniques and outcomes - a systematic review. J Stomatol Oral Maxillofac Surg. 2024;125(1):101631. doi:10.1016/j.jormas.2023.101631\u003c/li\u003e\n\u003cli\u003eLi B, Sun Y, Fu L, Zhou Y. Preoperative Simulation With 3D-Printed Models for Bilateral Inferior Alveolar Nerve Lateralization: A Case Report With 6.5-Year Follow-Up and Literature Review. Journal of Oral Implantology. 2025;51(3):248\u0026ndash;57. doi:10.1563/aaid-joi-D-24-00232\u003c/li\u003e\n\u003cli\u003eChe S, Ismail NH, Wang W, Awang RA. From freehand to precision: Dynamic navigation systems in transmandibular nerve canal implantation: A case series. Medicine. 2025;104(11):e41922. doi:10.1097/md.0000000000041922\u003c/li\u003e\n\u003cli\u003eEbrahimpour A, Rahbar F, Ghasemi H, Taghian M, Pashmaki M. Evaluation of facial anthropometric index among 15-20 Year old individuals in Sari City. Helix. 2017;8(2):1083\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eHafez Maleki F, Shokri A, Hosseini Zarch SH, Bahraniy A, Ebrahimpour A, Alimohamadi SM. Cone Beam CT Evaluation of the Bony Changes in the Temporomandibular Joint and the Association with the Clinical Symptoms of Temporomandibular Joint Disorders. Journal of Dental Materials and Techniques. 2019;8(1):25\u0026ndash;32. doi:10.22038/jdmt.2018.12123\u003c/li\u003e\n\u003cli\u003eRaju MS, Gottumukkala SNVS, Rakshitha KSS, Raju MAKV. Precision implant placement: A novel approach using dynamic navigation system-guided alveolar ridge splitting. The Journal of Indian Prosthodontic Society. 2025;25(2):179\u0026ndash;84. doi:10.4103/jips.jips_372_24\u003c/li\u003e\n\u003cli\u003eTahmaseb A, Wu V, Wismeijer D, Coucke W, Evans C. The accuracy of static computer-aided implant surgery: A systematic review and meta-analysis. Clin Oral Implants Res. 2018;29 Suppl 16:416\u0026ndash;35. doi:10.1111/clr.13346\u003c/li\u003e\n\u003cli\u003eAltındağ A, Yalın H, Y\u0026uuml;ksel İB. Pattern diversity and prevalence of bifid mandibular canal: a CBCT-based cross-sectional study. Oral and Maxillofacial Surgery. 2025;29(1):110. doi:10.1007/s10006-025-01409-4\u003c/li\u003e\n\u003cli\u003eSchneider D, Marquardt P, Zwahlen M, Jung RE. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. Clin Oral Implants Res. 2009;20 Suppl 4:73\u0026ndash;86. doi:10.1111/j.1600-0501.2009.01788.x\u003c/li\u003e\n\u003cli\u003eJiang Z, Kong D, Zhou C, Liang Y, Liu M, Qu Z. Stability of alveolar ridge following horizontal guided bone regeneration after implant loading for 1\u0026thinsp;-2 years: a retrospective comparative study. BMC Oral Health. 2025;25(1):673. doi:10.1186/s12903-025-06025-y\u003c/li\u003e\n\u003cli\u003eAbad-Coronel C, Vandeweghe S, Vela Cervantes MD, Tobar Lara MJ, Mena C\u0026oacute;rdova N, Aliaga P. Accuracy of Implant Placement Using Digital Prosthetically-Derived Surgical Guides: A Systematic Review. Applied Sciences. 2024;14(16):7422. \u003c/li\u003e\n\u003cli\u003eNaves Freire AE, Iunes Carrera TM, Rodriguez LS, Lara de Carli M, Filho AP, Costa Hanemann JA, et al. Piezoelectric Surgery in the Inferior Alveolar Nerve Lateralization With Simultaneous Implant Placement: A Case Report. Implant Dent. 2019;28(1):86\u0026ndash;90. doi:10.1097/id.0000000000000855\u003c/li\u003e\n\u003cli\u003ede Vicente JC, Pe\u0026ntilde;a I, Bra\u0026ntilde;a P, Hern\u0026aacute;ndez-Vallejo G. The use of piezoelectric surgery to lateralize the inferior alveolar nerve with simultaneous implant placement and immediate buccal cortical bone repositioning: a prospective clinical study. Int J Oral Maxillofac Surg. 2016;45(7):851\u0026ndash;7. doi:10.1016/j.ijom.2016.01.017\u003c/li\u003e\n\u003cli\u003eRonda M, Stacchi C. A Novel Approach for the Coronal Advancement of the Buccal Flap. Int J Periodontics Restorative Dent. 2015;35(6):795\u0026ndash;801. doi:10.11607/prd.2232\u003c/li\u003e\n\u003cli\u003ePeleg M, Mazor Z, Chaushu G, Garg AK. Lateralization of the inferior alveolar nerve with simultaneous implant placement: a modified technique. Int J Oral Maxillofac Implants. 2002;17(1):101\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eDeryabin G, Grybauskas S. Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances. Int J Implant Dent. 2021;7(1):44. doi:10.1186/s40729-021-00334-x\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental Implants, Mandible, Nerve Transfer, Computer-Assisted Surgery, Cone-Beam Computed Tomography, Piezoelectric Surgery","lastPublishedDoi":"10.21203/rs.3.rs-7447762/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7447762/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTreating severe posterior mandibular bone resorption with dental implants is challenging due to the proximity of the inferior alveolar nerve (IAN). While IAN lateralization creates space for implants, it carries a high risk of nerve damage. This report introduces a novel approach: a single, digitally designed surgical guide that precisely facilitates both the IAN lateralization osteotomy and immediate implant placement, aiming to significantly reduce neurosensory complications and enhance procedural efficiency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis report details the case of a patient presenting severe vertical bone deficiency in the posterior mandible. Utilizing cone-beam computed tomography and digital scans, a custom tooth-supported surgical guide was fabricated. This guide facilitated a combined, precise procedure performed under local anesthesia: a guided osteotomy for IAN lateralization using a piezoelectric device, followed by the immediate placement of two dental implants while the nerve was protected. Subsequently, the IAN was carefully repositioned, and the surgical site was closed. The patient experienced uneventful healing with no permanent nerve injury.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case demonstrates the successful and safe application of a novel, fully guided technique for simultaneous IAN lateralization and immediate implant placement. This precision-guided method offers unprecedented accuracy in osteotomy and implant positioning, potentially reducing operative time and minimizing IAN risk. It presents a superior alternative to traditional extensive bone grafting or short implants for severe mandibular atrophy, paving the way for safer and more predictable outcomes in complex cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003enot applicable.\u003c/p\u003e","manuscriptTitle":"Guided Inferior Alveolar Nerve Lateralization and Simultaneous Implant Placement Using a Tooth-Supported Surgical Guide: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 01:02:55","doi":"10.21203/rs.3.rs-7447762/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1eb6b7b9-de2d-42e2-9be3-6d8a5dd9fae6","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T10:23:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 01:02:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7447762","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7447762","identity":"rs-7447762","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}