Inferior Alveolar Nerve (IAN) transposition and horizontal extensive regeneration on the posterior atrophic mandible

1. Initial panoramic X-ray showing the mental foramen near the bone ridge

2. Initial clinical photographic intra-oral situation

3. Bone ridge exposed after full thickness raised flap and incision with 15c scalpel blade

4. Mental (main and accessory) nerves exposed and individualized

5. Mental nerves retracted with yellow sterile rubber and designed window for exposing inferior alveolar and incisive nerves, with grey sterile pencil

6. After cutting the window to expose the IAN with piezotome, removing the cortical wall with the help of a chisel

7. Retrieving the IAN nerve from his canal after cutting the incisive part of the nerve 3 mm in front of mental nerve (IAN transposition)

8. Implant placed in front of new position of transposed IAN

9. Decortication of bone that needs to be regenerated horizontally, mesially to transposed IAN

10. OsteoBiol® mp3® mixed with autologous bone (plate from the window that was milled with bone mill) and I-PRF and OsteoBiol® Lamina® Curved with I-PRF

11. Sticky bone with OsteoBiol® mp3®, autologous grinded bone and I-PRF in place

12. OsteoBiol® Lamina® Soft in place after placing some OsteoBiol® Putty between the sticky bone and the Lamina®. The Lamina® was also stabilized by a metallic pin and with sutures

13. Non resorbable sutures supramid 4(0) to close the operatory wound

14. Result after 6 months of healing of the horizontal ridge augmentation

15. Placing of extra 3 implants on the regenerated ridge

16. Panoramic x-ray with all implants placed

17. Final rehabilitation with metalo - ceramic crowns. Case with 7 years of follow-up