Tooth Replacement Made Possible by Nerve Repositioning Operation

Tooth Replacement Made Possible by Nerve Repositioning Operation

New breakthrough in Implant Dentistry in Vietnam:

Nguyen Van Luom has now fully recovered. He can chew very well -- even tough, hard foods -- just five months after the operation to reposition the inferior alveolar nerve and place dental implants by Dr Vo Van Nhan, director of Nhan Tam Dental Implant Surgery Center.

This case was carried out and presented by Dr. Vo Van Nhan at the Dental Implant Conference held by Ho Chi Minh City Society of Dental Implantology (HSDI) on October 10, 2013. It can be said that the case has been the first ever successful nerve repositioning and implant placement case performed and reported in Vietnam.

Nerve repositioning technique has been done in a number of countries with advanced health care system. So far medical literature has reported that there have been about 44 doctors all over the world who have ever performed this technique of nerve repositioning and dental implantation and published their works in scientific journals.

This achievement gives hope to Vietnamese patients with missing teeth, especially those with complex cases where conventional dental restoration techniques do not work. It is considered a milestone in the development of implant dentistry in Vietnam.


Hope for patients with jaw bone resorption and tooth missing
‘The restored teeth have been very stable, not moving, chewing very well and completely painless, especially I can eat all my favorite foods’, said Nguyen Van Luom (59, Ho Chi Minh City),. He said that 40 years ago he was shot with a bullet which broke his left lower jaw, all the teeth were missing and he had to wear a removable denture for all those years. Before the surgery, the denture became so loose that it was very hard for him to chew.

‘On examination, I found the lower jaw is severely resorbed, the lower alveolar ridge is at the level of the floor of the mouth. The tissue overlying the ridge is loose and fluctuant, completely without keratinized gum. Luom’s case is very common in Vietnam because patients often lose teeth early and wear removable dentures for years’, said Dr. Nhan.

According to the doctor, one of the common problems in patients with severe jaw bone resorption who have indication of implant placement is the inadequate bone volume especially in areas anatomically related to the inferior alveolar nerve. In Luom’s case, examining X-ray tomography and using software to reconstruct the three-dimensional structure of the jaw bones showed that there had been the severe jaw bone resorption and the inferior alveolar nerve had an abnormal trajectory extending from the right to the opposite left side across the midline. Even the nerve is exposed on the alveolar ridge in a couple of places and so implants cannot be placed using conventional techniques. The height of the bone from the crest of the ridge to the nerve is just 1-2 mm, not enough to place an implant of appropriate length (10 mm) safely (in principle the implant has to be 2 mm from the nerve). In Luom’s case, placing implant will damage the nerve, techniquie to improve the bone height such as the vertical ridge augmentation, distraction osseogenesis, use of short implants or implant placement in the chin area were considered but can not be implemented, meaning that he will not have the teeth for the rest of his life. To solve the problem for Mr. Luom, a feasible solution was surgery to reposition the nerve to place the implant and then construct an implant-supported restorartion.

Based on the technique of O. Jensen, Dr Nhan performed the repositioning surgical procedure and then harvested a piece of pelvic bone to graft into the lower jaw bone to increase the height and placed four dental implants. The whole surgical team worked hard, completing the surgery in 5 hours. Besides, the doctor also harvested the gum from the palate to graft to the lower arch to improve the condition of the gum tissue around the implant, considered an important factor to ensure the long-term success of the implant. The entire treatment process took 5 months.


 * The effecitveness of treatment depends on each person's particular health condition

The strength of nerve repositioning technique

The greatest strength of the nerve displacement technique is its application in complex cases of missing teeth and losing the bone so severely that the conventional bone graft and implantation can not work. Besides, this technique also has the advantage of limiting permanent neurological injury caused by the efforts to place the implants when bone height does not allow. Therefore, this technique is highly appropriate to the long-standing tooth missing and denture wearing patients in Vietnam.
But this technique also has some disadvantages such as numb lip, usually temporary (lasting 6 months to 1 year) but also a small number of cases with permanent lip numbness. Thus, this technique should only be done by experienced and skilled doctors.


New breakthroughs in implant dentistry in Vietnam
According to Prof. Le Van Son, Chairman of Reconstructive Maxillofacial Surgery Department Dental Hospital in Hanoi, dental implants have been done in Viet Nam for around 10 years now, making certain progress but without any significant achievements. Nerve repositioning and dental implant placement surgery performed by Dr. Nhan is a good sign for the Vietnam implant dentistry.

“As far as I know, so far in our country, no surgeon but Dr Nhan at the same time combined four advanced surgical techniques including inferior alveolar nerve repositioning, pelvic crest bone graft vertical augmenation, keratinized gum graft and implant placement for restorations. This is the first surgical breakthrough in implant dentistry in Vietnam”, said Prof. Le Van Son.



Dr. Vo Van Nhan and patient Nguyen Van Luom

Luom said: “My denture has been loose for over five years. I wanted to enjoy delicious food, but could not chew and I lost my appetite. My health was compromised and I lost weight year after year. Before I weighed nearly 50 kgs. My weight was now just 38 kg as I could not chew any food”. “My son took me to a few big dental centers in the city but I was told my situation was very difficult. My son kept looking for information on the internet, and finally we found Nhan Tam Dental Center.

“Dr Nhan said the case was still treatable with operation to reposition the nerve. I was a bit nervous but after explained by the doctor I found the faith and hoped to have new better teeth. So far, I was much better after 5 months surgery. I gained 4 kgs and regained my appetite, especially I can eat all my favorite foods. Now my dream has come true”, said patient Nguyen Van Luom


Source: Thanh Nien Newspaper 

Nhan Tam Dental Clinic


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