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

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.