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Warrington Study Club - 20 February 2019

Nerve Damage and Surgical Risk Management Strategies for Implant Placement in the Mandible

Presented by: Cemal Ucer
Host: Amit Mistry
Exhibitors: Neoss, Implantium UK, Megagen Implants (UK), Osstem UK
Date: 20 February 2019
Time: 1900 Refreshments 1930 Lecture
Location: The Park Royal, Stretton Road, Stretton, Warrington, WA4 4NS

The Trigeminal nerve (TGN) and its branches, as well as the lingual artery are at risk during implant surgery in the mandible. Iatrogenic damage to vital structures occurs if adequate clearance is not allowed when placing an implant near the mandibular branches of the TGN or the blood vessels. Complications in this area are serious - even life threatening - and often result in medico-legal complaints or disciplinary sanctions. The evidence suggests that the risk assessment, treatment planning, and the consent processes performed by implant dentists may be inadequate or fall short of the established best practice guidelines in implant dentistry.

This presentation will aim to summarise the findings of a series of research papers published by Yilmaz, Ucer, Scher, Suzuki and Renton (2016: 2017) & Renton and Yilmaz (2011). Evidence-based pre-, intra- and post-operative risk management strategies for implant surgery in the mandible based on protocols published by Ucer et al (2017) will be discussed with special reference to human-factors related error prevention.

Aetiology, diagnosis and management of nerve injury will be briefly covered together with discussion of the informed consent process including specific treatment alternatives that may be employed to reduce the risk of nerve/ blood vessel damage occurring during dental implant surgery. The speaker’s experience using alternative techniques to mitigate against iatrogenic damage to vital structures, in the atrophic mandible, including the use of Bone Ring technique, shorter implants, vertical bone grafting, the nerve repositioning surgery and improved surgical precision using depth stops and 3D guided-surgical navigation techniques will be presented.

Learning Outcomes:

  • To discuss the aetiology, diagnosis and management of iatrogenic nerve damage related to implant surgery in the mandible
  • To discuss evidence-based risk management protocols to mitigate and prevent iatrogenic nerve damage occurring in the mandible during implant surgery
  • To discuss the aetiology and prevention of human factors’ related surgical error
  • To discuss implant treatment options which may be employed to reduce the risk of iatrogenic damage occurring to vital structures during surgery in the mandible


Prof Cemal Ucer, BDS, MSc, PhD, FDTFEd., RCSEd, ITI Fellow, Specialist Oral Surgeon Professor of Dental Implanology, School of Health & Society, University of Salford Director of Postgraduate Institute of Clinical Excellence (ICE) Salford, UK Member of National Advisory Board Human Factors in Dentistry (NABHFD)

Location and Further Actions

Dr Amit Mistry