Técnica minimamente invasiva de lateralização do nervo alveolar inferior (in-block): descrição da técnica, indicações e aspectos relevantes

RESUMO

A técnica de lateralização in-block consiste de uma adicional alternativa de mobilização do nervo alveolar inferior, com acompanhamento de longo prazo clínico e tomográfico de 54 casos, com mínimo de três anos de acompanhamento e tempo médio de follow-up de três a dez anos. Diante dos resultados apresentados ao longo deste tempo, a técnica vem demonstrando ser uma opção previsível e eficiente no tratamento das atrofias posteriores de mandíbula, evitando o uso de enxertos ou biomateriais de alto custo, bem como exodontias múltiplas de dentes anteriores saudáveis para a realização de reabilitações totais inferiores. As situações clínicas com menos de 4 mm de altura óssea alveolar, limite para o tratamento com implantes extracurtos, tornam-se a principal indicação da lateralização in-block, que se caracteriza principalmente pela modificação da via de acesso ao nervo alveolar inferior (NAI), permitindo sua ampla visualização durante o procedimento e com a consequente manipulação mais previsível e delicada do nervo. O uso da piezocirurgia e o reposicionamento do bloco ósseo ao leito original permite a recomposição do contorno mandibular basal e a ideal cicatrização do implante instalado. Apesar da técnica ser considerada relativamente sensível e necessitar de desenvolvimento e evolução continuada, podemos observar que os resultados obtidos até então vêm consolidando sua indicação na reabilitação das condições de severa atrofia mandibular posterior.

Palavras-chave – Nervo mandibular; Implantação dentária; Cirurgia bucal; Lateralização do nervo alveolar inferior; Mandíbula atrófica.

ABSTRACT

The in-block lateralization technique consists of an additional alternative of inferior alveolar nerve mobilization, with long-term clinical and tomographic follow-up of 54 cases with a minimum of 3 years of follow-up and mean follow-up time of 3 to 10 years. Given the results presented over this time, the technique has proven to be a predictable and efficient option in the treatment of posterior jaw atrophies, avoiding the use of grafts or high-cost biomaterials, as well as multiple extractions of healthy anterior teeth to perform lower total rehabilitation. Clinical situations with less than 4 mm of alveolar bone height, the limit for treatment with extra-short implants, becomes the main indication of in block lateralization which is characterized mainly by the modification of the access route to the inferior alveolar nerve (IAN), allowing its wide visualization during the procedure and with the consequent more predictable and delicate manipulation of the nerve. The use of piezosurgery and the repositioning of the bone block to the original bed allows the recomposition of the basal mandibular contour and the ideal healing of the implant installed. Although the technique is considered relatively sensitive and requires continuous development and evolution, we can observe that the results obtained so far have been consolidating its indication in the rehabilitation of conditions of severe posterior mandibular atrophy.

Key words – Mandibular nerve; Dental implants; Surgery oral; Inferior alveolar nerve lateralization; Atrophic mandible.

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