Nguyen Van Luom has now fully recovered. He can chew very well -- even tough, hard foods -- just five months after he underwent the surgery of nerve repositioning for dental implants by Dr. Vo Van Nhan.
This case was reported by Dr. Vo Van Nhan at the Dental Implant Conference held by the HCM City Dental Implant Association on November 10, 2013. This is the first successful nerve repositioning and implant placement case performed and reported in Vietnam.
Nerve repositioning technique has only been done in a number of countries with advanced health care system. At present, the 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 success will bring hope to those who suffer from tooth loss, especially in complex cases where traditional dental restoration techniques do not work. This can also be considered as a new milestone in the development of implant dentistry in Vietnam.
Doctor Vo Van Nhan in the surgery to reposition the nerve for implant placement
Hope for patients with jaw bone resorption and teeth loss
Patient Nguyen Van Luom (59 years old, Ho Chi Minh City), who underwent the operation of nerve repositioning by Dr.Nhan, said:"The restored teeth have been very stable, not moving, chewing very well and completely painless, especially I can eat all my favorite foods". 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.
Doctor Nhan said: "When I examined, I found that the lower jaw is severely resorbed, the lower alveolar ridge is at the same level of the floor of the mouth. The alveolar tissue is loose and completely no keratinized gum. Mr. Luom's cases are very popular in Vietnam because patients often lose their teeth early and wear removable dentures for many years."
According to Dr. Nhan, one of the most common problems in patients with severe bone loss, who receive the indication of implant placement is the inadequate bone volume, particularly in the areas anatomically related to the inferior alveolar nerve. In Mr. Luom case, through X-rays tomography and software for reconstruct the three-dimensional structure of the jaw showed that there had been the severe bone resorption and the inferior alveolar nerve had an abnormal trajectory extending from the right to the opposite left side across the midline. The nerve even was exposed on the alveolar nerve in a couple of places and so implants could not be placed using conventional techniques. The height of the bone from the alveolar ridge to the nerve was just 1-2 mm, not enough to place an standard implant of appropriate length (10 mm) safely (in principle the implant has to be 2 mm from the nerve). In Mr. Luom’s case, placing implant will damage the nerve. Techniques to improve the bone height such as the vertical ridge augmentation, distraction osteogenesis, 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 for an implant-supported restoration.
Based on the technique of Jensen O, Dr. Nhan and his team performed nerve repositioning surgery and then harvested a block of illiac bone to graft into the lower jaw to increase the bone height and placed four dental implants. The entire surgical team worked extremely hard to complete the operation in 5 hours. Besides, Dr. Nhan also took the gum from the jawbone to graft to the lower arch to improve the condition of the soft tissue around the implant, which is also one of the important factors to ensure long-term success of the implant. The whole process of treatment was completed within 5 months.
The strength of nerve repositioning technique
The greatest strength of nerve repositioning technique is to be used in complex cases that conventional bone augmentation and implantation solutions cannot be performed. This can be considered as the last method for patients with tooth loss and severe bone loss to get back the aesthetic and functional teeth. In addition, this technique has the advantage of limiting permanent neurological injury due to implant placement efforts when bone height is not allowed. Hence, this technique is highly applicable to patients who suffer from permanent loss of teeth and denture wearing in Vietnam.
However, this technique also has some shortcomings such as lip numbness, which is usually temporary (6 months to 1 year) but there are also a few cases that are permanent, depending on the means of use and skill of doctor. Thus, this technique should only be done by experienced and skilled doctors.
New breakthroughs in dental implant industry in Vietnam
According to Assoc. Prof. Dr. Le Van Son - Chairman of Reconstructive Maxillofacial Surgery Department at Hanoi National Hospital of Odonto-Stomatology, dental implant industry in Vietnam has been grown for about 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, vertical illiac crest bone graft augmentation, keratinized gum graft and implant placement for implant-supported restorations. This is the first surgical breakthrough in implant dentistry in Vietnam”, said Prof. Le Van Son.
Dream comes true
Mr.Luom said: "For more than 5 years, my teeth had become increasingly loose, I found food very craving but difficult to chew, I lost my appetite, so my health was deteriorated. Previously, I weighed nearly 50 kg, then I lose weight every year. 6 months ago I completely cannot chew so I had only more than 38 kg. I always wish to have teeth for chewing. My son took me to several large dental centers in the city. They said that my condition was difficult to reconstruct. I ran out of hope. But my child did not give up, continuing to search on the internet and took me to Nhan Tam dental center. After the examination, Dr. Nhan said my case could still be treated but had to be performed nerve repositioning operation. I was a bit nervous but after being thoroughly explained by the doctor, I felt confident and hoped to have better new teeth.
Patient Nguyen Van Luom after surgery of repositioning mandibular nerve and implant placement performed by Dr. Vo Van Nhan. Now he can eat normally.
"So far, my health was much better after 5 months implantation. I gained 4 kgs and regained my appetite, especially, I can eat all my favorite foods. Now my dream has come true. I am very grateful to Dr. Nhan." - Patient Nguyen Van Luom
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