Surgical Management of Pain and Paresthesia Associated with the Superficialization Phenomenon of the Inferior Alveolar and Mental Nerve in Severely Atrophic Mandibles: A Case Series

Dear Editor,

Mandibular atrophy secondary to aging and prolonged edentulism can lead to superficialization of the inferior alveolar and mental nerves[1]. This condition may result in chronic pain, paresthesia and hyperesthesia, significantly reducing patients’ quality of life and complicating prosthetic rehabilitation. In such cases, removable dentures often fail due to loss of retention, mucosal overload and nerve compression, which in turn lead to both functional and psychological problems [2].

Superficialization of the inferior alveolar nerve (IAN) is usually reported by patients as complaints of pain, paresthesia, or hyperesthesia. Radiographically, IAN superficialization was defined on cone-beam computed tomography (CBCT) imaging as an alveolar crest-to- mandibular canal distance of ≤2 mm and/or a cortical bone thickness overlying the canal of <1 mm, or complete loss of the cortical plate. These radiological findings were evaluated together with the patients’ clinical complaints of pain and paresthesia, both of which may severely compromise quality of life. In atrophic mandibles, nerve superficialization carries the risk of iatrogenic nerve injury, particularly during placement of prostheses or implants, as these may exert pressure on the nerve. Autogenous block bone grafting, which has been reported with high success rates, represents a promising method for both relieving pain and paresthesia and creating adequate bone volume for rehabilitation [3].

In this letter, the authors present their clinical experience with autogenous bone grafting in patients suffering from pain and paresthesia due to nerve superficialization in severely atrophic mandibles, and emphasize its potential as a low-risk and effective treatment option.