Let Staff Help Me Avoid Injury to the Inferior Alveolar Nerve

  1. If preop PA does not show the inferior alveolar nerve (IAN) well, use endo device to retake it
  2. This is appiled to especially the lower 2nd molar or 2nd premolar
  3. If it still does not work, refer to take CT, especially for the patient who is easily gagging 
  4. No nerve visible, no surgery to be scheduled
  5. Update PA
  6. Take PA after extraction with minimal insertion of a pilot drill or a large drill (just drop in)
  7. No block anesthesia until the length of osteotomy is clearly defined
  8. No infiltration around the mental foramen when working on the lower premolars, especially with Septocaine
  9. Comfort the patient about slight pain with infiltration
  10. Watch for pain sign, agitation, blinking eyes
  11. Incision increases visibility and reduces complication
  12. Use a shorter implant for a suspicious case, 2 mm from IAN
  13. Achieve marginal primary stability
  14. Automatically pass a long explorer to the doctor to check osteotomy every time after drilling
  15. Watch for excessive bleeding
  16. Stop surgery when failing to take intraop PA after initial osteotomy

Xin Wei, DDS, PhD, MS 1st edition 02/07/2014, last revision 01/19/2018