The Soft Tissue Island Technique for Neurovascular Protection in Cases of Inferior Alveolar Canal Dehiscence During Vertical Ridge Augmentation of the Posterior Mandible

Extensive posterior mandibular bone resorption can result in exposure of the inferior alveolar neurovascular bundle, challenging implant rehabilitation and increasing the risk of surgical complications. This case report describes the successful management of a severely atrophic posterior mandible with emergence of the mandibular canal by means of guided bone regeneration (GBR) using a perforated titanium-reinforced PTFE (Polytetrafluoroethylene) mesh and a combination of autogenous and xenogeneic bone grafts, followed by successful implant placement and prosthetic rehabilitation, with a 12-month follow-up. A bone deficiency coronal to the inferior alveolar nerve, resulting from a complication of a prior surgical intervention, led to an unintended communication between the neurovascular bundle and the overlying oral soft tissues. The "soft tissue island" technique, executed with the aid of a surgical guide to identify the defect, allowed complete isolation of this communication through precise manipulation of the vestibular flap. This technique facilitated the execution of all necessary procedures for bone augmentation and implant placement without inducing neurological complications. The described approach may serve as a valuable and less invasive alternative to conventional surgical techniques, which are often associated with a higher risk of post-operative complications involving the inferior alveolar neurovascular bundle.