Background: Rehabilitation of atrophic posterior mandibles using dental implants is often complicated by anatomical limitations, particularly the proximity of the inferior alveolar nerve (IAN). Techniques such as IAN lateralization and transposition enable implant placement but are associated with neurosensory disturbances (NSDs). This systematic review and meta-analysis aimed to assess the incidence, duration, and predictors of NSDs following IAN repositioning for implant placement and to evaluate the effectiveness of adjunctive methods like piezo-surgery and platelet-rich fibrin (PRF) in minimizing complications. Methods: Following PRISMA 2020 guidelines, a comprehensive search of electronic databases and gray literature identified 20 studies, including randomized controlled trials, prospective cohorts, and retrospective analyses published between 2009 and 2024. Outcomes analyzed included incidence of NSDs, recovery rates, implant stability quotient (ISQ), marginal bone loss, and implant success rates. Meta-analysis was performed using RevMan 5.3 software, with heterogeneity and publication bias assessed using standard Cochrane tools. Results: Transient NSDs occurred in 15�40 of cases, with higher rates observed in transposition techniques. Most patients experienced recovery within 6 months. Piezoelectric surgery significantly reduced the incidence and duration of NSDs compared to rotary instruments. Meta-analysis revealed no statistically significant differences between lateralization and transposition techniques in ISQ, marginal bone loss, success rate, or NSDs at 3 months (p > 0.05). PRF was associated with accelerated nerve recovery. IAN repositioning is effective for implant placement in atrophic mandibles with a risk of transient NSDs. Conclusions: Lateralization combined with piezo-surgery and PRF shows favorable outcomes in minimizing nerve injury and optimizing implant success. The PROSPERO registration code is as follows: CRD420251086835. © 2025 Elsevier B.V., All rights reserved.