Study of the mandibular canal and its surrounding canals by multi-view cone-beam computed tomography.

OBJECTIVES: To determine the mandibular anatomical structures by observing cone-beam computed tomography (CBCT) from multiple angles. MATERIALS AND METHODS: This retrospective study analyzed 1593 consecutive CBCT images. Ultimately, 95 CBCTs met the inclusion criteria. The mandibular, inferior lingual, and bony canals at the tooth apex were studied by multi-angle observation CBCT. Descriptive statistics were used for statistical analysis. RESULTS: It is beneficial to further observe the anastomosis of the mandibular, lingual, and mandibular canals when the course of the mandibular lingual canal is observed on CBCT cross-section. The frequency of the inferior lingual canal anastomosis with the mandibular canal was 43.2% (95% confidence interval (CI) 33, 53.3) in the sample. The mental foramen was located below the long axis of the tooth in a few samples, with an occurrence rate of 29.5% (95% CI 20.1, 38.8). The occurrence rate of various types of the bony canal at the apex of the tooth in canines, first premolars, second premolars, first molars, and second molars under the root apex was recorded through the multi-angle observation of the dental volume reformat (DVR) and three-dimensional (3D) levels in CBCT. CONCLUSION: This study demonstrates the utility of CBCT imaging in examining mandibular anatomy from multiple angles, providing valuable insights into anatomical variations, and enhancing our understanding of mandibular structures. This research emphasizes the crucial role of meticulous CBCT examination in precisely identifying and understanding key anatomical structures, ultimately reducing the risk of surgical complications. CRITICAL RELEVANCE STATEMENT: By examining cone-beam computed tomography scans from various perspectives, it is possible to determine the precise position of anatomical structures within the jaw. This allows for a more accurate assessment, reducing the risk of harm to these structures during treatment. KEY POINTS: • It is crucial to utilize image data effectively to enhance the comprehension of human anatomy. • We captured detailed images of the mandible from different angles and orientations utilizing cone-beam computed tomography (CBCT). • This study provides essential anatomical information for procedural planning to ensure optimal outcomes and patient safety.

Bilateral Inferior Alveolar Canal Variations Detected by Cone Beam Computed Tomography-Case Report.

Inferior alveolar canal (IAC) is an important anatomical landmark in dentistry. It is a bony canal in the mandible, one on each side and transmit inferior alveolar neurovascular bundle. However, it has been reported to have anatomical variations in its course. IAC is visible on radiographs and cone beam computed tomography (CBCT) has been identified as the one of the best methods to assess IAC preoperatively. An interesting case of IAC anatomy in a CBCT is presented here. There were accessory mandibular foramina, retromolar foramina on both sides, accessory mental foramen on the right side and lingual foramina in the midline as well as on the body of the mandible. The IAC was showing several branching within ramus as well as in the body of the mandible. This case report highlights the possible anatomical variations and importance of careful assessment of IAC in dental and maxillofacial procedures which can cause damage to the neurovascular bundle.

Morphometric Analysis of the Midline Mandibular Lingual Canal and Mandibular Lingual Foramina: A Cone Beam Computed Tomography (CBCT) Evaluation.

BACKGROUND: This study aimed to evaluate the midline mandibular lingual canals and foramina and their anatomic variations using CBCT scans. METHODS: This study used retrospective analysis. A total of 320 CBCT scans were used to evaluate the study parameters, which comprised the presence or absence of the mandibular lingual foramen (MLF)/mandibular lingual canal (MLC) and its category, the distance between the buccal cortex and the start of the MLC, the distance between the inferior border of the mandible and the superior border of the foramen at its lingual and buccal terminals. The length and diameter of each canal at its lingual and buccal terminals. RESULTS: MLC was found in all included CBCT scans. Out of 320 included CBCT scans, a single canal was represented by 30.9%, double canals (Supra with Infra -spinosum) configuration appeared in 54.7%, and triple canals (Supra-Inter-Infra) represented 14.7%. The supraspinosum canals averaged 5.81 ± 2.08 mm in length and 0.87 ± 0.30 mm in diameter at the lingual terminal. In terms of the number of canals, there was a significant difference between men and women (p ≤ 0.001), with 60% of the men in the sample having double canals and 43.1% of the women having single canals. Moreover, the male gender had a higher prevalence of triple canals (21.3% vs. 8.1%) than females. Males and females were distributed equally among the supraspinosum canals, with no statistically significant difference (p ≤ 0.7). A considerable increase in the finding of interspinosum and infraspinosum canals was seen in the male sample (p ≤ 0.001). CONCLUSIONS: midline mandibular canals were found in all investigated CBCTs of the sample of both sexes; however, the anatomy and location of the MLF and canals varied significantly among the Saudi population.

Vascular and neurosensory evaluation in relation to lingual canal anatomy after mandibular midline implant installation in edentulous patients.

OBJECTIVES: The aim of this study is to investigate vascular and neurosensory complications in edentulous patients following the installation of mandibular midline single implants in relation to lingual canals. MATERIALS AND METHODS: After performing a cone beam computed tomography scan for the 50 recruited patients, the relationship between the potential implant site and the lingual canals was assessed, and all vascular and neurosensory complications were recorded. RESULTS: Six patients (12%) reported profuse bleeding during implant placement, and 13 (26%) reported transient neurosensory changes, which were resolved after 3 months. According to the virtual implant planning, 44 patients (88%) would have their implants touching the lingual canals, six of them reported vascular changes (14%), and 12 out of 44 patients reported neurosensory changes (27%). For the six patients who would have their implants not touching the lingual canals, one patient reported transient neurosensory changes. CONCLUSIONS: The mandibular lingual canals are constant anatomic landmarks. Injury to the supra-spinosum lingual canals may occur during midline implant placement, depending on the implant length and the bone height. CLINICAL RELEVANCE: Despite that injury to the supra-spinosum lingual canals during implant insertion does not result in permanent vascular or neurosensory complications, caution is required to avoid the perforation of the lingual cortices.

The lingual foramina, a potential risk in oral surgery. A retrospective analysis of location and anatomic variability.

OBJECTIVE: This study evaluates the mandibular lingual foramina (LF) using computed tomographic imaging data from a large Central European cohort, focusing on the most relevant anatomical parameters. We aimed to examine whether there are differences in key parameters between ethnic groups, or based on age and gender. Additionally, we analyze the potential effect of tooth loss on the LF and discuss risk management options before and during surgery. METHODS: 460 CT scans of adults (273 females and 186 males) were examined. The number, the location and the diameter of the median and lateral LF were assessed for each patient. The data was analyzed statistically, whereby a p-value lower than 0.05 was considered as significant. RESULTS: Median and lateral LF were present in 95,9%, and 38,9% of patients, respectively. Male patients had a greater number of LF than females. While the majority of median LF (62%) was located above the mental spine, the majority of lateral LF was located below (84%). The diameter of lateral LF (1,15 mm ± 0,33) was smaller than for median LF (1,22 mm ± 0,35), as well the lateral canals (4,8 mm ± 1,28) were shorter than the median canals (5,32 mm ± 1,74). Lateral LF were equidistant to the symphysis (13,89 ± 3,63 mm) on either side. Critical diameter size >1 mm was found in about 2/3 of our cases. The distance from the foramen to the residual ridge was ∼7 mm less in edentulous patients compared to dentulous patients. CONCLUSION: The median LF is a near-obligatory structure of the mandible, while the lateral LF is a frequently encountered structure. Age does not seem to affect the frequency of LF. Edentulous patients did not show differences regarding the presence of the LF, but their vertical osseous dimension was diminished by 7 mm and they may, therefore, be at an increased risk of adverse surgical incidents. The main findings of this study relate to the substantial variability in the anatomy and location of the LF and confirm with previous studies. As the LF can be reliably detected using CT/CBCT, the use of three-dimensional-imaging is recommended prior to conducting oral surgery. Careful pre-operative planning and accurate anatomical information may help to avoid surgical complications. To ascertain the potential significance of ethnicity on LF, more data need to be collected using standardized methodologies. A definitive conclusion on the impact of ethnicity on LF thus cannot currently be drawn based on the results of our study and those available from the published medical literature.

Cone-beam CT assessment of implant-related anatomy landmarks of the anterior mandible in a Chinese population.

PURPOSE: To investigate the prevalence, location, and morphology of the mandibular lingual foramen (MLF), mandibular incisive canal (MIC), and anterior loop of the inferior alveolar canal (ALC) in a Chinese population using cone-beam CT (CBCT). MATERIALS AND METHODS: From 2014 to 2016, CBCT images from patients with various scanning purposes were obtained from the database of the Affiliated Stomatology Hospital of Kunming Medical University, China. Imaging analyses of the MLF, MIC, and ALC were performed via the NNT viewer software. The prevalence, location, length, classification of MLF, and its distances to the alveolar crest and the lower border of mandible were investigated, and the prevalence and length of MIC and the prevalence of ALC were also studied. RESULTS: This study examined 1008 subjects, 521 (51.7%) males, and 487 (48.3%) females. 916 (90.9%) subjects showed the medial lingual foramina (LF), a single medial LF with the supraspinous-type predominating. Lateral LF were observed in 547 (54.3%) subjects mostly located in the premolar areas. 876 (86.9%) subjects had the MIC on the left side, whereas 877 (87.0%) had the MIC on the right side. The ALC was present in 147 (14.6%) subjects. CONCLUSIONS: This study showed a high prevalence of LF and MIC in the Southwest Chinese population. Therefore, caution should be taken during the implant treatment at the anterior mandible region.

Determination of presence and morphometry of lingual foramina and canals in Chilean mandibles using cone-beam CT images.

PURPOSE: To describe the presence and anatomical characteristics of lingual foramina and canals using cone-beam computed tomography (CBCT) in a sample of Chilean dry mandibles. METHODS: Cone-beam computed tomography images of 68 adult mandibles of indeterminate sex and age were analyzed. The description of number and position of lingual foramina were tabulated using a position regarding the mental spines (superior, between, and inferior to the mental spines). Area and diameter of the foramina and length of the canals found were measured. RESULTS: All the mandibles had one or more lingual foramen. The median was 3 foramina with a minimum of 1 and a maximum of 4. The most frequent positions were superior and inferior with 88% and 85% of presence, respectively. The lingual canal diameter obtained for the superior position was 1.04 ± 0.38 mm, for the between position was 1.02 ± 0.5 mm, and finally 1 ± 0.3 mm for the inferior position. The lingual canal length for the superior position was 6.38 ± 2.4 mm, for the between position 6.77 ± 1.33, and 5.38 ± 0.25 mm for the inferior position. CONCLUSIONS: All the mandibles have one or more lingual foramina. The most frequent positions were superior and inferior. Many of the lingual foramina found were over 1 mm in diameter. The lingual canal length was over 5 mm for all the positions.

A Limited Field Cone-beam Computed Tomography-based Evaluation of the Mental Foramen, Accessory Mental Foramina, Anterior Loop, Lateral Lingual Foramen, and Lateral Lingual Canal.

INTRODUCTION: The aim of this retrospective observational study was to evaluate the cone-beam computed tomographic (CBCT)-based characteristics of the mental foramen (MF), accessory mental foramen (AMF), anterior loop (AL), lateral lingual foramen (LLF), lateral lingual canal (LLC) and to explore any relationships between their characteristics. METHODS: The location and dimension of the MF; the incidence, location, and dimension of the AMF along with its distance to the MF; the presence and dimension of the AL; and the presence, location, angle of entry of the LLF and LLC, and its relation with the mandibular canal (MC) were evaluated in 109 CBCT scans. The data were analyzed descriptively, and associations were tested using the chi-square and analysis of variance tests. RESULTS: The MF was most frequently located between the first and second mandibular premolar teeth (43.5%) or below the second premolar (34.3%). The mean horizontal dimension of the MF was 3.1 mm, the vertical dimension was 2.8 mm, and the mean vertical distance from the alveolar crest was 14.2 mm. An AMF was observed in 12.8% of cases with a mean distance of 4.1 mm from the MF. An AL was present in 47.2% of cases with a mean loop length of 3.38 mm. An LLF was present in 20.4% of cases, predominantly below the first premolar (27.3%) with a mean angle of entry of 148°. The LLC always communicated with the MC and generally not with the tooth apex. A statistically significant association existed between the presence of the LLF and AMF. CONCLUSIONS: The anatomic complexity of the MF region was confirmed; hence, CBCT-based evaluation is essential before surgical exploration of this region.

Presencia y morfometría de forámenes y canales linguales en cone beam CT de mandíbulas de individuos chilenos: correlación con medición directa en hueso / Presence and morphometry of lingual foramina and canal in cone beam CT of Chilean dry mandibles: correlation with direct bone measures

Se han descrito forámenes ubicados en la cara interna del sector mandibular anterior, ya sea en hueso seco, radiografía convencional y en estudios mediante cone beam CT (CBCT). El objetivo de este estudio fue comparar la presencia, posición y las características anatómicas de los forámenes y canales linguales encontrados en CBCT de mandíbulas Chilenas secas, con los resultados de la misma muestra estudiada con visión directa en hueso seco. Se utilizaron 68 mandíbulas secas de la unidad de morfología de la Universidad de los Andes. Se evaluó número de dientes remanentes, número de forámenes relacionados con las espinas mentonianas, posición, área y longitud de cada canal en hueso seco y en CBCT de la misma muestra. Se encontró presencia del foramen lingual en 100 % de CBCT y 97 % de observación directa en hueso. Se observaron 150 forámenes en hueso seco y 170 forámenes en CBCT. La mayor cantidad se encontró por superior (hueso: 55; CBCT:61) e inferior (hueso:66 ; CBCT:92) a las espinas mentonianas. La confiablidad no fue la esperada, con un kappa para el número de forámenes superiores de 0,43, una correlación intraclase (rho) para el número de forámenes inferiores de 0,31. El área de forámenes superiores tuvo un rho de 0,059 e inferiores un rho de 0,144, mientras que, la longitud de los canales superiores, un rho de 0,5 e inferiores un rho de 0,246. Se observó una tendencia a mayores diámetros y longitudes de canales en las mediciones realizadas en CBCT comparadas con las mediciones en hueso seco. Teniendo en cuenta la alta prevalencia de estos forámenes, es recomendable previo a cualquier cirugía en el sector mandibular anterior, el estudio mediante CBCT. Además de mantener un margen de seguridad respecto a los forámenes linguales debido a una mínima distorsión esperable de estas estructuras.

On several studies, there has been described foramina located in the inner face of the anterior mandible, whether on dry bone, conventional radiography and cone beam CT (CBCT). The aim of this study was compare the presence, position and anatomical characteristics of foramina and lingual canals found in CBCT of Chilean mandibles, with the results of the same sample studied with direct vision in dry bone. We studied 68 mandibles from the morphology unit of Universidad de los Andes. The number of teeth, foramina related to mental spines, position, area and length of each canal were evaluated, in dry bone and CBCT from the same sample. Presence of lingual foramen was found in 100 % of CBCT and 97 % of direct observation in bone. There were 150 foramina in dry bone and 170 foramina in CBCT. The greatest amount was found superior (bone: 55; CBCT: 61) and inferior (bone: 66; CBCT: 92) to the mental spines. . The reliability was not as expected, with a kappa for the number of upper foramina of 0.43, an intraclass correlation for the number of lower foramen of 0.31. The upper foramen area had an intraclass correlation of 0,059 and an inferior correlation of 0.144 while, the length of the superior canals, had a 0.5 and inferior 0.246 of intraclass correlation. A trend was observed for higher diameters and canal lengths in the measurements performed with CBCT compared to the measurements in dry bone. Taking into account the high prevalence of these foramina, it is advisable prior to any surgery in the anterior mandible, the prior study using CBCT. In addition to maintaining a margin of safety with respect to lingual foramina.

Evaluation of location and dimensions of mandibular lingual canals: a cone beam computed tomography study.

This retrospective study evaluated the presence, location, and diameter of the mandibular lingual canals in a Taiwanese population using cone beam computed tomography (CBCT), to help improve the safety of mandibular surgical procedures. A total of 101 patients (46 men and 55 women), with a mean age of 55 years, were enrolled. Cross-sectional CBCT images of the mandible were used to define the orifice and diameter of each lingual canal detected. The relevance of all data for both sexes was assessed and analyzed statistically using non-paired t-tests. The canals were categorized as median (MLC) and lateral lingual canals (LLC) based on the position of the mandible. The midline of the symphysis showed the highest frequency of lingual canals (97.0%), and all patients exhibited at least one lingual perforating bone canal in the mandible. The lingual canal diameter ranged from 0.25 to 1.90 mm (mean 0.61 mm) in the midline region and from 0.25 to 1.60mm (mean 0.58 mm) in the lateral region. Significant differences in diameter were observed between the sexes in the MLC and LLC groups (men>women). The results suggest that mandibular lingual vascular canals are common and detected regularly using CBCT.

Influencia de dientes remanentes en la presencia y morfometría de forámenes y canales en relación a las espinas mentales / Influence of remnant teeth in the presence and morphometry of foramina and canals in relation to mental spine

La zona anterior de la mandíbula, con frecuencia es intervenida desde el punto de vista quirúrgico (instalación de implantes oseointegrados, mentoplastias, genioplastias, profundizaciones de vestíbulo y flanco lingual, fracturas, etc.). Se ha descrito la presencia de vasos que penetran la tabla ósea lingual en la zona mediana mandibular, los cuales se relacionan con forámenes vasculares. La pérdida dentaria en la zona anterior mandibular podría influir en el tamaño de los forámenes y canales debido a la degeneración de los vasos incisivos provenientes de la arteria alveolar inferior. El objetivo fue evaluar la relación entre presencia y ausencia de dientes remanentes en el grupo V con la presencia y morfometría de forámenes y canales ubicados en cercanía a las espinas mentales. Se estudiaron 95 mandíbulas humanas secas, con sexo y edad indeterminada. Se midió el área de los forámenes y la longitud de los canales utilizando el programa Photoshop CS3 extended. Se obtuvo un total de 53 mandíbulas dentadas en el grupo V y 42 mandíbulas desdentadas en el grupo V. El 95,7% de la muestra tuvo al menos un foramen en relación a las espinas mentales. Se vio que los forámenes con mayor frecuencia de aparición fueron los superiores a las espinas mentales superiores en 75 mandíbulas, forámenes inferiores a las espinas mentales inferiores en 72 mandíbulas y los forámenes entre las espinas mentales en 26 mandíbulas. No se encontró asociación entre la presencia y ausencia de dientes con la frecuencia de forámenes en las tres posiciones estudiadas. Se observó que el foramen inferior a espinas mentales tuvo un diámetro mayor en mandíbulas dentadas (valor p= 0,0194) y la longitud del canal superior a las espinas mentales superiores fue significativamente más largo en mandíbulas desdentadas (valor p= 0,0206).

The anterior mandibular body is an anatomical area that is often subjected to surgery such as for installation of osseointegrated implants, mentoplasty, genioplasty, fractures, among others. The presence of vessels that penetrates through foraminas at its midline from the lingual table has been described. Tooth loss in the anterior mandibular zone may influence the size of the foramina and canals due to the atrophy of incisors vessels that originates from the inferior alveolar artery. The aim was to evaluate the relationship between presence and absence of remaining teeth in group V, with the presence and morphometry of foramina and canals located in proximity to the mental spines. We studied 95 dry human mandibles with indeterminate sex and age. We measured the area of the foraminas and the length of the canals using the program Photoshop CS3 Extended. We obtained a total of 53 dentate and 42 edentulous mandibles in group V. In 95.7% of the sample had the presence of at least one foramina relative to the mental spines. The foramina that was found more often, tended to be upper to the superior mental spines, in a total of 75 mandibles; lower to the inferior mental spines in 72 mandibles and between the mental spines in 26 mandibles. There was no association between the presence and absence of teeth versus the frequency of the foramina in the three positions established. It was seen that the foramina lower to the inferior mental spine had a greater diameter in dentate mandibles (p-value= 0.0194) and the canal upper to the superior mental spines was significantly longer in the edentulous mandibles (p-value= 0.079).

Presencia y morfometría de forámenes y canales en relación a las espinas mentonianas / Presence and morphometry of foramina and canals in relation to mental spines

Los procedimientos quirúrgicos desarrollados en la porción anterior del cuerpo mandibular, como por ejemplo la instalación de implantes oseointegrados, genioplastias, profundizaciones de flanco lingual, fracturas, etc. pueden presentar complicaciones de importancia cuando estas invaden estructuras vasculares, con la consecuente hemorragia y formación de hematomas sublinguales. Dentro de estos elementos anatómicos se encuentran forámenes y canales que se ubican en relación a las espinas mentonianas. El objetivo de este estudio fue cuantificar la ubicación, diámetro y longitud de los forámenes y canales presentes por superior, inferior y entre las espinas mentonianas superiores e inferiores en 71 mandíbulas secas de la Unidad de Morfología de la Universidad de los Andes las que fueron fotografiadas. Analizando las fotografías con el programa Photoshop® Cs 3 extended, se midieron en pixeles el diámetro y longitud de los forámenes y canales para luego transformarlos en mm. El 97 por ciento de las mandíbulas observadas presentaron al menos un foramen, el 45 por ciento presentó dos y el 31 por ciento tres. En relación a su ubicación el 82 por ciento de las mandíbulas presentó forámenes por superior a las espinas y el 76 por ciento por inferior. El diámetro promedio fue de 0,73 mm para los de ubicación superior y de 0,71 mm para los de ubicación inferior. La longitud promedio de los canales fue de 6,77 mm para los ubicados por superior y de 5,5 mm para los de ubicación inferior a las espinas mentonianas. Debido a la alta prevalencia de forámenes y canales en nuestra muestra es recomendable tenerlos siempre en cuenta en la planificación de intervenciones quirúrgicas que involucren ya sea el flanco lingual mediano mandibular o el cuerpo mandibular en la zona de la sínfisis.

Surgical procedures developed in the anterior mandibular body, such as the installation of osseointegrated implants, genioplasties, lingual edge insights, fractures, etc. may produce mayor complications when these invade vascular structures, with consequent bleeding and sublingual hematoma formation. Within these anatomical elements we find foramina and canals that are located in relation to the mental spine. The objective of this study was to quantify the location, diameter and length of the foramina and canals present superior, inferior and between the upper and lower mental spine in 71 dry mandibles from the Morphology Unit, Universidad de los Andes, which were photographed. Analyzing the pictures with Photoshop ® Cs 3 extended program, the diameter and length of the foramina and canals were measured in pixels and then transformed into mm. 97 percent of the jaws observed had at least one foramen, 45 percent had two and 31 percent three. In relation to location 82 percent of the mandibles showed foramina in the bones superior and inferior 76 percent. The average diameter was 0.73 mm for superior placement and 0.71 mm for inferior placement. The average length of the superior canals was 6.77 mm and 5.5 mm for those inferior to the mental spine. Due to the high prevalence of foramina and canals in our sample its recommended to keep always in mind when planning surgical procedures that involve either medium mandibular lingual flank as the mandibular body at the symphysis area.

Assessing the anatomical variations of lingual foramen and its bony canals with CBCT taken from 102 patients in Isfahan.

BACKGROUND: Some studies have been performed on assessing the anatomical variations of lingual foramen and its bony canals, in many different countries but no study has been performed in Iran yet. The purpose of this study is to assess the anatomical variations of lingual foramen and its bony canals with cone-beam computed tomography (CBCT) imaging in Isfahan. MATERIALS AND METHODS: This was a cross-sectional study in which CBCT images taken from 102 patients referred to the Radiology Department of Head and Neck in Esfahan (Iran) University between 2010 and 2011. The presence of the lingual foramen and its bony canals, the locations, sizes, and length were assessed. The distances between the terminal end of lingual canal at the buccal and lingual side from the inferior border of the mandible and alveolar crest were measured. We also evaluated the effect of patient age and gender on the dimensional measurements of the anatomical landmark mentioned above t test, analysis of variance (ANOVA), and pearson's correlation were used for statistical analysis and P value lower than 0.05 was considered significant. RESULT: All of the CBCT images taken showed the presence of lingual foramen. Of all the participants, 52% of them had two foramens in their images. The mean diameters of the upper and lower lingual foramen were 1.12 and 0.9 mm, respectively. CONCLUSION: These anatomical landmarks in Isfahan population vary from previous studies. All of the images had at least one lingual foramen which demonstrates high prevalence of this anatomy among Isfehanian population. Therefore, it is recommended to use CBCT imaging for preoperative evaluation prior to installing dental implants.