Injury Risk Estimation in Mandible-Related Surgical Procedures: A CBCT Study Based on Vital Interforaminal Anatomical Structures.

The mandibular interforaminal region has been considered safe for surgical procedures; nevertheless, the risk of injury to neurovascular structures, such as the mental foramen (MF) and its related structures (anterior loop [AL] and lingual foramina [LF]) should not be overlooked. The study aimed to evaluate the relative risk of injury to these structures during surgical procedures in the anterior region of the mandible based on cone-beam computed tomography (CBCT) scans. A retrospective cross-sectional and observational study was performed on 250 CBCTs from adults (18-69 years) with dentate jaws. Linear measurements of the MF, AL, and LF were evaluated to estimate the risk of injury to these structures during chin-related surgical procedures. The most frequent distance between the base of the mandible (BM) and MF was 8 mm (30.2%). In addition, 20.4% of the CTs had 6 mm from the vestibular cortical bone to the LF. The commonly found measurement from LF to the apex of the nearest tooth was 7 mm (24.0%); 64.2% of the CTs showed a 2-mm distance between the most distal point of the dental implant site to the most anterior point of the AL. Safety distances for genioplasty techniques (MF to mandible base > 6 mm, 96.6% [CI 95%, 95.0%-98.2%]) were observed. Considering the 5-mm cut-off point between the lower limit of a hypothetical bone graft and the chin, 65.4% (CI 95%, 58.9%-71.9%) of CTs were within this distance. Regarding the safety margin of 8 mm, 85.6% (CI 95%, 80.8%-90.4%) were up to this value. This study found safety margins for genioplasty and chin bone grafting surgical techniques that adopt a 5-mm cut-off point. Further similar studies assessing other surgical methods and employing larger samples from different geographical origins may contribute to this field of investigation.

Evaluation of Lingual Foramen in the South Indian Population Using Cone-Beam Computed Tomography: A Prospective Cross-Sectional Study.

Background: Surgical procedures in the anterior mandibular region require a profound understanding of the complex anatomical structures to ensure patient safety. The lingual foramen (LF) and its intra-osseous canal are pivotal structures, supplying vascular and neural support to the mental region. The prevalence of LF is widely recognized, with variations among populations. Methods: The study involved 650 adult participants. Data were collected using high-resolution cone-beam computed tomography (CBCT), and statistical analysis was conducted, establishing inter-rater agreement. Results: The population had a varied age distribution, with males comprising 53.23% and females comprising 46.77%. The median lingual canal was found in the Supra and Infra spinosum (65.38%). Most participants had lateral lingual canals (60.92%). The most prevalent lingual foramina was 4 (30.62%). The study found no significant associations between gender and LF diameter, distribution in different travel directions, or LF locations. However, males had a slightly larger diameter. Conclusion: The findings provide valuable insights into LF variations based on anatomical locations, and there were no statistically significant differences in measurements across different age groups. This knowledge contributes to the evolving field of oral and maxillofacial surgery, ensuring better patient outcomes.

CBCT Evaluation of Lingual Foramen and its Anatomic Variations in Northeast Indian Population.

Background: The identification of nearby neurovascular structures is a vital part of dental implant treatment planning. Commonly two implants are placed in the mandibular inter foraminal region to support the overdenture. Placing dental implants in this region is considered relatively safe. The purpose of this study was to employ cone beam computed tomography (CBCT) on a representative sample of Northeast Indians to find out the location and distribution of lingual foramen in the anterior mandible. Study Design: A total of 104 CBCT scans were performed using the Cranex 3D CBCT system. Three Oral and Maxillofacial Radiologists agreed on a visibility grade for assessing the lingual foramen using a 3-point scale. The number and presence of foramina were noted. On cross-sectional pictures, the distance in millimeters between the crest of the alveolar ridge and the superior cortical margin of the foramen was determined. Furthermore, the analysis of the distribution of lingual foramina in terms of frequency and percentages was performed. Results: Scan results showed that the lingual foramen was clearly visible in 65.4% of cases, somewhat visible in 12.5% of scans, and not visible at all in 22.1% of cases. Half of the people in the study had two foramina, whereas 27.9 percent had one and 22.1 percent had none. The mean distance from the crest of the alveolar ridge was 10.84 mm in males whereas 9.91 mm in females. Conclusion: The Northeast Indian population exhibits an unusually high prevalence of lingual foramen in the anterior portion of the mandible. This research will aid in the precise pre-operative identification of the position and number of lingual foramina prior to surgical treatments involving the midline of the mandible.

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.

Evaluation of the distribution characteristics of the mandibular lingual foramen and its potential risks during implant surgery using cone-beam computed tomography a cross-sectional, retrospective study.

OBJECTIVES: The lingual foramen is a risk factor for implantation and other mandibular surgeries, but there are few systematic studies on the anatomical and distribution characteristics of the lingual foramen in the entire mandible. MATERIALS AND METHODS: A retrospective study was performed using 405 CBCT images. The anatomical characteristics and symmetrical distribution of the mandibular lingual foramen were analyzed. RESULTS: All patients had at least one lingual foramina. According to the positional relationship between the mandibular lingual foramen and the root apex of tooth, the mandibular lingual foramen is divided into the upper lingual foramen and the lower lingual foramen. Upper lingual foramen were divided into three types according to its running direction, namely Type 1 (Enters the mandible and descend in the direction of the lower edge of the mandible), Type 2 (Enters the mandible and descends in the direction of the lower edge of the mandible with branches), and Type 3 (It enters the mandible and divides into two branches, one ascends toward the crest of the alveolar ridge, and the other descends toward the lower edge of the mandible). And their respective prevalence are 84.0% [95% Tolerance Limit (TL) 81.2%-86.8%], 9.9% [95% TL 7.6%-12.1%], and 6.1% [95% TL 4.3%-8.0%]. In addition, the 81.8% [95% TL 79.0%-84.7%] of the upper lingual foramen is distributed in the central incisor area. Lower lingual foramen were divided into three categories according to the running direction, namely Category 1 (Enters the mandible and ascends toward the buccal bone plate), Category 2 (Enters the mandible and descends toward the buccal bone plate), and Category 3 (Go straight into the mandible toward the buccal bone plate). And their respective prevalence are 29.6% [95% TL 26.4%-32.7%], 50.9% [95% TL 47.5%-54.4%] and 19.5% [95% TL 16.8%-22.3%]. The frequency of lower lingual foramen distributed anteriorly to the mental foramen is 55.8% [95% TL 52.3%-59.2%], mid-mental foramen is 21.4%[95% TL 18.5%-24.2%], and posterior to the mental foramen is 22.8% [95% TL 20.0%-25.8%]. CONCLUSION: Both the upper and lower lingual foramina should be evaluated in the anterior, middle, and posterior regions of the mental foramen before implant surgeries.

Radiographic analysis of the anterior mandible and its anatomical variations using cone-beam computed tomography.

OBJECTIVE: The anterior loop, the mandibular incisive canal, and the lingual symphyseal foramen are important structures in the anterior mandible. The purpose of this study was to assess the prevalence of these structures using CBCT. METHOD AND MATERIALS: A total of 170 projections were analyzed in different sectional planes. The study analyzed the prevalence and extension of the anterior loop and the prevalence of both the mandibular incisive canal and the lingual symphyseal foramen by using the GALAXIS software by Sirona. RESULTS: In 98.2 % (n = 167) a lingual symphyseal foramen was detected. An anterior loop was present in 31.2% (n = 53) with statistically significant higher detection rate in younger patients (P = .001). The median length was 1.26 mm (range 0.53-3.70 mm). No statistically significant differences regarding patient side or sex were found in either case. In 72.4% (n = 123) a mandibular incisive canal was detected. There was a statistically significant dependence of the mandibular incisive canal on patient sex (P = .007): female patients had a mandibular incisive canal significantly more often than male patients. Among male patients a significant difference of the mandibular incisive canal regarding the mandibular side (P = .031) was found; it was significantly less frequent on the right than on the left side. CONCLUSION: Anterior loop, mandibular incisive canal, and lingual symphyseal foramen are often present. Furthermore, the anatomical, neurovascular variability in the interforaminal area of the mandible emphasizes the importance of 3D imaging like CBCT in preoperative assessment, and confirms that a general safe zone should not solely be relied upon when performing surgery in this region.

Evaluation of neurovascular anatomical variation in the anterior mandible in North Indian population: A CBCT assessment.

Introduction: The purpose of this retrospective study was to determine the visibility, location and other morphometric features of lingual foramina on CBCT along with its age wise and gender wise correlation. Material and methods: A total of 250 patients were included in the study. Cross-sectional CBCT images of the mandible in the midline were used to locate and define each detected lingual foramen and canal. Descriptive statistics including tables and graphs were used. Genderwise and Age wise correlations were analyzed using Chi-square tests. Results: The number, direction, length, diameter, distance from alveolar crest and inferior borders of mandible were evaluated. Genderwise Lingual foramen was most frequently located in the mandibular midline, above genial tubercle (81.7%). Agewise it was found to be significant (p = 0.019). Genderwise length of canal was found to be significant (p = 0.022). Genderwise diameter of canal at midpoint was found to be very highly significant (p < 0.001) and at innermost point was found to significant. (p = 0.037) Genderwise and Agewise distance between orifice of canal and alveolar crest was found to be very highly significant. (p < 0.001) Genderwise and Agewise distance between innermost point of canal and alveolar crest was found to be highly significant (p = 0.001) and very highly significant (p < 0.001) respectively. Conclusion: Clinicians may consider CBCT for procedures with a risk of hemorrhagic and neurosensory complications such as dental implant placement in the anterior mandible.

Lingual foramina of the anterior mandible in edentulous patients: CBCT analysis and surgical risk assessment.

OBJECTIVE: The mandible has various unnamed accessory foramina, and surgery is often performed in the symphyseal area. The aim of this study was to analyze the anatomical characteristics of mandibular lingual foramina with the objective of preventing clinical complications during implant surgery on an edentulous mandible. STUDY DESIGN: A total of 100 cone beam computed tomography scans of completely edentulous patients were included in this study. For each canal, nine measurements were recorded in millimeters: seven length or height measurements and two diameter measurements. The placement of a standard implant was simulated and whether the implant passed through the canal was noted. The results were analyzed by t-test and chi-squared at a significance level of 0.05. Pearson correlation analysis was used to assess the relationship between variables. RESULTS: We identified 309 foramina: 236 medial lingual foramina and 73 lateral lingual foramina. We found no significant relationship between the number of foramina and the age of the individuals, or between diameter and the age or gender of the individuals. The mandibular canal was injured in 32.7 % of implant placement simulations. CONCLUSION: The risk of injury to neurovascular bundles is increased in edentulous patients due to vertical bone resorption.

Morphometric analysis of the mandibular lingual foramina using cone-beam computed tomography in elderly Korean / Análisis morfométrico de los forámenes linguales mandibulares mediante tomografía computarizada de haz cónico en adultos mayores coreanos

SUMMARY: The aim of this study was to determine the morphologic characteristics of the lingual foramen and lateral lingual foramen using cone-beam CT in elderly Korean. Cone-beam CT images were obtained from 80 Korean older than 50 years (mean age, 65.2 years). The prevalence of the lingual and lateral lingual foramina at the lingual aspect of the mandible was determined. The diameter and height to the upper margin of the foramina from the mandibular inferior margin, and the bone height to the alveolar crest from the mandibular inferior margin were measured. In addition, the location of the lateral lingual foramen, the direction of its canal, and the presence of communication with the mandibular canal were evaluated. All of elderly Korean possessed at least one lingual foramen, with two or three foramina occurring in 77.5 % of Korean. A lateral lingual foramen was observed in 91.3 % of Korean, with the prevalence being highest at the second premolar in dentulous cases (21.6 %; 33/153). The very high frequencies of these foramina were attributable to high frequencies of relatively small-diameter inferior lingual foramen and lateral lingual foramen in the incisor region. The prevalence of a large-diameter (≥1 mm) superior lingual foramen was high, at 31.0 %. A large-diameter lateral lingual foramen in the premolar region occurred at a frequency of 17.0 %; communication with the mandibular canal was observed in 70.0 % of these cases. These quantitative data on the lingual and lateral lingual foramina of the mandible provide valuable information that could help to avoid surgical complications during implant placement in elderly Korean.

RESUMEN: El objetivo de este estudio fue determinar las características morfológicas del foramen lingual y del foramen lingual lateral mediante TC de haz cónico en adultos mayores coreanos. Se obtuvieron imágenes de TC de haz cónico de 80 coreanos mayores de 50 años (edad media, 65,2 años). Se determinó la prevalencia de los forámenes linguales y linguales laterales en la cara lingual de la mandíbula. Se midió el diámetro y la altura hasta el margen superior de los forámenes desde el margen inferior mandibular, y la altura ósea hasta la cresta alveolar desde el margen inferior mandibular. Además, se evaluó la ubicación del foramen lingual lateral, la dirección de su canal y la presencia de comunicación con el canal mandibular. Todos los adultos mayores coreanos tenían al menos un foramen lingual, con dos o tres forámenes en el 77,5 %. Se observó un foramen lingual lateral en el 91,3 %, siendo la prevalencia más alta en el segundo premolar en casos dentados (21,6 %; 33/ 153). Las mayores frecuencias de estos forámenes se atribuyeron a altas frecuencias de foramen lingual inferior y foramen lingual lateral de diámetro relativamente pequeño en la región de los incisivos. La prevalencia de un foramen lingual superior de gran diámetro (≥1 mm) fue alta, del 31,0 %. Un foramen lingual lateral de gran diámetro en la región premolar ocurrió con una frecuencia del 17,0 %; se observó comunicación con el canal mandibular en el 70,0 % de estos casos. Estos datos cuantitativos sobre los forámenes linguales y linguales laterales de la mandíbula proporcionan información valiosa que podría ayudar a evitar complicaciones quirúrgicas durante la colocación de implantes en adultos mayores coreanos.

Frequency and anatomic variability of the mandibular lingual foramina: a cone-beam CT study.

BACKGROUND: To evaluate the distribution of lingual foramina (LF) and their correlation with demographic characteristics and mandible width, shape, and bone thickness in Caucasian Italian patients subjected to cone-beam CT (CBCT). METHODS: CBCTs were reviewed to assess the number of all LF, midline and lateral LF. We also assessed the relationship of the number of lateral LF with gender and mandibular width, shape, and bone thickness using the Chi Square test. A p value < 0.05 was considered statistically significant. RESULTS: Three-hundred patients (180 males; age range: 21-87 years) were included. The highest frequency per patient was of 2 LF (97/300, 32.3%), followed by 3 (81/300, 27%) and 4 (53/300, 17.7%). No LF were observed in 2/300 patients (0.7%), while the highest number was of 8 LF in one patient. The highest frequency of midline LF per person was of 2 LF (57.3%, 172/300), while the highest number per person was 5 LF in one patient (0.3%). The highest frequency of midline LF located above and below the genial tubercle was of 1 in 197/300 patients (65.7%) and in 169/300 patients (56.3%), respectively. Concerning lateral LF, the highest frequencies were of 0 (113/300, 37.7%) and of 1 (112/300, 37.3%). We did not observe any significant difference of the number of midline and lateral LF based on gender (P = .438 and P = .195, respectively) or mandible width (P = .069 and P = .114, respectively). The mandible shape was normal in 188 cases, with facial constriction in 42, lingual constriction in 54, and hour glass constriction in 16. The mean bone thickness was 10.76 mm in the symphysis, 10.92 mm in the right hemiarches, and 10.68 in the left hemiarches. No significant differences in the distribution of LF were observed also based on mandibular shape and bone thickness (both with P > .05). CONCLUSIONS: We have shown the high variability of number and anatomic distribution of LF in an Italian group of patients subjected to CBCT without reporting any association with gender and mandible width, shape, and bone thickness.

Anatomical evaluation of the medial lingual foramen using cone-beam computed tomography: a retrospective study / Avaliação anatômica do forame lingual medial usando tomografia computadorizada de feixe cônico: um estudo retrospectivo

ABSTRACT Objective: To evaluate the frequency of medial lingual foramina present in the cortex of the mandible using cone beam computed tomography (CBCT). Methods: A total of 953 CBTC exams of the mandible were evaluated to determine the presence of canals in the mandibular midline, canal location in relation to the mental spine, canal diameter, distance to the base and alveolar crest of the mandible, trajectory of the canal, and coincidence measurements of the panoramic image containing the location of the canal in relation to the mental spine. Results: Foramina were located in three positions: above the mental spine (FSS) 89.2%, below the mental spine (FIS) 67.9%, and other positions (FOP) 21.3%. Non-edentulous individuals had a significantly higher number of FSS than did edentulous individuals (P<0.001). Male individuals presented a significantly greater distance from the FSS (P=0.001), FIS (P=0.045) and FOP (p=0.002) to the base of the mandible than female individuals. Younger individuals presented a significantly higher distance from the FSS (P=0.001) and FIS (P=0.001) to the alveolar crest of the mandible. Male individuals had a significantly greater FIS (P=0.002) and FOP (P=0.001) diameter than female individuals. Male individuals had a significantly higher number of bifurcations in FOP than female individuals (P=0.017). Conclusion: CBCT supplies the provider with a detailed assessment of the foramina and canals, which improves the quality of surgical planning and mitigates the chances of surgical intercurrences.

RESUMO Objetivo: Avaliar a frequência dos forames linguais mediais presentes na cortical da mandíbula por meio da tomografia computadorizada de feixe cônico (TCFC). Métodos: Um total de 953 exames de TCFC da mandíbula foram avaliados para determinar a presença de canais na linha média mandibular, localização do canal em relação ao tubérculo geniano, diâmetro do canal, distância à base e crista alveolar da mandíbula, trajetória da canal e medidas de coincidência da imagem panorâmica contendo a localização do canal em relação ao tubérculo geniano. Resultados: Os forames localizaram-se em três posições: acima do tubérculo (FSS) 89,2%, abaixo do tubérculo (FIS) 67,9% e outras posições (FOP) 21,3%. Indivíduos não edêntulos apresentaram um número significativamente maior de FSS do que indivíduos edêntulos (P <0,001). Indivíduos do sexo masculino apresentaram distâncias significativamente maior do FSS (P = 0,001), FIS (P = 0,045) e FOP (p = 0,002) até a base da mandíbula do que indivíduos do sexo feminino. Os indivíduos mais jovens apresentaram uma distância significativamente maior do FSS (P = 0,001) e FIS (P = 0,001) até a crista alveolar da mandíbula. Indivíduos do sexo masculino tiveram um diâmetro de FIS (P = 0,002) e FOP (P = 0,001) significativamente maior do que indivíduos do sexo feminino. Indivíduos do sexo masculino tiveram um número significativamente maior de bifurcações no FOP do que indivíduos do sexo feminino (P = 0,017). Conclusão: a TCFC fornece ao profissional uma avaliação detalhada dos forames e canais, o que melhora a qualidade do planejamento cirúrgico e diminui as chances de intercorrências.

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.

Evaluation of the relationship between appearances of the lingual foramen on panoramic radiography and cone-beam computed tomography.

AIM: The aim of this retrospective study is to determine the level of visibility of the lingual foramen in panoramic radiography using cone-beam computed tomography (CBCT) as a reference tool. METHOD: A total of 200 patients (111 females and 89 males) were included in the study. Cross-sectional CBCT images of the mandible in the midline were used to locate and define the orifice and diameter of each lingual canal that was detected. The appearance of the lingual foramen in the anterior mandible in panoramic radiography was assessed using a five-point ordinal scale. Descriptive statistics including tables and graphs were used. The correlation between CBCT and panoramic radiography findings were analyzed using Chi-square tests. RESULTS: The lingual foramen was found to be located most frequently in the mandibular midline, above the genial tubercle (78.5%). A narrow-diameter type was found to occur most frequently (56.5%). A prominent genial tubercle was the most commonly found type (57.5%). The lingual foramen could be definitively identified in panoramic radiographs in only 8 cases (4%), while a high degree of probability was found in 25 cases (12.5%). The lingual foramen appears wider and therefore more distinctive in panoramic radiographs when the angulation of the lingual canal is less than 20° to the ground plane. CONCLUSIONS: Radiological evaluation with panoramic radiographs alone may lead to inadequate assessments prior to surgical procedures involving the anterior mandible. Clinicians may consider using three-dimensional imaging for procedures with a risk of hemorrhagic and neurosensory complications such as dental implant placement in the anterior mandible.

Comparison of anterior mandible anatomical characteristics between obstructive sleep apnea patients and healthy individuals: a combined cone beam computed tomography and polysomnographic study.

PURPOSE: This study aims to evaluate the morphology of the genial tubercle (GT) and lingual foramen (LF) between obstructive sleep apnea (OSA) and non-OSA patients for considerations of mandibular advancement surgery. METHODS: Cone beam CT records of 198 patients were retrospectively collected and analyzed. Five variables were measured for genial tubercle; anterior mandible thickness (AMT), the distance from the lower incisors to the superior border of the genial tubercle, the distance from the inferior border of the genial tubercle to inferior border of the mandible, the height of GT, and genial tubercle width. Lingual foramen were classified according to the genial tubercle. The frequencies, distances of lingual foramen to alveolar crest, lower border of mandible (LVDL) and diameter of LF were also measured. RESULTS: Significant differences was found for genial tubercle width, anterior mandible thickness, and the distance of lower mandibular border to the midline lingual foramina between OSA and non-OSA patients (p < 0.05). AMT gets thicker and GT gets narrower in OSA patients (p < 0.05). A linear regression analysis on the apnea hypopnea index with measured anatomical variables showed the LVDL (R = - 0.355*), body mass index (R = 0.254), and age (R = 0.33) showed a statistically significant association (p < 0.05). None of the other variables reached formal significance. CONCLUSION: LVDL is linearly associated with sleep apnea severity. The variable dimensions and anatomy of genial tubercle as well as lingual foramen for OSA patients suggest the need of 3D preoperative radiological evaluation before genioglossus advancement surgery. Cone beam CT can be a powerful low radiation dose tool both for evaluating the anatomy of the upper airway and mandibular structures at the same time for OSA patients.

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.

Available bone morphology and status of neural structures in the mandibular interforaminal region: three-dimensional analysis of anatomical structures.

PURPOSE: This study aimed to clarify the size and morphology of the mandible and to determine state of neural structures for the planning of the dental implantation using cone-beam computerized tomography (CBCT). METHODS: Of the 252 patients, CBCT images of 48 selected patients were evaluated. The bone height and width were measured and the type of the mental portion of the inferior alveolar canal, the anterior loop length (ALL), the location of the incisive canal and lingual foramen were identified with cross-sectional and multiplane reformatted CBCT images. According to buccal and lingual concavities, the shape of the mandible is classified as type A, B and C. RESULTS: Bone widths of males were significantly higher than female (p < 0.05). The thickest part of the alveolar bone was measured in the middle triple zone (d line) and the thinnest part was measured in the area near the alveolar crest (b line). The most seen type of mandible was type B (45.8%) that mandible was concave on the buccal side. Bone heights had a tendency to increase towards to the anterior mandible, and bone height in male patients was slightly but not significantly greater than that in female patients. ALL was 4.2 ± 1.2 mm and visible incisive canal length on CBCT was 9.7 ± 3.8 mm. CONCLUSION: CBCT assessment of morphological features of the alveolar bone and locations of nerve canals and foramina in the anterior-premolar region of mandible represent useful practical anatomical information about the interforaminal region. This information is the guide to the dentist before implant surgery.

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.

Avaliação anatômica do forame lingual medial em tomografias computadorizadas de feixe cônico: um estudo retrospectivo / Anatomical evaluation of the medial lingual foramen in cone-beam computed tomography: a retrospective study

A região anterior mandibular é um local bastante acessado, tanto para colocação de implantes, quanto para outros tipos de cirurgias (enxertos, ortognática) devendo ser avaliada minuciosamente para garantir o sucesso e evitar intercorrências cirúrgicas. O presente estudo avaliou a frequência dos forames mediais presentes na cortical lingual. Foram avaliados 954 exames de tomografia computadorizada de feixe cônico (TCFC) de mandíbula para determinação da presença de canais na linha média mandibular, localização em relação ao tubérculo geniano, diâmetro, distância até a base e à crista alveolar, angulação da trajetória do canal, e coincidência da imagem panorâmica com a localização do canal em relação ao tubérculo geniano. O forame foi localizado em três posições: Forame Superior ao Tubérculo (FST) 89.2%, Forame Inferior ao Tubérculo (FIT) 67.9%, Forame em Outras Posições (FOP) 21.3%. O diâmetro médio dos forames variou entre 0.35 mm a 0.55 mm. A média da distância crista/forame do FST em mulheres foi de 14.57 mm; em homens foi de 14.13 mm. A média do FIT, em mulheres, foi de 22.08 mm; em homens, 21.81mm. A média do FOP, em mulheres foi de 23.67; em homens, 22.29 mm. A média da distância forame/base para FST em mulheres foi de 13.57 mm; em homens foi de 14.70 mm. Para FIT, essa medida média, em mulheres, foi de 5.74 mm; em homens foi de 6.21 mm. A média de FOP em mulheres foi de 3.29 mm; em homens foi de 3.97 mm. A TCFC possibilita o estudo minucioso do canal, facilitando o planejamento cirúrgico e minimizando as intercorrências.

The mandibular anterior region is well-suited for surgeries and should be thoroughly evaluated for success. The present study evaluated the frequency of the medial foramina present in the lingual cortex. 954 CT scans of mandible were evaluated to determine the presence of canals in the mandibular midline, location in relation to the genital tubercle, diameter, distance to the base and alveolar crest, angulation of the trajectory of the canal, and coincidence of the panoramic image with the location of the canal in relation to the genic tuber. The foramen was located in three positions: Upper Extremity to Tuber (FST) 89.2%, Lower Inferior Tuber (FIT) 67.9%, Other Positions (FOP) 21.3%. The mean diameter of the foramens varied from 0.35 mm to 0.55 mm. The mean crest / foramen distance of FST in women was 14.57 mm; in men was 14.13 mm. The mean FIT in women was 22.08 mm; in men, 21.81mm. The mean FOP in women was 23.67; in men, 22.29 mm. The mean distance of foramen / base for FST in women was 13.57 mm; in men was 14.70 mm. For FIT, this mean measure, in women, was 5.74 mm; in men was 6.21 mm. The mean FOP in women was 3.29 mm; in men was 3.97 mm. The CBCT allows the detailed study of the canal, facilitating the surgical planning and minimizing the intercurrences.

Lingual Foramina and Canals of the Mandible: Anatomic Variations in a Lebanese Population.

OBJECTIVE: The aim of this study was to evaluate the mandibular lingual foramina (LF) and canals and their anatomic variations using cone-beam computed tomography (CBCT) technology in a Lebanese population. MATERIALS AND METHODS: In this study, we analyzed CBCT images of 90 adult Lebanese patients (41 males and 49 females). We assessed the number and location of the LF. In additional, we measured: (a) The distance from both the alveolar crest and the inferior border of the mandible to the LF and (b) the length of the lingual canals (LCs). The data obtained was analyzed statistically using Shapiro-Wilk normality test, t-test, Chi-square, and Fisher's exact tests. Statistical significance was set at 0.05. RESULTS: In our sample, the LF and canals were present in 93.33% of the CBCT analyzed, and the majority (76.64%) was located above the genial tubercles. The distance from the foramen of the superior and the inferior LCs to the alveolar crest was 16.24 ± 2.82 mm and 25.49 ± 2.43 mm, respectively. The distance from the foramen of the superior canal to the inferior border of the mandible was 14 ± 2.32 mm. The mean length of the superior canal was 5.81 ± 1.6 mm and 4.25 ± 1.2 mm for the inferior one. There were no gender-related differences in the anatomic characteristics of the LF and canals except for the distance measured from the superior canal foramina to the alveolar crest where the measurement was significantly greater in males compared to females. Neither the number of canals nor the positions of the foramina were different between males and females. CONCLUSION: Within the limits of this study, we concluded that in our sample of Lebanese adults, there was substantial variability in the LF and canals anatomy and location.