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      Anatomical characteristics of mental foramen and canal: A cone-beam computed tomography analysis

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          Abstract

          Background

          So far, different studies have endeavored to evaluate the position and dimensions of mental foramen and canal using cone-beam computed tomography (CBCT) images with various results. This study aimed to assess the anatomical variations of the mental foramen and canal utilizing CBCT images.

          Material and Methods

          In this retrospective observational study, we investigated CBCT scans of 355 patients (710 terminal branches of mental canal and foramen) who were referred to a private dental and maxillofacial radiology center in Babol, during 2020-2022. We recorded different anatomical variations of mental foramina and canals on left (n=355) and right (n=355) mandibles.

          Results

          Most of the mental canals had a distal opening (n=334, 47.0%). The distance between the mental foramen and the lower mandibular border was greater on left mandible (13.92±3.73 mm) than on the right mandible (12.25±3.94 mm) ( p<0.001). On left mandible, the vertical diameter of the mental foramen, as well as the distance between the mental foramen and the lower mandibular border, were significantly greater in men than in women. On right mandible, the distance between the mental foramen and the upper alveolar crest edge, as well as the distance between the mental foramen and the lower mandibular border, were significantly greater in men versus women. Finally, on right mandible, the vertical diameter of the mental foramen was significantly greater in subjects aged >45 years compared with those aged ≤45 ( p=0.024).

          Conclusions

          There were notable variations in the morphological characteristics of the mental foramen and canal, which should be considered by clinicians.

          Key words:Mental foramen, mental canal, cone-beam computed tomography.

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          Most cited references25

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          The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review.

          The mental foramen is a strategically important landmark during osteotomy procedures. Its location and the possibility that an anterior loop of the mental nerve may be present mesial to the mental foramen needs to be considered before implant surgery to avoid mental nerve injury. Articles that addressed the position, number, and size of the mental foramen, mental nerve anatomy, and consequences of nerve damage were evaluated for information pertinent to clinicians performing implant dentistry. The mental foramen may be oval or round and is usually located apical to the second mandibular premolar or between apices of the premolars. However, its location can vary from the mandibular canine to the first molar. The foramen may not appear on conventional radiographs, and linear measurements need to be adjusted to account for radiographic distortion. Computerized tomography (CT) scans are more accurate for detecting the mental foramen than conventional radiographs. There are discrepancies between studies regarding the prevalence and length of the loop of the mental nerve mesial to the mental foramen. Furthermore, investigations that compared radiographic and cadaveric dissection data with respect to identifying the anterior loop reported that radiographic assessments result in a high percentage of false-positive and -negatives findings. Sensory dysfunction due to nerve damage in the foraminal area can occur if the inferior alveolar or mental nerve is damaged during preparation of an osteotomy. To avoid nerve injury during surgery in the foraminal area, guidelines were developed based on the literature with respect to verifying the position of the mental foramen and validating the presence of an anterior loop of the mental nerve. These guidelines included leaving a 2 mm zone of safety between an implant and the coronal aspect of the nerve; observation of the inferior alveolar nerve and mental foramen on panoramic and periapical films prior to implant placement; use of CT scans when these techniques do not provide clarity with respect to the position of the nerve; surgical corroboration of the mental foramen's position when an anterior loop of the mental foramen is suspected of being present or if it is unclear how much bone is present coronal to the foramen to establish a zone of safety (in millimeters) for implant placement; once a safety zone is identified, implants can be placed anterior to, posterior to, or above the mental foramen; and prior to placing an implant anterior to the mental foramen that is deeper than the safety zone, the foramen must be probed to exclude the possibility that an anterior loop is present. In general, altered lip sensations are preventable if the mental foramen is located and this knowledge is employed when performing surgical procedures in the foraminal area.
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            Location and dimensions of the mental foramen: a radiographic analysis by using cone-beam computed tomography.

            The mental foramen (MF) is an important landmark in dentistry. Knowledge of its position is central to perform block anesthesia of the mental nerve or to avoid nerve damage during surgical procedures in the premolar area of the mandible. The present radiographic study aimed at evaluating the location and dimension of the MF and measuring distances to neighboring structures by using limited cone-beam computed tomography (CBCT).
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              Anatomical characteristics and visibility of mental foramen and accessory mental foramen: Panoramic radiography vs. cone beam CT

              Background The mental foramen (MF) is a small foramen located in the anterolateral region of the mandible through which the mental nerve and vessels emerge. The knowledge on the anatomic characteristics and variations of MF is very important in surgical procedures involving that area. The aim of this study was two-fold: firstly, to analyze the anatomic characteristics of MF and the presence of accessory mental foramen (AMF) using CBCT and, secondly, to compare the capability of CBCT and PAN in terms of MF and AMF visualization, as well as influencing factors. Material and Methods A sample of 344 CBCT scans was analyzed for presence and characteristics (i.e. diameter, area, shape, exit angle) of MF and AMF. Subsequently, corresponding PANs were analyzed to ascertain whether MF and AMF were visible. Results Out of the 344 patients, 344 (100%) MFs and 45 (13%) AMFs were observed on CBCT. Regarding gender, MF diameter and area, MF-MIB and MF-MSB distances, and exit angle were all significantly higher in males. Also, statistically significant differences were found in terms of age and dental status. Statistically significant differences in MF long and short diameters and MF area were found with respect to AMF presence (p=.021, p=.008, p=.021). Only 83.87% of the MFs and 45.83% of the AMFs identified on CBCT were also visible on PANs. MF diameter, shape, exit angle, and age had a significant influence on MF visualization on PAN (B=.43, p=.005; B=-.55, p=.020; B=.20, p=.008; B=.61, p=.005). Conclusions PAN is not an adequate technique to properly identify MF and AMF. Diameter, shape, exit angle, and age are all factors influencing MF visualization on PAN images. For surgery involving the MF anatomical region, a preoperative radiological study with CBCT is of crucial importance to avoid complications. Key words:Mental foramen, accessory mental foramen, mandibular anatomy, cone beam computed tomography, panoramic radiography.
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                Author and article information

                Journal
                J Clin Exp Dent
                J Clin Exp Dent
                Medicina Oral S.L.
                Journal of Clinical and Experimental Dentistry
                Medicina Oral S.L.
                1989-5488
                1 August 2024
                August 2024
                : 16
                : 8
                : e1004-e1011
                Affiliations
                [1 ]Student Research Committee, Babol University of Medical Sciences, Babol, Iran
                [2 ]Dental Materials Research Center, Department of Oral and Maxillofacial Radiology, Dental Faculty, Babol University of Medical Sciences, Babol, Iran
                [3 ]Department of Oral and Maxillofacial Surgery, Dental Faculty, Babol University of Medical Sciences, Babol, Iran
                [4 ]Health Research Institute, Babol University of Medical Sciences, Babol, Iran
                Author notes
                Dental Materials Research Center Department of Oral and Maxillofacial Radiology Dental School, Babol University of Medical Sciences Ganjafrooz street, Babol, Mazandaran, Iran , E-mail: abesifarida1@ 123456gmail.com
                Article
                61861
                10.4317/jced.61861
                11392452
                83f96aeb-4cb3-4c1e-9e33-bcef1a1586d9
                Copyright: © 2024 Medicina Oral S.L.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 July 2024
                : 28 June 2024
                Categories
                Research
                Oral Medicine and Pathology

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