Assessment of Anatomic Variations in the Mandible by CBCT

Year 2024, Volume: 6 Issue: 3, 270 - 279, 30.12.2024

Mehmet Emin Doğan , Sedef Kotanlı

https://doi.org/10.51122/neudentj.2025.125

Abstract

Objective: In this study, it was aimed to evaluate the frequency of all mandibular neurovascular anatomical variations in the mandible in the Turkish subpopulation with Cone beam computed tomography (CBCT).
Methods: Sagittal, axial, coronal, serial cross-sectional and three-dimensional reformatted 410 CBCT images were investigated in accordance with age and gender. Median lingual foramen, lateral lingual foramen, mandibular incisive canal, anterior loop, accessory mental foramen, retromolar foramen, bifid mandibular canal, absence of mental foramen were evaluated in multiplanar sections. The obtained data were analysed with the IBM SPSS Statistics 25 package program.
Results: Images of cases with a mean age of 44.25 ± 17.47 years, consisting of 233 (56.8%) men and 177 (43.2%) women, total 410 CBCT were included in the study. The most widespread anatomical variation in all cases was the median lingual foramen (44.7%), followed by the mandibular incisive canal (33.9%). No statistically important relationship was found between the examined parameters and sex (p>0.05)
Conclusions: Although the interforaminal region is known as a safe region for surgery, the results of this study show that the presence of lingual foramens and mandibular incisive canal is not at a level that can be ignored.

Keywords

Anterior loop, bifid mandibular canal, accessory mental foramen, mandibular incisive canal

Mandibuladaki Anatomik Varyasyonların KIBT ile Değerlendirilmesi

Abstract

Amaç: Bu çalışmada, Türk alt popülasyonunda mandibuladaki tüm mandibular nörovasküler anatomik varyasyonların sıklığının konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi amaçlandı.
Yöntem: Aksiyal, sagital, koronal, seri kesitsel ve üç boyutlu reformat 410 KIBT görüntüsü yaşa ve cinsiyete göre değerlendirilmiştir. Median lingual foramen, lateral lingual foramen, mandibular kesici kanal, anterior loop, aksesuar mental foramen, retromolar foramen, bifid mandibular kanal ve mental foramen yokluğu çok düzlemli kesitlerde değerlendirildi. Elde edilen veriler IBM SPSS Statistics 25 paket programı ile analiz edilmiştir.
Bulgular: Çalışmaya 233 (%56.8) erkek, 177 (%43.2) kadından oluşan ortalama yaşı 44.25 ± 17.47 olan toplam 410 KIBT görüntüleri dâhil edilmiştir. Tüm olgularda en çok izlenen anatomik varyasyon median lingual foramen (%44.7), ikinci olarak mandibular insiziv kanal (%33.9) olarak tespit edilmiştir. İncelenen parametreler ile cinsiyet arasında istatistiksel olarak anlamlı bir ilişki bulunamamıştır (p>0.05)
Sonuç: İnterforaminal bölge cerrahi için güvenli bir bölge olarak bilinmesine rağmen bu çalışmanın sonuçları lingual foramenlerin ve mandibular insiziv kanalın varlığının göz ardı edilebilecek düzeyde olmadığını göstermektedir.

Keywords

Anterior loop, bifid mandibular kanal, aksesuar mental foramen, mandibular insiziv kanal

Ethical Statement

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University XXX (Date: 14.11.2022 /No: 2022/22/18)

Supporting Institution

not available

Thanks

not available

References

• Oliveira‐Santos C, Souza PHC, De Azambuja Berti‐Couto S, Stinkens L, Moyaert K, Van Assche N, et al. Characterisation of additional mental foramina through cone beam computed tomography. J Oral Rehabil. 2011;38:595-600.
• Zivic MZ, Vasovic MR, Acovic AB, Lukovic AZ, Zivanovic-Macuzic IK, Velickovic MM, et al. Assessment of accessory mental foramen using cone-beam computed tomography and its clinical relevance. J Anat Soc India. 2020;69: 91.
• Zmysłowska-Polakowska E, Radwański M, Łęski M, Ledzion S, Łukomska-Szymańska M, Polguj M. The assessment of accessory mental foramen in a selected polish population: a CBCT study. BMC Med Imaging. 2017;17:1-5.
• Al-Shayyab MH, Alsoleihat F, Dar-Odeh NS, Ryalat S, Baqain ZH. The mental foramen II: radiographic study of the superior-inferior position, appearance and accessory foramina in Iraqi population. Int J Morphol. 2016;34:310-9.
• Wang D, He X, Wang Y, Li Z, Zhu Y, Sun C, et al. External root resorption of the second molar associated with mesially and horizontally impacted mandibular third molar: evidence from cone beam computed tomography. Clin Oral Investig. 2017;21:1335-42.
• Wang X, Chen K, Wang S, Tiwari SK, Ye L, Peng L. Relationship between the mental foramen, mandibular canal, and the surgical access line of the mandibular posterior teeth: a cone-beam computed tomographic analysis. J Endod. 2017;43:1262-6.
• Kalender A, Orhan K, Aksoy U. Evaluation of the mental foramen and accessory mental foramen in Turkish patients using cone‐beam computed tomography images reconstructed from a volumetric rendering program. Clin Anat. 2012;25: 584-92.
• Laçin N, Aytuğar E, Veli İ. Cone-beam computed tomography evaluation of bifid mandibular canal in a Turkish population. Int Dent Res. 2018;8: 78-83.
• Bilginaylar K, Orhan K, Uyanik LO. Mandibular incisive canal in relation to periapical surgery. Contemp Clin Dent. 2016;7:79-81.
• Bilecenoglu B, Tuncer N. Clinical and anatomical study of retromolar foramen and canal. J Oral Maxillofac Surg. 2006;64:1493-7.
• Direk F, Uysal II, Kivrak AS, Fazliogullari Z, Unver Dogan N, Karabulut AK. Mental foramen and lingual vascular canals of mandible on MDCT images: anatomical study and review of the literature. Anat Sci Int. 2018;93:244-53.
• Yu SK, Lim J, Bae CJ, Seo YS, Kim, HJ. Morphometric analysis of the mandibular lingual foramina using cone-beam computed tomography in elderly Korean. Int J Morphol. 2022;40:688-96.
• Borghesi A, Di Salvo D, Ciolli, P, Falcone T, Ravanelli M, Farina D, et al. Detection Rate and Variability in Measurement of Mandibular Incisive Canal on Cone-Beam Computed Tomography: A Study of 220 Dentate HemiMandibles from Italy. J Imaging. 2022;8:161.
• Genú PR, Vasconcellos RJDH, Oliveira BPD, Vasconcelos BCGD, Delgado NCDC. Analysis of anatomical landmarks of the mandibular interforaminal region using CBCT in a Brazilian population. Braz J Oral Sci. 2014;13:303-7.
• Pancer B, Garaicoa-Pazmiño C, Bashutski JD. Accessory mandibular foramen during dental implant placement: case report and review of literature. Implant Dent. 2014;23:116-24.
• Shokri A, Ehsani A, Yousefi A. Prevalence of bifid variations of the mandibular canal in an Iranian population using cone-beam computed tomography. Oral Radiol. 2023;39:779-83.
• Pannalal V, Deoghare A, Fating C, Jha S, Biranjan R. The elusive retromolar foramen and retromolar canal: A CBCT study. IP Int J Maxillofac Imag, 2021;7:118-24.
• Citir M, Karslioglu H, Sumer A, Kasap P. Evaluation of the Appearance, Location and Morphology of Lingual Foramina in Dentates and Edentulous Mandibles Using CBCT. Meandros Med Dent J. 2022;23:148-54.
• Ayesha RT, Pachipulusu B, Govindaraju P. Assessmentof prevalence and position of mandibular incisive canal: A cone beam computed tomography study. Tzu Chi Med J. 2020;32:205-10.
• de Brito ACR, Nejaim Y, de Freitas DQ, de Oliveira Santos C. Panoramic radiographs underestimate extensions of the anterior loop and mandibular incisive canal. Imaging Sci Dent. 2016;46:159-65.
• Dereci Ö. Comparison of panoramic radiography and cone beam computed tomography in the detection of mandibular anatomic variations. 7tepeklinik. 2018;14:31-6.
• Ikuta CRS, da Silva Ramos LMP, Poleti ML, Capelozza ALA, Rubira-Bullen IRF. Anatomical Study of the Posterior Mandible: Lateral Lingual Foramina in Cone Beam Computed Tomography. Implant Dent. 2016; 25: 247-51.
• Taschieri S, Corbella S, Silnovic A, Francetti L, Messina C, Sconfienza LM, et al. Frequency and anatomic variability of the mandibular lingual foramina: a cone-beam CT study. BMC Med Imaging. 2022;22:12.
• Rai S, Misra D, Misra A, Kidwai S, Bisla S, Jain A, et al. Evaluation of neurovascular anatomical variation in the anterior mandible in North Indian population: A CBCT assessment. J Oral Biol Craniofac Res. 2022;12:505-11.
• Wang YM, Ju YR, Pan WL, Chan CP. Evaluation of location and dimensions of mandibular lingual canals: a cone beam computed tomography study. Int J Oral Maxillofac Surg. 2015; 44: 1197-203.
• Martins VB, Guimarães LC, Franco A, et al. CBCT study on the prevalence, morphology and position of the mandibular incisive canal in a North-Brazilian population. J Clin Exp Dent. 2022;14;e524-e40.
• Gupta A, Kumar S, Singh SK, Kumar A, Gupta A, Mehta P. Assessment of anterior loop of inferior alveolar nerve and its anatomic variations with age, gender, and dentition status in Indian population: A CBCT study. Int J Dent. 2021;2021:1813603.
• Yang Xw, Zhang Ff, Li Yh, Wei B, Gong Y. Characteristics of intrabony nerve canals in mandibular interforaminal region by using cone‐beam computed tomography and a recommendation of safe zone for implant and bone harvesting. Clin Implant Dent Relat Res. 2017;19:530-38.
• Sahman H, Sisman Y. Anterior Loop of the Inferior Alveolar Canal: A Cone-Beam Computerized Tomography Study of 494 Cases. J Oral Implantol. 2016;42:333-6.
• Filo K, Schneider T, Locher MC, Kruse AL, Lübbers HT. The inferior alveolar nerve's loop at the mental foramen and its implications for surgery. J Am Dent Assoc. 2014;145:260-9.
• Noruzi M, Mostafavi M, Ghaznavi A, Abdollahi AA. Prevalence and anatomic characteristics of accessory mental foramen using cone-beam computed tomography views in an Iranian population. Avicenna J Dent Res. 2020;12:136-41.
• Tiwari, N. Left Accessory Mental Foramen in Dry Mandibles in Department of Anatomy of a Medical College: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2022;60:805-7.
• Sisman Y, Sahman H, Sekerci A, Tokmak T, Aksu Y, Mavili E. Detection and characterization of the mandibular accessory buccal foramen using CT. Dentomaxillofac Radiol. 2012;41:558-63.
• de Gringo CPO, de Gittins EVCD, Rubira CMF. Prevalence of retromolar canal and its association with mandibular molars: study in CBCT. Surg Radiol Anat. 2021;43:1785-91.
• Han SS, Hwang YS. Cone beam CT findings of retromolar canals in a Korean population. Surg Radiol Anat. 2014; 36: 871-6.
• Patil S, Matsuda Y, Nakajima K, Araki K, Okano T. Retromolar canals as observed on cone-beam computed tomography: their incidence, course, and characteristics. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115: 692-9.
• Alves N, Deana NF. Anatomical and radiographical study of the retromolar canal and retromolar foramen in macerated mandibles. Int J Clin Exp Med. 2015; 8: 4292-6.
• Demiralp KO, Bayrak S, Orhan M, Alan A, Cakmak EK, Orhan K. Anatomical characteristics of the lingual foramen in ancient skulls: a cone beam computed tomography study in an Anatolian population. Folia Morphol. 2018;77:514-20.
• Akbulut A, Orhan K. Evaluation of anatomical characteristics of mandibular incisive canal in a Turkish subpopulation using cone beam computed tomography. West Indian Med J. 2021;69:292-303.
• Barbosa DAF, Kurita LM, de Menezes Pimenta AVdM, Teixeira RC, Silva PGB, Ribeiro TR, et al. Mandibular incisive canal-related prevalence, morphometric parameters, and implant placement implications: a multicenter study of 847 CBCT scans. Med Oral Patol Oral Cir Bucal. 2020;25:e337-45.