Evaluation of the Mental Foramen and Accessory Mental Foramen with Cone Beam Computed Tomography

Year 2025, Volume: 12 Issue: 2, 230 - 233, 22.08.2025

Tansu Çimen , Yunus Yiğit Saka , Helin Kayacan Ünel , Onurcem Duruel

https://doi.org/10.15311/selcukdentj.1706374

Abstract

Abstract
Background The mental foramen (MF) is the opening through which the mental nerve leaves the mandible and is usually located between the roots of the first and second mandibular premolars. Some anatomical variations, such as accessory mental foramen (AMF), have been reported and must be considered to prevent clinical complications.
Various AMF studies have been presented in the literature. However, the MF and AMF remain to be evaluated in detail. This study aimed to assess the AMF via cone beam computed tomography (CBCT) and evaluate its relationship with the MF.
Methods Two hundred forty-four CBCT images that met the inclusion criteria were evaluated. The AMF and MF diameter, AMF number, MF–crest distance, MF–mandibular basis distance, AMF–crest distance, and AMF–mandibular basis distance were measured.
Results The prevalence of AMF was 9.4%, with a total of 46 (26 on the right and 20 on the left) observed. The diameters of the first and second AMFs were 0.67 ± 0.28 mm and 0.56 ± 0.11 mm on the right and 0.68 ± 0.23 mm and 0.46 ± 0.11 mm on the left, respectively. Regarding the MF, the right and left sides measured 2.06 ± 1.37 mm and 1.91 ± 0.45 mm, respectively. The first and second AMF–crest distances and first and second AMF–mandibular basis distances were 15.18 ± 2.77 mm, 13.5 ± 2.0 mm, 16.63 ± 2.64 mm, and 14.13 ± 4.36 mm (right side) and 13.90 ± 3.01 mm, 12.23 ± 0.9 mm, 13.14 ± 2.4 mm, and 14.40 ± 3.21 mm (left side), respectively. Regarding the diameter of the left MF, the distance between the right and left MF crest and the distance between the MF and mandibular basis were greater in males (p <0.05).
Conclusion Considering the presence of AMFs during surgical procedures and local anesthesia is critical. CBCT is a useful method for determining the presence of AMFs to prevent possible nerve damage.

Keywords CBCT; Accessory mental foramen; Mental foramen

Keywords

CBCT , accessory mental foramen , mental foramen

References

• 1. Greenstein, G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. Journal of Periodontology. 2006;77(12):1933–1943.
• 2. Naitoh M, Hiraiwa Y, Aimiya H, Gotoh K, Ariji E. Accessory mental foramen assessment using cone-beam computed tomography. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2009;107(2):289–294.
• 3. Zmysłowska-Polakowska E, Radwański M, Ł¸eski 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).
• 4. Naitoh M, Hiraiwa Y, Aimiya H, Gotoh K, Ariji E. Accessory mental foramen assessment using cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. 2009;107(2):289–94.
• 5. Sisman Y, Sahman H, Sekerci AE, Tokmak TT, Aksu Y, Mavili E. Detection and characterization of the mandibular accessory buccal foramen using CT. Dentomaxillofacial Radiol. 2012;41(7):558–63.
• 6. Coban D, Unal Erzurumlu Z, Sadik E, Yasa Y. Evaluation of mental foramen and accessory mental foramen using cone beam computed tomography in a Turkish population. BMC Medical Imaging. 2025;25(1):140.
• 7. Yoon, T. Y., Ahmadi, A. G., Saed, N. A., Estrin, N. E., Miller, D. E., & Dinh, T. N. Prevalence and anatomical characteristics of the accessory mental foramen: a study using cone beam computed tomography. General dentistry. 2019;67(5), 62-67.
• 8. Wei, X., Gu, P., Hao, Y., & Wang, J. Detection and characterization of anterior loop, accessory mental foramen, and lateral lingual foramen by using cone beam computed tomography. The Journal of Prosthetic Dentistry. 2020;124(3), 365-371.
• 9. Lam, M., Koong, C., Kruger, E., & Tennant, M. Prevalence of accessory mental foramina: a study of 4,000 CBCT scans. Clinical Anatomy. 2019;32(8), 1048-1052.
• 10. Aytugar E, Özeren C, Lacin N, Veli I, Çene E. Cone-beam computed tomographic evaluation of accessory mental foramen in a Turkish population. Anat Sci Int. 2019;94(3):257–65.
• 11. Zivic, M. Z., Vasovic, M. R., Acovic, A. B., Lukovic, A. Z., Zivanovic-Macuzic, I. K., Velickovic, M. M., & Kanjevac, T. V. Assessment of accessory mental foramen using cone-beam computed tomography and its clinical relevance. Journal of the Anatomical Society of India. 2020;69(2), 91-96.
• 12. Yalcin TY, Bektas-Kayhan K, Yilmaz A, et al. An alternative classification scheme for accessory mental foramen. Curr Med Imaging. 2020; 16:1–7.
• 13. Xiao L, Pang W, Bi H, et al. Cone beam CT-based measurement of the accessory mental foramina in the Chinese Han population. Exp Ther Med. 2020; 20:1907–16.
• 14. Beshtawi K, Qirresh E, Parker M, et al. Custom focal trough in cone-beam computed tomography reformatted panoramic versus digital panoramic for mental foramen position to aid implant planning. J Clin Imaging Sci. 2020; 10:34.
• 15. Spin-Neto R, Stavropoulos A, Dias Pereira LA, Marcantonio Jr E, Wenzel A. Fate of autologous and fresh-frozen allogeneic block bone grafts used for ridge augmentation. A CBCT-based analysis. Clin Oral Implants Res. 2013; 24:167–173.
• 16. Cremonini CC, Dumas M, Pannuti C, Lima LA, Cavalcanti MG. Assessment of the availability of bone volume for grafting in the donor retromolar region using computed tomography: a pilot study. Int J Oral Maxillofac Implants. 2010; 25:374–378.
• 17. Verdugo F, Simonian K, D'Addona A, Pontón J, Nowzari H. Human bone repair after mandibular symphysis block harvesting: a clinical and tomographic study. J Periodontol. 2010; 81:702–709.
• 18. Verdugo F, Simonian K, Frydman A, D'Addona A, Pontón J. Long-term block graft stability in thin periodontal biotype patients: a clinical and tomographic study. Int J Oral Maxillofac Implants. 2011; 26:325–332.
• 19. Tebo Hg, Telford Ir. An analysis of the variations in position of the mental foramen. Anat Rec. 1950;107(1):61–6.
• 20. 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(5):584–92.
• 21. Naitoh M, Hiraiwa Y, Aimiya H, Gotoh K, Ariji E. Accessory mental foramen assessment using cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. 2009;107(2):289–94.
• 22. Singh R, Srivastav AK. Evaluation of position, shape, size and incidence of mental foramen and accessory mental foramen in Indian adult human skulls. Anat (International J Experimental Clin Anatomy). 2011;5:23–9.
• 23. Singh, R, Srivastav AK. Study of position, shape, size and incidence of mental foramen and accessory mental foramen in Indian adult human skulls." Int J Morphol. 2010:28(4):1141–6.
• 24. Brown AA, Scarfe WC, Scheetz JP, Silveira AM, Farman AG. Linear accuracy of cone beam CT derived 3D images. Angle Orthod. 2009;79(1):150–7.
• 25. Hegde S, Ajila V, Kamath JS, Babu S, Pillai DS, Nair, SM. Importance of cone-beam computed tomography in dentistry: an update. SRM Journal of Research in Dental Sciences. 2018;9(4):186–190.
• 26. Pelé A, Berry P-A, Evanno C, Jordana F. Evaluation of Mental Foramen with Cone Beam Computed Tomography: A Systematic Review of Literature. Radiol Res Prac. 2021; 2021.1: 8897275.
• 27. Goyushov S, Tozum MD, Tozum TF. Assessment of morphological and anatomical characteristics of mental foramen using cone beam computed tomography. Surg Radiol Anat. 2018;40:1133–1139.
• 28. Orhan AI, Orhan K, Aksoy S, Ozgul O, Horasan S, Arslan A, Kocyigit D. Evaluation of perimandibular neurovascularization with accessory mental foramina using cone-beam computed tomography in children. J Craniofac Surg. 2013;24:e365–369.
• 29. Von Arx T, Friedli M, Sendi P, Lozanoff S, Bornstein MM. Location and dimensions of the mental foramen: a radiographic analysis by using cone-beam computed tomography. Journal of Endodontics. 2013;39(12):1522–1528
• 30. Muinelo-Lorenzo J, Fernández-Alonso A, Smyth-Chamosa E, Suárez-Quintanilla JA, Varela-Mallou J, Suárez-Cunqueiro MM. Predictive factors of the dimensions and location of mental foramen using cone beam computed tomography. PloS One. 2017;12(8),e0179704.
• 31. Lam M, Koong C, Kruger E, Tennant M. Prevalence of accessory mental foramina: a study of 4,000 CBCT scans. Clinical Anatomy. 2019;32(8):1048–1052.
• 32. Muinelo-Lorenzo J, Rodríguez-Pato R, Martínez-Reglero C, Salgado-Barreira A, Suárez-Cunqueiro MM. Detection of the accessory mental foramina on human mandibles using cone-beam computed tomography: a systematic review and meta-analysis. Journal of Endodontics. 2021;47(8):1215–1228.
• 33. Katakami K, Mishima A, Shiozaki K, Shimoda S, Hamada Y, Kobayashi K. Characteristics of Accessory Mental Foramina observed on limited cone-beam computed tomography images. J Endod. 2008;34(12):1441–5.
• 34. Iwanaga J, Watanabe K, Saga T, Tabira Y, Kitashima S, Kusukawa J, et al. Accessory mental foramina and nerves: application to periodontal, periapical, and implant surgery. Clin Anat. 2016;29(4):493–501.
• 35. Muinelo-Lorenzo J, Suárez-Quintanilla JA, Fernández-Alonso A, Varela-Mallou J, Suárez-Cunqueiro MM. Anatomical characteristics and visibility of mental foramen and accessory mental foramen: Panoramic radiography vs. cone beam CT. Medicina Oral, Patologia Oral Y Cirugia Bucal. 2015;20(6): e707.