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Purpose: Various anatomical variations of the inferior alveolar canal increase the incidence of surgical complications; Therefore, this study aimed to evaluate the frequency and configuration of bifid and trifid mandibular canals using cone beam computed tomography (CBCT) in the Turkish subpopulation. Methods: The inferior alveolar canal was evaluated on 1014 hemi-mandibles in the CBCT (I-CAT 3D Imaging System) images of 513 patients. The frequency and configuration of the bifid and trifid mandibular canal (MC) were examined. The relationship between bifid MC configuration and dental status and age groups was analyzed. The distance of the accessory canal to the buccal and lingual walls and the alveolar crest was measured. The diameter of the main canal and accessory canal was measured and its relationship with dental status and age groups was evaluated. Results: Bifid MC was found in 266 hemi-mandibles (24.7%) and 212 (41.3%) of 513 patients. The most common type of bifid MC was the retromolar canal (87 sides), followed by the forward canal without confluence (41; 4%) and the dental canal (34; 3.4%). 10 of the dental canals were opening to the 1st molar, 14 of the 2nd molars, and 10 of the 3rd molars. The number of retromolar foramina was 1 on 56 sides, 2 on 15 sides, and 3 on 4 sides. Forward canal without confluence was more common in edentulous patients than in dentulous patients, while the dental canal was more common in dentulous patients. The main canal diameter was 3.53 ± 0.97 mm and the bifid MC diameter was 1.82 ± 0.70 mm. Distance of the bifid MC to the lingual wall was higher in the > 64 years group than in the 18–39 years group (p = 0.022). Distance of the bifid MC to the alveolar crest was lower in the > 64 years group compared to the 18–39 years group and 40–64 years group (p = 0.015). The main canal diameter was higher in the 40–64 years group than in the 18–39 years group (p = 0.012). Conclusion: Bifid MC has a high prevalence, occurring in almost one in two patients. Dental and retromolar types, which are close to the teeth, are more common, and this increases the possibility of complications. CBCT is the most accurate imaging technique used to detect and define these variations. [ABSTRACT FROM AUTHOR]

Purpose: To assess the presence of mandibular canal bifurcation (BMC) and classify these variations by correlating findings with sex, age and facial skeletal pattern, measurements were made, including height, width, and distance from bifurcation to anatomical cortical bones. Methods: BMC was identified in cone beam CT exams of 301 patients and classified according to its origin, location, direction, configuration and ending. The height and width of the MC before and after the bifurcation; height and width of the BMC; and distance from BMC to alveolar (C1), buccal (C2), lingual (C3) and basal (C4) bone cortices were measured. All data were correlated with sex, age, and facial skeletal pattern (class I, II, III). The significance level was 5%. Results: 67 BMC (22.26%) were identified in 55 patients (18.28%). Bifurcations were more prevalent in females (p = 0.57), aged 18–39 years (p = 0.40), class I (p = 0.77). Single bifurcations, located in the posterior region of the mandible, originating in the MC, with a superior direction and ending in the retromolar foramen were more prevalent (p > 0.05). Mean cortical measurements were higher in male individuals, with significant differences only at C1 (p = 0.03). The mean height and width of BMC were 2.24 (± 0.62) and 1.75 (± 0.45) mm. There was no association between BMC classification and the variables studied (p > 0.05). Conclusion: Approximately 1/5 of the population studied had BMC. There were no associations of BMC presence or characteristics with sex, age, and facial skeletal pattern. The distance from bifurcation to alveolar (superior) cortical bone is greater in male individuals. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study aimed to determine the prevalence and morphological characteristics of accessory mandibular canals (AMCs) in an eastern Chinese population to provide clinical guidance for reducing intraoperative and postoperative complications. Methods: Cone beam computed tomography (CBCT) scans of 300 Chinese patients were used to identify AMCs according to a modification of Naitoh's classification. The length of the branch (L0) and the upper and lower angles between the branch and mandibular canal were measured on sagittal images. Additionally, the branches were divided into narrow or wide types by calculating the ratio of the branch diameter to the main canal diameter. The location of the bifurcation point was characterized by measuring its distance to the buccal wall of the mandible (L1), lingual wall of the mandible (L2) and alveolar ridge (L3). Results: The prevalence rate of AMCs was 40.7% (95% CI: 35.1–46.3), and the most common type was the retromolar canal, followed by the forward canal, dental canal, trifid mandibular canals (TMCs) or others, inferior canal and buccolingual canal. Twenty-one cases of multiple branches with unusual patterns were observed in the study. The average values of L0, L1, L2 and L3 were 15.05 ± 0.63 mm, 5.79 ± 0.14 mm, 4.40 ± 0.18 mm and 14.61 ± 0.31 mm, respectively. The mean upper angle and lower angle were 141.59° ± 2.44° and 50.64° ± 2.57°, respectively. Approximately 20.8% of the branches were defined as wide type, and no statistical significance was found between different types. Conclusion: AMCs are not rare anatomic variations of the mandibular canal in the eastern Chinese population; thus, CBCT examination is highly recommended for precise evaluation before surgeries involving the mandibles. [ABSTRACT FROM AUTHOR]

Purpose: This study focused on the detailed structure of microvessels of the neurotransmitter-positive vasa nervorum of the inferior alveolar nerve, vein, and artery in the mandibular canal (MC) to obtain information for improved safety in dental treatments. We also observed the detailed structure of the MC from the mental foramen to the mandibular foramen using cone-beam computed tomography (CBCT). Methods: In this study, mandibles from 45 sides of 23 human cadavers aged 76–104 years were examined by microscopy, immunohistochemistry, and CBCT analysis. These data were further evaluated by principal component analysis (PCA). Results: The microvessels of the vasa nervorum with calcitonin gene-related peptide- and neuropeptide Y-positive reactions were classified into 5 types: large (4.19%, 28/667); irregular large (7.35%, 49/667), numerous intermediate (29.23%, 195/667), irregular intermediate (29.23%, 195/667), and scattered fine (30.0%, 200/667) microvessels. The MC showed various structures from the 3rd molar to the premolars and was also classified into three types, including complete (57.0%, 228/400), partial (33.8%, 135/400), and unclear (9.2%, 37/400), from the mandibular foramen to the mental foramen. PCA results revealed that developed capillaries were mainly localized in the molar region. Conclusions: Fine microvessels of the vasa nervorum expressing neurotransmitters are present from the molar to premolar region, which is key information for mandibular dental treatments. The different microvessel structures also indicate differences in specific characteristics between dentulous and edentulous cadavers regarding oral surgical and implant treatments. [ABSTRACT FROM AUTHOR]

Purpose: Since cone-beam computed tomography was developed, a number of radiological studies on the bifid mandibular canals (BMCs) and trifid mandibular canals (TMCs) have been reported. However, many of the suggested subtypes of the BMC described in the literature seem to be normal branches of the inferior alveolar nerve. This might be due to a lack of revisiting classic anatomical studies in the field of radiology. Therefore, such studies are revisited here. Methods: A database search using PubMed and Google Scholar was conducted on BMC and TMC. Eighty-nine articles underwent full-text assessment. The reported three classifications of BMC and the six modified classifications were reviewed and compared to the intramandibular inferior alveolar nerve branches. Results: Some subtypes of BMC and TMC simply represent normal inferior alveolar nerve branches, i.e., retromolar branch, molar branch (alveolar branch/dental branch), large mental branch, or communicating branch. Others such as Naitoh's type III BMC and forward canal might be a true BMC. Conclusion: We found that the bifid mandibular canal is an additional intramandibular canal running parallel to the mandibular canal with/without confluence with the main canal through comparison of classifications of BMC/TMC between the radiology and anatomy fields. [ABSTRACT FROM AUTHOR]

Introduction: The anatomical variations of the mandibular canal have been described according to the number of additional branches it presents, bifid and trifid. Within the bifids we can also find subtypes of variations such as the retromolar mandibular canal. These anatomical variations can have important clinical implications for the work of dental professionals. Methods: A systematic search of the literature was carried out in different databases that met the following criteria: articles published between 2000 and 2020, and articles that established a clinical correlation with variations in the mandibular canal. Results: After applying inclusion and exclusion criteria, 32 articles were obtained, in which the variations of the mandibular canal were identified, their prevalence and incidence, which was very varied between the different articles, it was also found that the CBCT was the main technique to identify the anatomical variations of the mandibular canal. Lastly, the anatomical variations of the mandibular canal have a direct clinical correlation with pre-surgical, intra-surgical and postsurgical complications in pathologies that require surgical intervention. Conclusions: The anatomical variations of the mandibular canal have a high incidence, so knowing them is of vital importance both for clinicians and anatomy professors who provide morphological training. We believe that research should focus on describing and diagnosing the causes of these anatomical variations. That said, there is also a continuous challenge for all health professionals to learn about the different anatomical variations that the human body presents and how these can affect clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: This study reviewed the literature on the position of the mandibular canal (MC) relative to the root apices (RA) of neighbouring teeth using cone beam computed tomography (CBCT). Methods: The authors searched the PubMed, Scopus, EBSCO Dentistry and Oral Sciences Source, Cochrane and Lilacs databases for relevant English-language articles with no year limitations published through January 25, 2018. Results: The search identified 888 articles, 12 of which met the inclusion criteria. Three groups were found based on the measuring method: the shortest distance from the RA to the MC, the vertical distance from the RA to the MC, or the distance from the RA to the superior cortical bone of the MC. In the first and second groups, the shortest distances to the canines, first premolars, second premolars, first molars, second molars, and third molars were 3.8 mm, 4.76 mm, 1.65 mm, 1.23 mm, 0.64 mm, and 1.28 mm, respectively. In the third group, the shortest distances to the second premolars, first molars, and second molars were 2.71 mm, 3.82 mm, and 1.4 mm, respectively. Conclusions: The distance from the MC to the RA was generally shorter in females and younger people, with decreasing distances in patients over 60 years old, and depended on the tooth type. Trial registration: The protocol for this systematic review was registered on PROSPERO (CRD42018085478). [ABSTRACT FROM AUTHOR]

Purpose: In bilateral sagittal split osteotomy (BSSO), the risk of lesion of the inferior alveolar nerve (IAN) is important. The aim of this study was to investigate the situation of the IAN in the area of the BSSO in preoperative 158 CBCT. Methods: The situation of the mandibular canal (MC) has been studied in six coronal sections (one section each 4 mm) from the proximal root of the second mandibular molar. The height of the MC related to the height of the mandible, and the horizontal distance between the MC and the lateral cortical plate related to the mandibular width have been determined in each section. The cancellous bone width has been measured allowing to determine a cancellous bone ratio. Results: The variability of the MC was high, depending mainly on the cancellous bone ratio which was higher when the IAN was deep. When a third molar was present, the MC was lower in the area of the third molar. Conclusions: To decrease the risk of injuring the IAN in BSSO, the evaluation of the cancellous bone ratio by a preoperative CBCT may be proposed to adapt the surgical technique to the anatomy. [ABSTRACT FROM AUTHOR]

Purpose: An accessory foramen around the mandibular foramen is called an accessory mandibular foramen (AMF). The clinical anatomy of the AMF has not been well described. The aim of this study was to reveal the clinical anatomy of the AMF for a better understanding of its implication during ramus surgeries. Methods: Twenty-two sides fresh-frozen cadaveric heads with a mean age of 76.2 ± 14.4 years at death underwent dissection. The neurovascular bundles passing through the AMF were observed. Additionally, a hemi-face of a latex injected embalmed cadaver was dissected medially to laterally and the neurovascular bundles of the AMF investigated. Results: A unilateral foramen, bilateral foramina, and absence of foramina were found in 45.4%, 18.2%, and 36.4%, respectively. The origin of the neurovascular bundle entering the AMF was a branch of the maxillary artery in 20% and a tributary of the inferior alveolar vein in 80%. In the latex embalmed cadaver, the AMF was found to contain a branch from the maxillary artery and a tributary of the maxillary vein. Conclusion: Given the practical meaning of the specific AMF located in the operative field of the ramus osteotomy, we suggest these be named "foramina for ramus osteotomy." [ABSTRACT FROM AUTHOR]

Anatomical variations of the mandibular canal as well as the presence of accessory canals and foramina are common findings in the human mandible. Here, we present a previously unreported type of anatomical variation, consisting of a large full-thickness bone defect of the right mandibular ramus, observed in a young male unearthed from a mediaeval cemetery located in North-Eastern Italy. The defect was located very close to, yet not directly connected with, the mandibular canal. Awareness of the existence of deviations from the anatomical norm such as that we describe here is strategic to avoid diagnostic misinterpretations, minimise technical hitches, and prevent clinical complications during invasive procedures in the region of the mandible. [ABSTRACT FROM AUTHOR]

The normal flexibility in morphology and topography of body structures may be termed as an anatomical variation. This manuscript, aims to present a unique discovery of ‘coronoid foramina’ bilaterally along with bilateral accessory foramina over the ‘lateral aspect of the ramus of the mandible’ which has never been seen or documented in the literature so far in a live patient. It is noteworthy to realize a trait of phylogenetic context in these discoveries. [ABSTRACT FROM AUTHOR]

Purpose: The mandibular canal contributes to the development and growth of the mandible, as it acts as a conduit for the growing inferior alveolar neurovascular structures. A clear understanding of the canal's pathway is, therefore, important in interpreting the growth pattern of the inferior alveolar neurovascular bundle. This study investigated the position of the mandibular canal within the body of the mandible and its general dimensions within a pediatric collection of mandibles. Methods: The sample included 45 mandibles and was subdivided into three: group 1 (30 gestational weeks to birth), group 2 (birth to 12 months), and group 3 (1 to 4 years). Mandibles were scanned using a Nikon XTH 225L micro-CT unit. Scanning conditions ranged between 85 kV/83 µA and 100 kV/100 µA. Measurements included: the maximum width and height of the mandibular canal and distances between the mandibular canal and the relevant surfaces of the mandible. Data analysis included an ANOVA, MANOVA, and principal component analysis. Results: The mandibular canal increased significantly in size from 30 gestational weeks to 12 months relative to the deciduous molar crypts. Postnatally, the mandibular canal increased significantly in height at the level of the second deciduous molar crypt. The canal lies closer to the buccal surface in the region of the first and second deciduous molar teeth. Conclusion: The consistency in the positioning of the mandibular canal within the body of the mandible may assist in predicting the occurrence of aberrant growth patterns, particularly during the initial stages of growth. [ABSTRACT FROM AUTHOR]

Purpose: The inferior alveolar neurovascular bundle (NVB) is important in implant placement and many other surgeries in dentistry because it is a major supplier of sensation and blood to the mandible via the mandibular canal. The purposes of the present study were to determine the areas and diameters of the NVB, the inferior alveolar nerve (IAN), and the inferior alveolar artery (IAA), and to verify the buccolingual location of the mandibular canal. Methods: The anatomical configuration of the NVB was examined by histomorphometrically analyzing 20 embalmed dentulous hemimandibles. The areas and maximum horizontal and vertical diameters of the NVB, IAN, and IAA were measured according to tooth region. The distances from the internal border of the mandibular canal to the outer surface of the buccal and lingual cortical plates were also measured. Results: The areas of the vertically oval-shaped NVB and IAN appeared to be constant between the molar and premolar regions, which contain the mental branch, and decreased sharply in the lateral incisor after branching off of the mental branch via the mental canal. The mandibular canal was located close to the lingual cortical plate in the posterior tooth region before passing through the mental canal, immediately after which it was situated quite close to the buccal cortical plate, and then closer to the middle toward the anterior tooth region. Conclusions: The findings of this study provide useful anatomical information that should help to minimize the risk of injury to the NVB during surgical procedures in the mandibular region. [ABSTRACT FROM AUTHOR]

Purpose: This study was aimed to detect the positions of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region in Chinese population to supply the reference data of the surgical safe zone in chin for clinicians. Materials and methods: A total of 80 formalin-fixed semi-mandibles of Chinese adult cadavers were dissected, the positions and courses of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region were measured. Results: The mental foramina were present in all cases (100 %), and most of them were located below 2nd premolar (58.75 %). Accessory mental foramina were observed in 5 %. The anterior end of mandibular canal, extending along the course of 7.37 ± 1.10 mm above the lower border of mandible to interforaminal region about 3.54 ± 0.70 mm medial to the mental foramen, most often ended below between the two premolars (73.75 %), where it continued as the incisive nerve canal (100 %) and the mental canal (96.25 %). Mental canal, with the wall formed by compact bone, being 2.60 ± 0.60 mm in diameter and 4.01 ± 1.20 mm in length, opened into mental foramen. Incisive nerve canal, with the wall formed by thin compact bone and/or partly or completely by spongy bone, being 1.76 ± 0.27 mm in diameter and 24.87 ± 2.23 mm in length, extended to the incisor region along the course of 9.53 ± 1.43 mm above the lower border of mandible, and most often ended below the lateral incisor (70.00 %). Conclusion: This research recommended for chin operations in Chinese population: the surgical safe zone could be set in the region about over 4 mm anterior to the mental foramen, and over 12 mm above inferior border of mandible for anterior alveolar surgery, or within 9 mm above inferior border of mandible for genioplasty. [ABSTRACT FROM AUTHOR]

Purpose : The present study aims to estimate the prevalence of bifid mandibular canals in patients treated at the Dental Clinic of the Federal University of Paraná, Brazil. Methods: The sample consisted of 3,024 panoramic radiographs from male ( n = 1,155) and female ( n = 1,869) patients (mean age 30 years). An experienced radiologist analyzed the panoramic radiographs according to the study of Langlais et al. (J Am Dental Assoc 110:923-926, ), which classifies bifid mandibular canals into four different types. Results: Sixty patients (1.98 %) presented bifid mandibular canals. Specifically, 50 patients revealed bifid mandibular canals type I, while 10 patients revealed bifid mandibular canals type II. All the variations were unilateral. In addition, statistically significant results were not observed for gender distribution. Conclusion: The present findings indicate a low prevalence of morphologic alterations of the mandibular canal in the studied population. However, the present outcome highlights the clinical relevance of investigating the radiologic morphology of the mandibular canal prior to surgical interventions. [ABSTRACT FROM AUTHOR]

Purpose: The identification of the variation involving the mandibular canal is important during surgical procedures in the mandible. This study aims to investigate the incidence, course, width, and location of retromolar canals in a Korean population using cone beam CT. Methods: The cross-sectional, sagittal, and three dimensional images from volumetric cone beam CT data of 446 patients were reconstructed using imaging analysis software for the presence of a retromolar canal. Retromolar canals were classified into three types according to the courses. The width and location (distance from the second molar) of retromolar canals were evaluated. Results: A retromolar canal was observed in 8.5 % of patients (38/446). Most retromolar canals had vertically curved courses (Type 1, 66.7 %), followed by horizontally curved courses (Type 2, 20 %). Type 3 retromolar canals, which run independently from separate foramina in the mandibular ramus, were rare (13.3 %). The mean width of a retromolar canal was 1.13 mm (SD ± 0.38, 0.60-2.00), and the mean distance to the second molar was 14.08 mm (SD ± 3.85, 8.50-24.00). Conclusions: The incidence of retromolar canals in the Korean population was lower than that reported in the investigated ethnic groups. In the presence of a retromolar canal, local anesthesia may be ineffective. The damage to a retromolar canal may be unavoidable during surgical procedures involving the mandible and may result in paresthesia, excessive bleeding, postoperative hematoma, or traumatic neuroma. [ABSTRACT FROM AUTHOR]

Purpose: The mandibular canal is a significant anatomical structure in implant dentistry, and cone beam computed tomography (CBCT) is an important diagnostic image modality in this field of dentistry. The aim of this study was to evaluate the frequencies of anatomic variations and lesions affecting the mandibular canal in CBCT images of the mandible produced for dental implant planning. Methods: This cross-sectional study evaluated a sample of 250 CBCT examinations (500 mandibular canals). The inclusion criterion was CBCT examinations of the mandible requested for dental implant planning. The presence of anatomic variations and lesions affecting the mandibular canal was evaluated in the CBCT examinations. Moreover, the buccolingual position of the mandibular canal was evaluated in the molar region and in the ramus region. The CBCT exams were evaluated by one observer. The data were analyzed using descriptive and analytical statistics. The one-way ANOVA test was employed to compare the age between the anatomic variations. A paired t test was used to compare the buccolingual position between the molar region and the ramus region. Differences were considered significant when p values were lower than 0.05. Results: The anatomic variations detected were large-diameter mandibular incisive canal (51.6 %), ramification (12 %), and accessory mental foramen (3.2 %). No difference was observed in the age of the patients between the anatomic variations ( p > 0.05). The identified lesions included hypomineralization of the canal walls (20.8 %), idiopathic osteosclerosis (8.8 %), osteolytic lesions (3.2 %), iatrogenic perforation of the mandibular canal (2.8 %), and fibro-osseous lesions (1.6 %). The distance between the mandibular canal and the vestibular cortical bone was higher in the molar region than in the ramus region ( p < 0.05). Conclusions: Anatomic variations and lesions affecting the mandibular canal were common findings in the CBCT images of the mandible produced for dental implant planning. An awareness of these alterations is important for dentistry because some of them might require treatment, change oral surgery planning and difficult inferior alveolar nerve anesthetic block. [ABSTRACT FROM AUTHOR]

Purpose: To describe configurations of human prenatal mandibular, lingual canals using a limited-field cone beam computed tomography (CBCT) to examine their origin and anatomical significance. Materials and methods: Nine fetal mandibles were examined using a CBCT. Mandibular maturity was assessed according to the mandibular size measured directly and image findings on development of dental crypts. Mandibular, lingual canals and the related foramina (mandibular, mental, and lingual foramina) were observed on axial, sagittal, and cross-sectional images. The horizontal position of mental and lingual foramina was assessed by direct observation using a loupe. Results: In all nine mandibles, CBCT images depicted three separate mandibular canals, which individually occurred at the ramus area. One was a short canal directly connecting to the permanent molar crypt. The other two showed a parallel course, following the mandibular corpus toward the frontal area; the upper one connected to the mental foramen, and the lower one distributed anterior area of canine and incisor crypts. Lingual foramina were observed bilaterally in eight of nine mandibles, whose horizontal position was lingual against the crypt of deciduous canine. The lingual canals occurred from lingual foramina, and connected to the close deciduous tooth crypt or the mandibular canal distributing in the frontal area. Conclusions: It was suggested human dentition could be developed by plural mandibular and lingual canals. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare panoramic and paraxial views of dental CT reformatted images to detect the mandibular canal, and to evaluate the usefulness of the dental CT software function of 'Outlining the Mandibular Canal in the Panoramic View'. Methods: One hundred and fifty-five patients (310 sides), who underwent multi-slice computed tomography examination for pretreatment planning of dental implant were analyzed. After scanning, two types of dental CT reformatted image, panoramic and paraxial views were obtained. Two oral radiologists evaluated both views for the visibility of the mandibular canal using a 5-point rating scale: score 5, 100-80 % visible, to score 1, 20-0 % visible. The visibility scores of the two views were evaluated and compared by Wilcoxon's signed rank test. Results: The mean ± standard deviations of panoramic and paraxial views were 4.2 ± 1.1 and 3.5 ± 1.2, respectively, and the former was significantly higher than the latter ( p < 0.001). On the basis of these results, we attempted to apply the function of 'Outlining the Mandibular Canal in the Panoramic View' to cases with poor visibility of the canal (score 1, 2 or 3) on paraxial views. Consequently, we could reduce the number of such cases from 128 (41 %) to 56 (18 %). Conclusions: The detectability of the mandibular canal was significantly higher in panoramic views than in paraxial views. Using the function of 'Outlining the Mandibular Canal in the Panoramic View', the precision for identifying the canal on paraxial views was considered to be improved. [ABSTRACT FROM AUTHOR]

We report a highly unusual case of unilateral absence of the mental foramen, with the inferior alveolar nerve exiting the mandible via an orifice situated on the lateral surface of the angle of the mandible. However, the teeth on this side of the dental arch had normal sensitivity, and the mandible had grown correctly. Despite the absence of intraosseous course, the inferior alveolar nerve seems to keep its neural and guide roles. [ABSTRACT FROM AUTHOR]

Purpose: Bilateral sagittal split osteotomy (BSSO) is the most common procedure used to treat mandibular deformities. BSSO procedures include the Epker technique and the Dal Pont technique which are the most frequently used. Because of the intramandibular pathway of the inferior alveolar nerve (IAN), neurosensory disturbance of the lower lip and chin is the most common complication of BSSO. This study performed quantitative measurements from computed tomographic (CT) data obtained on dry human mandibles. The main aim of the study was to evaluate if mandibular divergence can predict the position of the IAN and the mylohyoid nerve (MHN) to prevent nerve injury. Methods: After CT and 3D reconstruction of 65 dry mandibles, 30 measurements were made on 3 planes for each hemi-mandible. This allowed analysis of the IAN and MHN pathways. Three groups of hemi-mandibles were created depending on their divergence, and a statistical analysis was performed. Results: Eight out of the 30 measurements showed a significant difference among the 3 groups. There was no significant difference for the remaining 22 measurements. Conclusions: The IAN seems to have a more superior position in the groups of mandibular hypo- and hyper-divergence. Orthognathic surgeons should use a more superficial retromolar bone incision in these cases. Finally, the Epker technique would be safer for preserving the MHN in normo- and hypo-divergent patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the visibility of the mandibular canal (MC) on panoramic radiographs after bilateral sagittal split osteotomy (BSSO), and to investigate what factors affect this MC visibility. Methods: We assessed MC visibility on panoramic radiographs of 200 BSSO patients. Images were acquired preoperatively (T0), immediately postoperatively (T1), 6 months postoperatively (T2), and 1 year postoperatively (T3), from three different predetermined regions of the mandible: the angle (Angle), distally to the second molar (M2), and mesially to the first molar (M1). All analyses were performed using SAS version 9.22. Results: The visibility of the MC was registered preoperatively in over 96 % (387/400) of the measurements at the angle of the mandible, 79 % (317/400) at M2, and <63 % (251/400) at M1. MC visibility decreased immediately after the operation and increased thereafter. Region of the mandible ( P ≤ 0.0001), plate removal ( P ≤ 0.0001), time of assessment ( P ≤ 0.0001), and age ( P = 0.0034) were the important predictors of whether MC would be radiographically visible. Conclusions: The visibility of the MC decreased immediately after BSSO, especially at the operation site (M2 and M1), while maximum MC visibility was achieved at 12 months postoperatively in our series. Since MC was not visible at the operation site after BSSO for 50 % of the subjects, it may be necessary to use additional visualization modalities for postoperative patient assessment in this region. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the reliability of multidetector computed tomography (MDCT) in determining the surgical risk of the inferior alveolar neurovascular bundle in extractions of third molars. Methods: The sample comprised thirty-three individuals (63 third molars) who underwent preoperative evaluation by MDCT before extraction of impacted mandibular third molars. MDCT was used to determine the relationship between the roots of the third molars and the mandibular canal, and the course of the mandibular canal. Inferior alveolar nerve (IAN) exposure and the presence of hemorrhage were analyzed after removal of the teeth. IAN neurosensory deficit was recorded after 7 days. Clinical and MDCT findings were compared using Fisher's exact test ( P < 0.05). Results: There was a statistically significant association between IAN exposure and the tomographic relationship between the roots of third molars and the mandibular canal ( P = 0.015). Conventionally, all cases of IAN neurosensory deficit and hemorrhage occurred when the roots of the third molar presented in an at-risk relationship with the mandibular canal, however, this association was not statistically significant ( P > 0.05). A statistically significant association was found between the lingual course of the mandibular canal and IAN exposure ( P = 0.03). Conclusions: MDCT is an effective tool for determination of the surgical risk to the inferior alveolar neurovascular bundle in extraction of mandibular third molars. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the size and morphology of the mandible, and to identify the location of the mandibular canal for the planning of the dental implantation. CT data of 79 Japanese patients (52 male and 27 female) were analyzed. The means of the height and width ranged from 27.6 to 31.0 mm and from 10.5 to 15.8 mm, respectively. The height in male subjects was significantly greater than that in female subjects, and the width in male subjects was slightly but not significantly greater than that in female subjects. The morphology of the mandible was classified into three types. Type C (round) (59–61%) was the most common in the posterior region, followed by type A (lingual concavity) (36–39%), whereas type B (buccal concavity) (58–74%) and type C (17–36%) were the most common types in the anterior region. The distance from the mandibular canal to the alveolar crest, ranged from 15.3 to 17.4 mm. The anterior loop, was observed on 55% of all sides. The size and morphology of the mandible and the location of the mandibular canal were determined clearly using cross-sectional CT images. [ABSTRACT FROM AUTHOR]