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Abstract Background To develop and cross-validate site-specific panoramic radiography (PAN) analysis prediction equations of implant-to-mandibular canal dimensions (IMCD) in mandibular regions posterior to the mental foramen, and to help determine in which instances CBCT technology will be a justified adjunct in clinical practice. Methods IMCD by PAN (Pan-D) from implant site-specific regions (first premolar, second premolar, first molar, and second molar sites) were collected from 40- to 70-year-old adolescents. They were randomly assigned to validation (n = 144) and cross-validation (n = 148) groups. The cone-beam computed tomography (CBCT) technique was used as the criterion method for the estimation of IMCD (CBCT-D). The PAN analysis equations were developed using stepwise multiple regression analysis and cross-validated using the Bland–Altman approach. Results There was a significant relationship between PAN-D and CBCT-D for both validation (R 2 = 57.8 %; p

The objective of this study was to evaluate, compare and validate different protocols of inferior alveolar canal tracing. 60 DICOM files with a total of 80 inferior alveolar canals were retrieved and imported to a third-party software where all proposed protocols can be performed. Initially, inferior alveolar canal was traced by two oral and maxillofacial radiologists together on cone beam CT cross-sectional images and considered as the baseline for future comparisons. Oral and maxillofacial surgeon performed the proposed different protocols. The protocols were color-coded differently by the surgeon before being compared with the baseline canal by the radiologists through a 5-point scale. Results showed that no single protocol was successful in all cases, even the cross-sectional protocol. According to the present study, the hybrid protocol was the most accurate while the automatic protocol was the least accurate. The hybrid protocol was reliable and showed the highest number of successful applications followed by the commonly used cross-sectional protocol. Dental practitioners should be aware of the application of multiple protocols and their pros and cons as no single protocol was successful in all the cases. Applying the same protocols on a larger sample size using different cone beam CT and multislice CT machines with different exposure parameters is recommended. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine the effect of tooth loss on the cancellous bone pattern of the mandible and on the superior bony wall of the mandibular canal. Methods: Twenty-four dry mandibles without any physical deformation were scanned with high-resolution micro-CT device. The second premolar, first, second, and third molar regions on the mandibular canal, the presence of the bony superior wall of the mandibular canal and the cancellous bone pattern of the mandible were examined on micro-CT images. The images were classified into three groups, Type I (trabecular pattern), Type II (osteoporotic pattern), and Type III (dense/irregular pattern). The presence of the bony superior wall of the mandibular canal was noted as absent or present. Results: While 133 (91%) of the dentulous sections were showing Type I trabecular cancellous bone pattern; 25 (54%) of the edentulous sections were of Type I. The superior wall was visible in 90 (62%) of the dentulous regions and in 41 (89%) of the edentulous areas. The cancellous bone pattern of the mandible of the majority of dentulous and edentulous areas had a regular trabecular structure. Dense and irregular trabecular structure were encountered only in edentulous areas. Conclusion: We suggest that there is a very strong relationship between the superior bony wall of the mandibular canal and the cancellous bone pattern of the mandible. We conclude that the trabecular structure of the mandible could change following tooth loss and this have an effect on the change of the structure and the presence of the superior wall of the mandibular canal. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the position of the mandibular canal (MC) before and after bilateral sagittal split ramus osteotomy (BSSRO) using cone-beam computed tomography (CT), and to compare the position of the MC in Class II and Class III patients in the preoperative period. Patients were divided into two groups: Class II (n = 38) and Class III (n = 41). Measurements of the superior, inferior, buccal, and lingual distances of the MC in relation to the cortical bone were taken at three levels in the proximal segment of the mandible. Results were analysed using the Kruskal–Wallis test (p < 0.05). In the Class II group the superior distance of the MC at levels 2 and 3, and the inferior distance at level 3 significantly decreased after BSSRO. In the Class III group, no significant differences were found at any level, and the inferior distances at all levels were smaller preoperatively than those in the Class II group. In the Class II group the position of the MC altered in relation to superior and inferior cortical bone after BSSRO. However, the position of the MC remained stable in the Class III group. Our results also suggest a deeper cut in inferior cortical bone in Class III patients. [ABSTRACT FROM AUTHOR]

Background: Sex determination from unidentified skeletal remains a daunting task in forensic odontology. The mandible is the strongest and most durable of bones available for post-mortem profiling and its morphometric characteristics have been investigated. Less explored is the location of the mandibular canal which in a few populations has shown gender dimorphism. Aim: The present cross-sectional study explores sexual dimorphism in an eastern Indian population of Odisha from an analysis of cone-beam CT system (CBCT) images for the relative position of the mandibular canal and its foramina. Method and Materials: A total of 120 CBCT images from either gender (1:1 ratio) of adult dentate individuals aged 18–60 years were analysed for the relative position of the mandibular canal. Ten measurements (8- coronal and 2- from axial slices) concerning the mandibular canal; at the level of the mandibular foramen, mandibular first molar and mental foramen were performed. Unpaired Student's t-test was employed to compare variables between the sexes at P < 0.05 level of significance. Results: The results revealed statistically significant differences (P < 0.05) between the genders in most of the variables (8/10), with higher mean values in males compared to females except in the distance between mandibular foramen and anterior border of the ramus (2.648 ± 0.67 mm in females, 2.527 ± 0.75 mm in males) and in the distance between the canal and lingual cortical plate in the region of the first molar (14.515 ± 1.33 mm in females, 14.288 ± 2.01 mm in males). Conclusion: The relative position of the mandibular canal and its associated foramina show sexual dimorphism in an adult eastern Indian population. [ABSTRACT FROM AUTHOR]

Background: Anatomical variations of the mandibular canal play a vital role while performing surgical procedures affecting an area with mandibular canal course in the mandible. The neurovascular bundle may be severed during surgical procedures carried out mandible. Aims and Objectives: The present retrospective study was aimed to assess and evaluate the mandibular canal and its variations on the panoramic radiography. Materials and Methods: The study included 88 randomly selected panoramic radiographs with complete mandible and associated bone. On a panoramic radiograph, the following parameters were assessed including bifid mandibular canal and location of bifurcation, the diameter of the mandibular canal as recorded in the first molar region, trabeculation in submandibular gland fossa, anterior loop measurement, direction and diameter of the bifid mandibular canal were all evaluated. Statistical analysis was done. Results: In 51 hemimandibles, the mandibular canal was found to be corticalized, whereas in 21.59% (n = 19), the mandibular canal was visible. In the remaining 20.45% (n = 18) of the study participants, the mandibular canal was not visualized. In the submandibular gland fossa region, diminished trabeculation was seen in 55.68% of the evaluated radiographs, whereas trabeculation was not seen at all in the remaining 23.86% of the subjects. A significant correlation was seen in decreased trabeculation of submandibular gland fossa and absence of the mandibular canal (P value < 0.001). The bifid mandibular canal was seen in 19.31% of the study participants (n = 17) with a mean width of 3.12 ± 1.1 mm. Extension of the anterior loop of the mental nerve was seen as up to 2 mm in majority participants in 67.04% individuals (n = 59). Conclusion: The present study suggests that panoramic radiographs are a reliable tool for assessment of the mandibular canal and associated anatomical variations associated with it.

Introduction Mandibular canal with the associated neurovascular bundle may be closely related to the apices of man-dibular teeth. In order to avoid injuries and damages to the inferior alveolar nerve during invasive dental procedures, it is important to know its localization. The aim of this study was to determine the average vertical distances of the root apices of second premolars, first molars and second molars mesially and distally from the upper projection of the mandibular canal on the sagittal section of CBCT images, and determine if there were statistically significant differences between the age and gender groups. Material and methods The research was conducted at the Faculty of Medicine of the University of Banja Luka, and the sample consisted of 146 CBCT images of patients. CBCT images were obtained using Planmeca ProMax 3D Mid instrument (Planmeca, Helsinki, Finland) and analyzed using Planmeca Romexis Viewer software. In the sagittal section , the vertical distance from the root apex to the upper projection of the mandibular canal was measured for each examined tooth. Results The distal root of the first molar (4.88 mm) had the greatest average vertical distance of the root apex from the mandibular canal, and the distal root of the second molar had the smallest average vertical distance (2.76 mm). There was statistically significant difference between certain age groups in the values of individual roots, for the second molar mesially and distally (p < 0.05), while for the first molar mesially the value of p was at the limit of significance (p = 0.05). Conclusion The results of this study showed that distal root of the mandibular second molar had the smallest vertical distance from mandibular canal, therefore an extra caution during a root canal treatment and careful planning of oral surgery in this region is recommended.

Bone grafting procedures are required for patients with insufficient bone volumes for dental implants. The incisive mandibular nerve is more prone to iatrogenic injury during bone graft harvesting. This study aimed at examining the relative position of the mandibular canal (MC), gender Variation and to observe a safe zone for the implant and bone harvesting. Cone beam computed tomography (CBCT) scans of 200 patients (males 56 %) with age ranging from 16 to 70 years (mean age, 34.1 ± 14.5 years) were selected from the database of the Dental Imaging Unit of the National Dental Teaching Hospital of Sri Lanka. The MC length, mental foramen (MF) diameter, and location and the safe zone distance for bone graft harvesting were recorded for each hemi-mandible. The mean length of left and right MC of males were 6.99 ± 0.21 cm and 6.98 ± 0.22 cm, respectively while for females the mean length was equal for both sides (6.88 cm). The mean MF horizontal length of males was 0.32 ± 0.03 cm on the left and right sides while for females it was 0.31 ± 0.03 cm on either side. The vertical length of MF was 0.25 cm for both left and right (for both genders). The mean safe zone distance of the left and right mandibles for males were 0.27 ± 0.07 cm and 0.30 ± 0.06 cm, respectively while for females the values were 0.26 ± 0.06 cm and 0.27 ± 0.06 cm, respectively. The most frequent position of the MF among males was below the second premolar on each side of the mandible. The MF of females were frequently located below and between the first and second premolar on each side of the mandible. MC and other measurements showed a high sexual dimorphism. Therefore, gender variation in MC length, diameter and location of MF should be considered during surgical interventions such as implant and bone harvesting. [ABSTRACT FROM AUTHOR]

One of the structures of greatest interest in the maxillofacial region is the mandibular canal, where its preservation optimizes the success of clinical procedures. Due to its disposition inside the mandible, in vivo visualization requires the use of radiographic techniques, among which the Cone Beam CT (CBCT) stands out. The objective of this work is to compare the visualization of the human mandibular canal by means of CBCT images with different observers and radiation programs. Using images generated with CBCT in dry mandibles with different acquisition programs, coronal slices were obtained in the anterior, middle and posterior sectors of the mandibular canal, with a total of 240 measurements, which included two voxel sizes and two doses different radiation sources. Each of the images was evaluated by a Dentist, an Anatomy Master's degree and a specialist in Oral & Maxillofacial Radiology. Percentages of visualization according to observer were obtained for each image acquisition program. The Cochran Q test yielded differences between the observers (p <0.05) and the McNemar test defined these dissimilarities between the specialist and the other observers, but not between the latter. The Yates and Mann-Whitney U tests did not show statistical differences according to the acquisition program (p> 0.05). The degree of expertise of the observer influences the visualization and its precision. In turn, using an image acquisition program with a different voxel/radiation dose not affect the visualization, since it depends on the anatomy of the structure itself. A protocol with less radiation could be used in patients complying with the ALARA ("As Low As Reasonably Achievable") premise. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the mandibular canal of ramus and design a suitable osteotomy line for intraoral vertical ramus osteotomy (IVRO) using cone-beam computed tomography (CBCT). Materials and methods: Ninety patients were classified into class I, II, and III skeletal pattern groups. When extended from the horizontal base plane (0 mm, mandibular foramen [MF]), with a 2-mm section interval, to 10 mm above and 10 mm below the MF, the following landmarks were identified: external oblique ridge (EOR), posterior border of the ramus (PBR), and posterior lateral cortex of ramus (PLC): IVRO osteotomy point. Results: In the base plane (0-mm plane), the EOR-PBR distance of class III (34.78 mm) and the IOR-PBR distance of class II (32.72 mm) were significantly higher than those of class I (32.95 mm and 30.03 mm). Compared to the EOR-PLC distance, the designed osteotomy point (two-thirds EOR-PBR length) has a 3.49-mm safe zone at the base plane and ranging from 0.89 mm (+ 10-mm plane) to 8.37 mm (− 10-mm plane). Conclusions: The position at two-thirds EOR-PBR length (anteroposterior diameter of the ramus) can serve as a reference distance for the IVRO osteotomy position. Clinical relevance: Mandibular setback operations for treating mandibular prognathism mainly include sagittal split ramus osteotomy (SSRO) and IVRO. IVRO has a markedly lower incidence of postoperative lower lip paraesthesia than SSRO. Our design presented a reference point for identification during IVRO, to prevent damage to the inferior alveolar neurovascular bundle. [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]

Objectives: The objective of our study was to develop and validate a deep learning approach based on convolutional neural networks (CNNs) for automatic detection of the mandibular third molar (M3) and the mandibular canal (MC) and evaluation of the relationship between them on CBCT. Materials and methods: A dataset of 254 CBCT scans with annotations by radiologists was used for the training, the validation, and the test. The proposed approach consisted of two modules: (1) detection and pixel-wise segmentation of M3 and MC based on U-Nets; (2) M3-MC relation classification based on ResNet-34. The performances were evaluated with the test set. The classification performance of our approach was compared with two residents in oral and maxillofacial radiology. Results: For segmentation performance, the M3 had a mean Dice similarity coefficient (mDSC) of 0.9730 and a mean intersection over union (mIoU) of 0.9606; the MC had a mDSC of 0.9248 and a mIoU of 0.9003. The classification models achieved a mean sensitivity of 90.2%, a mean specificity of 95.0%, and a mean accuracy of 93.3%, which was on par with the residents. Conclusions: Our approach based on CNNs demonstrated an encouraging performance for the automatic detection and evaluation of the M3 and MC on CBCT. Clinical relevance An automated approach based on CNNs for detection and evaluation of M3 and MC on CBCT has been established, which can be utilized to improve diagnostic efficiency and facilitate the precision diagnosis and treatment of M3. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to assess whether anatomical variations of the mandibular canal are associated with neurosensory disturbances of the inferior alveolar nerve (IAN) following mandibular third molar removal. Methods: Two observers compared the detection of third molar root-nerve relations and bifurcations of the mandibular canal on panoramic radiographs and CBCT images of 201 patients undergoing removal of 357 mandibular third molars. Potential neurosensory disturbances of the IAN were surveyed ten days after surgery. Fisher's Exact was performed to correlate presence of canal variations to postoperative neurosensory disturbances. Positive and negative predictive values (PPV, NPV) and likelihood ratios (LR + , LR–) were calculated. Results: Thirteen patients reported postoperative altered sensation of the lower lip, with 2 of them having mandibular canal bifurcations on the ipsilateral side of the injury. Fisher's Exact showed that the studied mandibular canal variations were not related to postoperative neurosensory disturbances. CBCT was superior in visualization of anatomical variations of the mandibular canal. Prevalence of bifurcations was 14% on CBCT and 7% on panoramic radiographs. In both imaging modalities and for all parameters, PPVs were low (0.04 − 0.06) and NPVs were high (0.92 − 0.98), with LR ranging around 1. Conclusion: In the present study, the assessed mandibular canal variations had limited predictive value for IAN neurosensory disturbances following third molar removal. Clinical relevance: While a close relation between the third molar and the mandibular canal remains a high risk factor, mandibular canal variations did not pose an increased risk of postoperative IAN injury after third molar removal. [ABSTRACT FROM AUTHOR]

The aim of the current cone beam computed tomography (CBCT) study was to evaluate the proximity of mandibular first and second molar roots to the inferior alveolar canal (IAC) and mandibular cortex in an Egyptian subpopulation. Scans of 120 patients (480 molars, 960 roots) were obtained from the College of Dentistry database at the Suez Canal University, Egypt. Buccal and lingual bone plates and root thickness were measured at the specified resected root end 3 mm from the radiographic apex, and so was the proximity of the root apices to the IAC. Measurements of the right and left mandibular first and second molars were recorded for each root. Three examiners performed the measurements separately. ANOVA was used to compare the different roots. Bonferroni's post-hoc test was used for pair-wise comparisons when ANOVA was significant. The significance level was set at p = 0.05. The findings displayed a closer proximity of the mandibular second molar apices to the IAC, as compared to the mandibular first molars. The mesial roots were at a shorter distance than the distal ones. Moreover, the mandibular second molars revealed the thickest total bone width including the root. So, it is beneficial for endodontists to be aware of the relation of the mandibular first and second molars to the surrounding cortical bone plates and the IAC before starting either nonsurgical or surgical endodontic treatment. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the prevalence of mandibular canal (MC) and mental foramen (MF) variations using cone-beam computed tomography (CBCT). Materials and Methods: CBCT images (n = 459) were retrospectively evaluated. The final sample consisted of 362 CBCT images of 152 men and 210 women between the ages of 10–87. MC and MF variations were evaluated according to presence and localizations. Data were analyzed using SPSS version 20. Results: Participants had a mean age of 38.79 ± 16.45 years. Fifty-seven images (15.7%) showed MC and MF variations. Forty-seven images (13%) showed bifid MCs (BMCs), 14 (3.9%) accessory mental foramen (AMF), and only five (1.4%) trifid MCs. MF was absent in one image (0.3%). The prevalence of AMF was statistically found to be higher among younger patients (7.9%). BMCs and AMF were more common in men than in women. Images with AMF presented unilateral placement, particularly on the right side. Conclusion: Variations were more common in men, and involvement was more frequent on the right side. Early identification of high-risk patients and variations can help prevent neurosensory complications such as bleeding, traumatic neuroma, paraesthesia, and paralysis. [ABSTRACT FROM AUTHOR]

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ABSTRACT Objective: The aim of this study was to evaluate the relationship of mandibular canal course with mental foramen localization on edentulous patients’ for implant placement. Material and Methods: This retrospective study was carried out on the panoramic radiographs of 788 edentulous patients. Horizontal measurements L (left mental foramen to the left mandibular ramus), R (right mental foramens to the right mandibular ramus), M (between the mental foramens) and vertical measurements D1 (mental foramen’s inferior border to the mandibular basis), D2 (mental foramen’s superior border to the alveolar crest) were digitally evaluated. Mandibular canals were classified into two types as linear and elliptic. Analysis of demographic data and correlations between canal course and linear measurements were carried out. Kolmogorov-Smirnov and Shapiro Wilks tests, Kruskal Wallis test, and Chi-squared test was used to compare the qualitative data (p

Introduction: Identification of the mandibular canal (MC) is essential before any lower jaw surgical procedures. Understanding the anatomical variations of the MC is essential for preventing postoperative complications. Objectives: We assessed the observer agreement for identifying the MC in cone-beam computed tomography (CBCT) images and to study the effect of changing the voxel size on such agreements. Material and methods: We obtained images of mandibles from ten dry skulls using a water phantom with two voxels: 0.18 and 0.3 mm. The identification of the MC was made in five sites bilaterally in each mandible by two examiners. Results: A total of 82 sites were included. Differences in measurements between images obtained with each scanning protocol and the reference images were calculated using descriptive statistics. There was an agreement between the two examiners in identifying the MC in CBCT images. No significant differences were found for identifying the MC when the voxel sizes were changed. There was a strong correlation coefficient between the two examiners for both voxel sizes (p

Background:Determining the location of mandibular canal and mental foramen in the implant treatment is important to prevent any damage to the mental foramen and mandibular canal. The interpretation of a radiographic image depends on the individual interpretation of the observer. The aim of this study was to assess the agreement between two radiologists on the identification of mental foramen and mandibular canal. Methods: In this study, 95 digital panoramic images ofedentulous patients were evaluated by two radiologists to determine the type of mental foramen according to the Yosue and Brooks classification as well as the type of mandibular canal according to the classification of Angelopoulos. Data were analyzed using SPSS version 17. Results: The most common appearance of mental foramen was continuous type. The intra-examiner agreement on the type of mental foramen on the right and left sides was as much as 0.60 and 0.72, respectively. The highest frequency was observed in the anterior and middle one-third of the superior border of the mandibular canal related to type zero and posterior one-third related to type three. Type three in the inferior border of mandibular canal was the most frequent type in all one thirds. There was also a significant difference in the anterior, middle, and posterior one-third of the superior and inferior borders of mandibular canal observations. Conclusion: The most common appearance of mental foramen on panoramic images was continuous type. The posterior one-third of mandibular canal was more clearly in panoramic images.

Background/Aim: The aim of the present study was to assess prevalence and morphologic mandibular canal variations in dry skulls.

Abstract Background With the aid of implants, Björk identified two-dimensional mandibular stable structures in cephalograms during facial growth. However, we do not know what the three-dimensional stable structures are with certainty. The purpose of this study was to identify the most stable mandibular landmarks in growing patients using three-dimensional images. Methods The sample was comprised of two cone-beam computed tomography (CBCT) scans taken about 4.6 years apart in 20 growing patients between the ages of 12.5 (T1) and 17.1 years (T2). After head orientation, landmarks were located on the chin (Pog), internal symphysis (Points C, D and E), and mandibular canals, which included the mental foramina (MF and MFA) and mandibular foramina (MdF). The linear distance change between Point C and these landmarks was measured on each CBCT to test stability through time. The reliability of the suggested stable landmarks was also evaluated. Results The total distance changes between Point C and points D, E, Pog, MF, and MFA were all less than 1.0 mm from T1 to T2. The reliability measures of these landmarks, which were measured by the Cronbach alpha, were above 0.94 in all three dimensions for each landmark. From T1 to T2, the distance changes from Point C to the right and left mandibular foramina were 3.39 ± 3.29 mm and 3.03 ± 2.83 mm, respectively. Conclusions During a growth period that averaged 4.6 years, ranging from 11.2 to 19.8 years old, the structures that appeared relatively stable and could be used in mandibular regional superimpositions included Pog, landmarks on the inferior part of the internal symphysis, and the mental foramen. The centers of the mandibular foramina and the starting points of the mandibular canal underwent significant changes in the transverse and sagittal dimensions.

The portion of inferior alveolar nerve (IAN) existent anterior to the mental foramen, before parting the canal, is referred to as the anterior loop (AL) of the IAN. The presence of AL is important when placing the implant interforaminal area of the mandible. These anatomical discrepancies can be assessed by cone-beam computerized tomography (CBCT), for evaluating its position and exact location. Mandibular neurovascular canal contents may be vulnerable to damage during mandibular surgical procedure. Greater knowledge of the location and configuration of the mandibular canal can help in the safe performance of these procedure in the dental clinic. Cross-sectional CBCT imaging is a good modality for studying the course, location, configuration and accessory branches of the mandibular canal. Advanced cross-sectional imaging modalities especiallly CBCT is a suitable tool for observing anatomic characteristics of mandibular canal to preserve this vital structure in surgical procedure.

Abstract Background The posterior regions of the jaws usually represent a significant risk for implant surgery. A non-valid assessment of the available bone height may lead to either perforation of the maxillary sinus floor or encroachment of the inferior alveolar nerve and consequently to implant failure. This study aimed to evaluate the reliability of surgeon’s decision in appraising the appropriate implant length, in respect to vital anatomical structures, using panoramic radiographs. Methods Only implants that are inserted in relation to the maxillary sinus (MS) or the mandibular canal (MC) were enrolled (first premolars [1P], second premolars [2P], first molars [1M], and second molars [2M]). All preoperative panoramic radiographs were evaluated under standard conditions. The postoperative estimation (under/over) was determined depending on the available bone height (ABH) measured from the apical end of the implant to the floor of the MS and the roof of the MC using cone beam computed tomography (CBCT). Any complication or side effect that associated with overestimated implants insertion was recorded. Results The study sample included 73 patients (predominantly females) who had consecutively received 148 implants, of which 68 were inserted in the posterior maxilla and 80 in the posterior mandible. Underestimation was recorded in 93.2% of the measurements. The remaining bone height after implants insertion was

Background & aim: The mandibular canal is a canal within the mandible that contains the inferior alveolar nerve, inferior alveolar artery, and inferior alveolar vein. Surgery within the mandibular canal requires accurate knowledge of the intra-bone pathway and anatomy of the canal due to the possibility of damage to the mandibular canal. Considering the importance of being aware of the variability of the mandibular canal and the fact that few researches has been conducted in Iran through CBCT, the aim of this study was to determine the frequency of bifurcated mandibular canal and to investigate its relationship with the third molar in CBTT images. Methods: In the present retrospective descriptive cross-sectional study, the Cone Beam Computed Topographies (CBCTs) of 101 patients were evaluated and classified by sex, and by the presence or absence of bifurcation. The CBCT examination was employed from recorded CBCT of a private oral and maxillofacial radiology center (Yasuj, Iran) from 22 July to 22 September 2019.The type of bifurcation was identified using Langlais and Correr classification. The Data was evaluated using the SPSS software, and the BMC types and frequency were determined. The Chi square test was used to assess the relationship between sex and bifid canals. P≤0.05 were considered statistically significant. Result: The results displayed 50% of the identified cases of type 1(one bilateral branch stretched to the third molar or around) and 50% of type 2 (two bilateral unilateral branches that were stretched along the main canal and join in the mandibular Ramus). Based on the blind classification 20% (2) of type B (i.e., the close proximity between the two-branched mandibular canal and one-third of the third molar tooth crown) and 80% (8) cases were of type D. In the present study, the frequency of bifurcated mandibular canal was 9.9% and a significant relationship was observed between bifurcated mandibular canal and sex (p

Problem of prevention and treatment of complications arising from the root canal teeth with different materials, remains urgent. The article deals with the surgical treatment of odontogenic compression injury of inferior alveolar nerve after endodontic procedures. Surgery is to remove the filling material of the mandibular canal. Of the 92 examined patients operated on 89 patients, 3 persons refused the surgery. Found that treatment of patients with acute compression-toxic neuropathy inferior alveolar nerve, severe complications should begin as early in intensive care, treating this disease, as the urgency of. The developed method is rapid access to the mandibular canal has advantages over access by gingival margin and horizontal cutting method, with the ability to remove all the filling material, to receive an autograft for closure of the defect cortical bone jaw, prevent gum recession in the post-operative period and gives a positive result in 98% of cases

Context and Aim: Dental implants are widely used for the rehabilitation of edentulous arches. Yet, placement of oral implants in the mandible is associated with numerous complications, including hemorrhage and neurosensory disturbances. Enumerating precise information concerning the vital structures of the mandible, thus, becomes all the more important before the placement of implants. The aim of the present study was to determine the efficiency and accuracy of digital orthopantomography (OPG) and cone-beam computed tomography (CBCT) in determining the location of mandibular canal in preoperative assessment of the mandibles for implant placement. Materials and Methods: Ten dry edentulous mandibles of adult humans were selected for this study which comprised two phases, namely a radiographic phase and an in vitro phase. The radiographic phase was based on the obtaining digital orthopantomographs and cone-beam computed tomograms. During the in vitro phase, all the mandibles were sectioned at an angle of 90° to the inferior border of the mandible, and in vitro measurements were obtained. Statistical Analysis Used: Statistical analysis was done using IBM SPSS statistics 20 (Chicago, IL, USA). Paired and unpaired t-tests were used to do a comparative analysis of the two modalities used. P < 0.05 was considered to be statistically significant. Results: The results of the present study revealed that the measurements of both the vertical (D1 and D2) and the buccolingual distances of the mandible (D3 and D4) obtained by CBCT were in accordance with the ones obtained with the help of in vitro measurements, and there was no statistically significant difference in the studied variables (D1, D2, D3, and D4) between the two measurements. On the contrary, there was a significant statistical difference between the values obtained from digital OPG (D1 and D2) when compared to the values obtained by in vitro measurements. Conclusion: The findings of the present study implied that CBCT is the most efficient and accurate diagnostic tool available to locate the course of mandibular canal in the selection of potential implant sites. The accuracy of the CBCT was found to be superior to the digital panoramic images in the present study because of multiplanar three-dimensional reconstructions.

Purpose To examine the effectiveness and safety of immediate implant placement (IIP), we evaluated the risk of lingual plate perforation (LPP) and mandibular canal perforation (MCP) associated with posterior mandible anatomy using cone beam computed tomography (CBCT) images. Materials and Methods A morphological study of the molar sockets of 135 patients (age: 18–84 y) was done and its relationship to the mandibular canal was investigated. The risk of LPP and MCP was recorded as yes or no. Mandibular cross-sectional morphology was defined as one of three types (U-P-C) using the criteria of Chan et al. Results The risk of LPP was significantly higher for second molars (p = 0.0001), and the risk increased with age (p = 0.039). There was a strong relationship between the risk of LPP and cross-section type U (p = 0.0001). The mean root to alveolar canal (RAC) distance (mm) of males was significantly higher than that of females. The mean RAC value was 5.02 mm for males and 3.49 mm for females. There was no statistically significant relationship between the risk of MCP and sex. There was a significant relationship between the risk of MCP and cross-section type U (p = 0.0001). Although the MCP risk was higher in second molars, there was no statistically meaningful relation between MCP and tooth type. Conclusion The results suggest that IIP in the mandibular molar area carries a high risk of MCP and LPP. Based on the elevated level of risk, a delayed implant protocol should be considered.

Objectives: The aim of this study was to assess the visibility of mandibular canal (MC) on cone beam CT (CBCT) images using a medical review monitor under two different calibration modes. The effect of age, gender, and location of the dental implant site was also assessed. Materials and Methods: CBCT images of 428 dental implant sites were selected for the study. Images were displayed twice on a medical review monitor using two different calibration modes: standard and DICOM, and two observers evaluated the visibility of the MC using four-point scoring scale (1–4, poor to excellent). Cohen Kappa was used to assess intra and inter-rater reliability. Chi-square test was used to compare proportions of MC visibility by gender and location and one-way ANOVA was used to compare mean age and MC visibility. Results: Each observer classified the visibility of MC with a total agreement of 100% between DICOM mode and standard mode (Kappa = 1, P < 0.001 for each observer). In each mode, a strong agreement (inter-rater reliability) was detected between the observers (Cohen's kappa = 0.88 for both modes, P < 0.001) with a percent agreement of 95.3% for each mode. Gender and location were not statistically associated with MC visibility (P > 0.05). Age, however, was a significant predictor of MC visibility (P < 0.05). Conclusions: DICOM calibration had no added value over standard calibration for assessing the visibility of MC at dental implant sites on a medical review monitor. Only the age had significant effect on the visibility.

Introduction: Dental implant is the most preferable option for the replacement of missing teeth because of its advantage of maintaining the structural and functional integrity of bone, like that of a natural tooth. Aim and Objectives of the Study: Aim of this study is to evaluate the depth of submandibular gland fossa and its relationship with the mandibular canal, based on gender and side of the mandible. Materials and Methods: 100 CBCT scans of both males and females were acquired. The deepest region of submandibular gland fossa and the superior, parallel, and the inferior relationship of the mandibular canal to submandibular gland fossae were obtained. Results: The mean ± SD of the depth of the submandibular gland fossa on the right side in males and females were 1.69 ± 0.73 mm and 1.62 ± 0.58mm, respectively, and those on the left were 1.69 ± 0.61 mm and 1.56 ± 0.42 mm, respectively. The deepest region in both the genders was above the infra-alveolar canal. Conclusion: Males showed greater depths when compared to females, Right side of the mandible showed greater depth when compared to the left side in both genders. Therefore, careful evaluation of alveolar bone thickness during implant placements is of great importance in males.

Abstract: The aim of the current cone beam computed tomography (CBCT) study was to evaluate the proximity of mandibular first and second molar roots to the inferior alveolar canal (IAC) and mandibular cortex in an Egyptian subpopulation. Scans of 120 patients (480 molars, 960 roots) were obtained from the College of Dentistry database at the Suez Canal University, Egypt. Buccal and lingual bone plates and root thickness were measured at the specified resected root end 3 mm from the radiographic apex, and so was the proximity of the root apices to the IAC. Measurements of the right and left mandibular first and second molars were recorded for each root. Three examiners performed the measurements separately. ANOVA was used to compare the different roots. Bonferroni’s post-hoc test was used for pair-wise comparisons when ANOVA was significant. The significance level was set at p ≤ 0.05. The findings displayed a closer proximity of the mandibular second molar apices to the IAC, as compared to the mandibular first molars. The mesial roots were at a shorter distance than the distal ones. Moreover, the mandibular second molars revealed the thickest total bone width including the root. So, it is beneficial for endodontists to be aware of the relation of the mandibular first and second molars to the surrounding cortical bone plates and the IAC before starting either nonsurgical or surgical endodontic treatment.

Bifid mandibular canals are common anatomical findings with variations based on direction and location of branching, which carry significant clinical implications for endodontic and surgical dental procedures. This case report describes a previously unreported ectopic dental canal that branches off the superior border of the mandibular canal, enters the apex of a mandibular second molar, traverses through the root, anastomoses with the root canal system, and subsequently exits through the lingual aspect of the root. The anastomosis of this ectopic dental canal with the mesial lingual canal led to significant bleeding during rotary instrumentation. This unique anatomical variation demonstrates the importance of a thorough cone-beam computed tomography analysis to identify critical structures prior to undertaking dental procedures involving the root apices of mandibular posterior teeth and adjacent areas., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aims to develop a deep learning framework for the automatic detection of the position relationship between the mandibular third molar (M3) and the mandibular canal (MC) on panoramic radiographs (PRs), to assist doctors in assessing and planning appropriate surgical interventions., Methods: Datasets D1 and D2 were obtained by collecting 253 PRs from a hospitals and 197 PRs from online platforms. The RPIFormer model proposed in this study was trained and validated on D1 to create a segmentation model. The CycleGAN model was trained and validated on both D1 and D2 to develop an image enhancement model. Ultimately, the segmentation and enhancement models were integrated with an object detection model to create a fully automated framework for M3 and MC detection in PRs. Experimental evaluation included calculating Dice coefficient, IoU, Recall, and Precision during the process., Results: The RPIFormer model proposed in this study achieved an average Dice coefficient of 92.56 % for segmenting M3 and MC, representing a 3.06 % improvement over the previous best study. The deep learning framework developed in this research enables automatic detection of M3 and MC in PRs without manual cropping, demonstrating superior detection accuracy and generalization capability., Conclusion: The framework developed in this study can be applied to PRs captured in different hospitals without the need for model fine-tuning. This feature is significant for aiding doctors in accurately assessing the spatial relationship between M3 and MC, thereby determining the optimal treatment plan to ensure patients' oral health and surgical safety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Ossifying fibroma (OF) is a benign fibro-osseous lesion characterized by the proliferation of fibrous connective tissue containing immature bone and/or cementum-like hard tissue. Although the pathogenesis of OF remains unclear, trauma, previous extractions, and periodontitis are considered potential trigger factors. OF is more common in women aged from the second to fourth decades. Clinically, OF is characterized by slow-growing and asymptomatic swelling, often observed incidentally on radiological examinations. OF occurs more frequently in the mandible, particularly above the mandibular canal. Herein, we present a rare case of OF in an 18-year-old man initially misdiagnosed as a static bone cavity. The lesion was first observed as a radiolucent finding below the left mandibular canal on a panoramic radiograph. Later, cone-beam computed tomography (CBCT) imaging revealed the presence of calcifications within the lesion. Additionally, CBCT confirmed the presence of the lesion within the lingual cortical bone, revealing lingual swelling and thinning of the outer cortex. Enucleation was successfully performed under general anesthesia without any postoperative complications. Histopathological examination confirmed the diagnosis of OF, revealing mineralized tissue and proliferating fibrous connective tissue. This case underscores the challenges in diagnosing OF, particularly when it is located below the mandibular canal, emphasizing the importance of thorough imaging and differential diagnosis to avoid misinterpretation as a static bone cavity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sugino et al.)

Purpose: To assess the prevalence and configuration of bifid (BMC) and trifid (TMC) mandibular canals using computed tomography (CT), describing the anatomical characteristics of the accessory canals, especially of the retromolar type., Materials and Methods: CT scans of 123 patients were analysed. BMCs were identified and the patterns of bifurcation were classified, including trifid canals. The width of accessory canals was measured. Retromolar canals were further classified according to their course and morphology, while their position and width were evaluated using linear measurements on CT images., Results: The majority of patients (53.6%) presented at least one BMC or TMC. 36.2% of mandibular canals were bifid, while 4.5% were trifid. The forward canals (12.6%) and retromolar canals (10.2%) were the most common among BMCs. In relation to the retromolar canals, 60% were vertical and 40% curved, with a mean width of 1.03 ± 0.28mm., Conclusion: BMCs and TMCs are common 3D radiographic findings, so that they should be considered as anatomical variations, not anomalies. Preoperative CT or CBCT evaluation should aid in identifying these variations and analysing their position and course in surgical planning.

Introduction: Impacted mandibular third molars pose challenges in dental practice, often requiring surgical intervention. This retrospective study aims to analyze the demographics, impaction patterns, and anatomical relationships of impacted mandibular third molars among Saudi patients., Methodology: Data from 722 patients visiting the Department of Maxillofacial Surgery and Diagnostic Sciences at Jizan University were retrospectively analyzed. Parameters including gender distribution, impaction types, relationship with the mandibular canal, and age demographics were evaluated based on panoramic radiographs., Results: Bilateral impaction predominated (57.59%), with mesioangular impaction being the most common (46.51%). Gender differences were noted in impaction types and relationships with the mandibular canal. Interruption of white lines of the canal was more frequent in males (70.00%). Early adulthood (20-25 years) exhibited the highest prevalence of impaction., Conclusion: The study provides insights into the demographics and characteristics of impacted mandibular third molars among Saudi patients. Gender-specific variations and age distribution underscore the importance of tailored treatment approaches and early intervention., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

Objective: To determine the longest upright and tilted implant that can be placed in posterior mandibular teeth (second premolars [2PM], first molars [1M], and second molars [2M]) in case of immediate implant placement (IIP), respecting a safe distance from the inferior alveolar canal (IAC) and the submandibularfossa, using cone beam computed tomography (CBCT) scans. Method and Materials: In CBCT scans of 118 subjects, the following were measured: distance from the tooth apex to the IAC (DTC), lateromedial width of the mandible, classification of mandibular cross-sectional morphology, upright and tilted implant placement simulation, tilting angle that allowed placement of the longest implant. Results: The DTC has shown to be greater for 1M, shorter for 2PM, and even shorter for 2M. Between 70% and 88% of all 2PM, 1M, and 2M present less than 6 mm of DTC. The cross-sectional morphology of the mandible had a tendency to be classified as "undercut" in more posterior regions. For both 4.0- and 5.0-mm implants, more posterior regions resulted in a greater difference in length between the upright and tilted implants. The tilting angle was greater for the more posterior regions. Most of the relationships between age/sex and the morphometric parameters were weak. Conclusion: Lingual concavity is a common clinical finding at the posterior mandibular region, and its occurrence varies according to the tooth type. The great majority of the 2PM, 1M, and 2M present limited available bone between the root apex and the IAC, which stresses the need for careful attention when IIP is planned in this area. [ABSTRACT FROM AUTHOR]

Background: Anatomical variations of the mandibular canal play a vital role while performing surgical procedures affecting an area with mandibular canal course in the mandible. The neurovascular bundle may be severed during surgical procedures carried out mandible. Aims and Objectives: The present retrospective study was aimed to assess and evaluate the mandibular canal and its variations on the panoramic radiography. Materials and Methods: The study included 88 randomly selected panoramic radiographs with complete mandible and associated bone. On a panoramic radiograph, the following parameters were assessed including bifid mandibular canal and location of bifurcation, the diameter of the mandibular canal as recorded in the first molar region, trabeculation in submandibular gland fossa, anterior loop measurement, direction and diameter of the bifid mandibular canal were all evaluated. Statistical analysis was done. Results: In 51 hemimandibles, the mandibular canal was found to be corticalized, whereas in 21.59% (n = 19), the mandibular canal was visible. In the remaining 20.45% (n = 18) of the study participants, the mandibular canal was not visualized. In the submandibular gland fossa region, diminished trabeculation was seen in 55.68% of the evaluated radiographs, whereas trabeculation was not seen at all in the remaining 23.86% of the subjects. A significant correlation was seen in decreased trabeculation of submandibular gland fossa and absence of the mandibular canal (P value < 0.001). The bifid mandibular canal was seen in 19.31% of the study participants (n = 17) with a mean width of 3.12 ± 1.1 mm. Extension of the anterior loop of the mental nerve was seen as up to 2 mm in majority participants in 67.04% individuals (n = 59). Conclusion: The present study suggests that panoramic radiographs are a reliable tool for assessment of the mandibular canal and associated anatomical variations associated with it. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the extent of cortical perforation in millimetres (mm) in inferior alveolar nerve (IAN) canal on coronal section of cone beam computed tomography (CBCT) to predict IAN injury in high risk patients. We also analysed relation of position of canal and number of roots with likelihood injury to IAN. We conducted a prospective clinical study of 100 high risk patients in which 78 patients had cortical perforation which was verified by CBCT. 13/78 of 3rd molars were associated with IAN injury at 1 month post extraction. Out of those, only 3 had a permanent decrease in sensation and remaining 10 had temporary paraesthesia. Owing to the large number of patients with cortical defects, we further sub-categorised them into five groups based on cortical perforation: Type 1 – No involvement, Type 2–1 - 3 mm, Type 3–4 - 6 mm, Type 4–7 - 9 mm, Type 5 – more than 9 mm. All of the 8 patients who had more than 6 mm (Type 4 and Type 5) had some sensory disturbance whereas no IAN injury was found in patients of type 1 and type 2. There were 5/23 who had nerve injury in type 3. The association between cortical perforation and IAN injury was statistically significant (p -

Accurate segmentation of mandibular canals in lower jaws is important in dental implantology. Medical experts manually determine the implant position and dimensions from 3D CT images to avoid damaging the mandibular nerve inside the canal. In this paper, we propose a novel dual-stage deep learning-based scheme for the automatic segmentation of the mandibular canal. In particular, we first enhance the CBCT scans by employing the novel histogram-based dynamic windowing scheme, which improves the visibility of mandibular canals. After enhancement, we designed 3D deeply supervised attention UNet architecture for localizing the Volumes Of Interest (VOIs), which contain the mandibular canals (i.e., left and right canals). Finally, we employed the Multi-Scale input Residual UNet (MSiR-UNet) architecture to segment the mandibular canals using VOIs accurately. The proposed method has been rigorously evaluated on 500 and 15 CBCT scans from our dataset and from the public dataset, respectively. The results demonstrate that our technique improves the existing performance of mandibular canal segmentation to a clinically acceptable range. Moreover, it is robust against the types of CBCT scans in terms of field of view.

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Objective: This study sought to analyse the relationship between mandibular posterior teeth and the surrounding anatomical structures. Methods: A total of 170 CBCT images were examined to obtain measurements regarding the following: buccolingual (BL) and mesiodistal (MD) root thickness at the standard level of resection (3 mm from the apex), the thickness of the overlying buccal and lingual bone at the same level, the proximity of the mandibular canal (MC) to the apices of the mandibular posterior teeth, as well as the horizontal location of the mental foramen (MF). Results: The BL root width at 3 mm from the apex was the broadest at the mesial roots of the first molars with males: 5.33±0.99 mm and females: 5.16±0.88 mm (mean±SD). The root width was narrowest at the second premolars (males: 3.80±0.83 mm; females: 3.61±0.60 mm). At the same level; the buccal bone was thickest over the distal roots of the second molars (males: 6.92±1.85 mm; females: 6.95±1.95 mm) and thinnest over the first premolars (males: 1.73±0.93 mm; females: 1.49±1.01 mm), while the lingual bone was thickest over the distal roots of the first molars (males: 5.58±1.36 mm; females: 4.52±1.24 mm) and thinnest over the distal roots of the second molars (males: 3.13±1.50 mm; females: 2.60±1.46 mm). The nearest root apices to the MC were the distal roots of the second molars (male: 1.21±1.45 mm; female: 1.75±1.97 mm), while the furthest were the mesial roots of the first molars (male: 4.00±2.39 mm; female: 4.77±2.58 mm). The most common horizontal location of the MF was between the first and second premolars (51.8%). The lingual bone was significantly thinner over both roots of first molars in females (P<0.05). Conclusion: As the position of the teeth became more posterior, the buccal bone thickness increased, the lingual bone thickness decreased, and the distance to the MC became closer. CBCT analysis provides distortion- and superimposition-free images of the relevant anatomic structures. [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]

A recent study found that the mandibular canal might be preferably called the inferior alveolar canal in recent publication years, certain journal categories, countries and departments with which the authors were affiliated. The canal can also be called the inferior dental canal that was not included in that study. This bibliometric analysis was conducted to evaluate the entire relevant literature, and to investigate if inferior alveolar canal was trending over the years. The Web of Science Core Collection electronic database was searched to identify publications exclusively mentioning mandibular canal, inferior alveolar canal, inferior dental canal, and publications mentioning them in combinations. Publication year, country of contributing authors, journal category, journal title, and citation count were recorded for the resultant publications. There were 1152 publications analyzed. Mandibular canal has always been the dominating term since the 1990s, whereas inferior alveolar canal seemed to become slightly more popular in the 2010s than in the past. Journals from dentistry, surgery, radiology, anatomy, and medicine all showed a preference towards mandibular canal. Leading dental surgery journals had a higher ratio of inferior alveolar canal usage than their dental radiology counterparts. Top 20 countries showed a preference towards mandibular canal except Saudi Arabia, which had 57.7 % of publications using inferior alveolar canal exclusively. Publications mentioning mandibular canal, inferior alveolar canal, and inferior dental canal did not differ in averaged citation count. The term mandibular canal was still dominating in all academic fields. The term inferior alveolar canal showed increased usage in the 2010s without an increasing trend. The argumentation of renaming mandibular canal as inferior alveolar canal has yet to accumulate considerable traction. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to analyse age‐related anatomical changes in teeth and mandibular structures using panoramic radiographs. Materials and Methods: We included 471 subjects aged 13–70 years (mean, 35.12 ± 18.72 years). Panoramic radiographs were used to record intraoral condition and radiomorphometric parameters. After grouping the subjects by age decade, descriptive statistics and analysis of variance were performed to assess age‐related patterns. Results: The number of missing teeth, endodontically treated teeth, full veneer crowns, and implant prosthesis increased with age (all p <.05). The prevalence of periodontitis significantly increased after the 40s and was the highest in the 60s (57.1%). The maxillary canine root was the longest in the 10s and 20s (p <.001). With age, the mandibular canal and mental foramen moved towards the alveolar bone crest, on the opposite side of the mandibular inferior border. The pulp area and pulp‐to‐tooth ratio of maxillary/mandibular first molars were significantly higher in the 10s and 20s than in other age groups (all p <.05). Conclusions: We provided comprehensive information on age‐related anatomical changes in teeth and mandibular structures based on panoramic radiographs. Various radiographic parameters showed specific changes with increasing age. Assessing these age‐related changes can be useful in determining an individual's age, and may aid in medico‐legal and forensic judgments. [ABSTRACT FROM AUTHOR]

The inferior dental nerve (IDN) is an important mandibular landmark in implant dentistry. Generally, IDN enters the mandible at the mandibular foramen, runs through the mandibular canal in the lingual-buccal direction, and emerges at the mental foramen, with or without anterior loop formation. Its exact course shows high age-related and race-related variability. To avoid nerve injuries, careful examination and appropriate knowledge of the anatomy and mandibular course are recommended. Various techniques have been developed to evaluate the response of IDN to injury. The prognosis is mainly dependent on the type of injury and timing of its management. An updated review of general anatomic considerations, guidelines for protection, and management of accidental injuries is provided. [ABSTRACT FROM AUTHOR]

Background and objective: Accurate understanding of the anatomy of the inferior alveolar nerve (IAN) and its relation with anatomical landmarks of mandibular molar teeth can reduce the risk of unwanted injuries to the IAN during implant placement. Methods: 44 CBCTs of patients,who have been reffered to the private oral and maxillofacial radiology center, were examined by a radiologist on the axial, sagittal and coronal planes. Then, the distances between mandibular canal and buccal cortex (BN) and lingual cortex (LN), buccolingual width of the mandibular canal (BL), and the distances between the canal and apex of the first molar (M1N) and second molar of mandible (M2N) were obtained from cross-sectional images. Data were analyzed using SPSS17 software and Kolmogorov-smirnov and Mann-whitney test. Results: 21 males and 23 females aged 20 to 50 years old (mean age: 37.8±7.52) were examined. The mean intervals in the regions of first molar in the right and left sides were BN: 4.03,4.06 mm, LN: 2.10,2.58 mm, BL: 2.20,2.20 mm, and M1N: 5.77,5.78 mm and in the second molar region, on the right and left sides were BN: 5.21,5.20 mm, LN: 1.95,1.80 mm and BL: 2.30,2.20 mm and M2N: 3.85,3.55 mm, respectively. There was a significant difference in the mean buccolingual width of mandibular canal in both sides in the region of first molar and left side in the region of second molar between two genders. (P=0.009, P=0.019, P=0.045). Other measurements were not significantly different between two genders (P>0.05). The age range of patients had no effect on any of the distances and measurements (P>0.05). Conclusion: buccolingual width of mandibular canal in both sides in the region of first molar and left side in the region of second molar was associated with gender.

Background and objectives: An effective factor in choosing the correct place for the dental implant and performing surgical procedures in the posterior regions of mandible is the position of the mandibular canal. Failure to consider this important landmark will damage the inferior alveolar nerve. Considering the widespread use of implants and the precision of the images obtained from CBCT. The aim of this study was to evaluate the rate of visibility of mandibular canal by CBCT in order to prevent damage to the inferior alveolar nerves and arteries. Methods: In this study, 90 archived CBCT images of patients from a private center of oral and maxillofacial radiology in Yazd that was taken by technician was evaluated during 2012-2019. The visibility of the mandibular canal in reconstructed panoramic images of CBCT was assessed by a dentistry student trained by the maxillofacial radiologist in five areas in different thicknesses on each side. Data were analyzed using SPSS 17 software. Chi-square, and correlation coefficient were done. Results: In total, in 53.38% of CBCT images both borders of mandibular canal were visible, in 17.95%, only one border was visible (difficult observation) and in 28.7% of cases, lack of visibility of mandibular canal was reported. There was no significant difference between sex, age, side and thickness in mandibular canal visibility (P >0.05). Conclusion: In more than half of CBCT images, both borders were clearly visible in both right and left sides; therefore we can conclude that CBCT is a useful tool for the observation of mandibular canal before surgeries.