Abstract
BackgroundInjury of the inferior alveolar nerve (IAN) is a serious intraoperative complication that may occur during routine surgical procedures, such as dental implant placement or extraction of impacted teeth. Thus, the purpose of this study was to analyze the trajectory of the mandibular canal (MC), the location of the mental foramen (MF) and the presence and extension of an anterior loop of the mental nerve (AL).Study DesignIn this cross-sectional study, a total of 348 CBCTs were analyzed. Distances from MC to the surface of the basal, medial and lateral cortical of the mandible were measured at the level of the second molar, first molar and second premolar. Location of the MF relative to the apices of the premolars, as well as incidence and anterior extent of the AL were also determined.ResultsSignificant and clinically relevant correlations were found between the position of the MC in women, which was located more caudal (r=-0.219, p=0.007; r=-0.276, p<0.001; right and left, respectively) and lateral (r=-0.274, p=0.001; r=-0.285, p<0.001; right and left, respectively), particularly at the level of the premolars. Additionally, the presence (r=-0.181, p=0.001; r=-0.163, p=0.002; right and left, respectively) and anterior extension (r=-0.180, p=0.009; r=-0.285, p=0.05; right and left, respectively) of the AL was found to be inversely correlated with the age of the patient.ConclusionsThis analysis of a Caucasian population has found that the older the patient, the lower the incidence of the loop and the shorter its anterior extension. Key words:Cone-beam computed tomography, mandibular nerve, mental foramen.
Highlights
The mandibular nerve is the inferior branch of the fifth cranial nerve, known as trigeminal nerve
inferior alveolar nerve (IAN) injury may result from needle-induced trauma after infiltration of local anesthetic, most common clinical procedures associated with this complication are third molar extractions, implant placement, alveolar bone splitting techniques and buccal flap elevation in the premolar area, specially if the anterior loop of the mental nerve is not properly identified with the correct imaging techniques [3,5]
anterior loop (AL) and number of mental foramen (MF) were the only possible measurements. - Mandibular canal The only significant correlations with potential clinical relevance are those related to the position of the mandibular canal (MC) at the level of the second premolar when accounting for gender
Summary
The mandibular nerve is the inferior branch of the fifth cranial nerve, known as trigeminal nerve. IAN injury may result from needle-induced trauma after infiltration of local anesthetic, most common clinical procedures associated with this complication are third molar extractions, implant placement, alveolar bone splitting techniques and buccal flap elevation in the premolar area, specially if the anterior loop of the mental nerve is not properly identified with the correct imaging techniques [3,5]. CBCTs reduce radiation dose in comparison with conventional CT [8] The aim of this retrospective, cross-sectional study was to investigate the IAN trajectory through the mandibular body in the posterior area and its relationship with the posterior teeth using CBCT data from a large Caucasian population. Injury of the inferior alveolar nerve (IAN) is a serious intraoperative complication that may occur during routine surgical procedures, such as dental implant placement or extraction of impacted teeth. Conclusions: This analysis of a Caucasian population has found that the older the patient, the lower the incidence of the loop and the shorter its anterior extension
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