Lingual Cortical Plate Research Articles

Sagittal Split Ramus Osteotomy in the Absence of Bone Marrow Space along the Ascending Ramus

The existence of cancellous bone between buccal and lingual cortical plates provides guidance for the desired split plane through the osteotomy lines and interruptions increase the risk of unfavorable fractures during sagittal split ramus osteotomy (SSRO). The aim of this study is to present a rare case of SSRO in the absence of cancellous bone concerning the osteotomy sites, a conservative approach using piezosurgery and bone separators to avoid complications.

Immediate placement of denture over undiagnosed ameloblastoma

Ameloblastoma is an odontogenic tumor that affects the bones of the jaw, often affecting posterior region of the mandible. It is a benign neoplasm and is fre­quently associated to an unerupted tooth. The purpose of this article is to report a case of failure in making an immediate full denture in a patient that had an ameloblastoma. A female patient aged 67 years complained of a hard swelling in the right mandible at the premolar region, that she noted after teeth extraction and confection of an immediate denture. Intraoral examination showed buccal and lingual cortical plate expansion and radiograph examination showed multilocular radiolucency with a well-defined margin. Fine needle aspiration was nonproductive and the provisional diagnosis was ameloblastoma. An incisional biopsy was performed and the histopathological report was conclusive of an acanthomatous ameloblastoma. The patient was sent for surgical excision of the lesion and after three years, the patient returned reporting that she was operated elsewhere in the past year and had an unsuccessful bone graft. She was sent to a prosthodontist to make a complete denture. In the present case the ameloblastoma was diagnosed only after the teeth extraction and immediate denture. KeywordsAmeloblastoma; Diagnosis; Mandibular neoplasms; Odontogenic tumors.

Juxta-apical radiolucency and relations with surrounding structures on cone-beam computed tomography.

The aim of this study was to investigate the incidence of juxta-apical radiolucency (JAR) and its relations with surrounding structures using cone-beam computed tomography (CT). A total of 215 cone-beam CT images was analysed retrospectively to record the presence, site, and size of the JAR, and the relations between the JAR and the mandibular canal, buccal or lingual cortical plates, tooth position, and condition of root apex. Descriptive analyses were made, and relations between the categorical variables were tested with the chi squared test. JAR was detected in 71 (33%) (5 bilateral and 66 unilateral) of 215 patients (378 mandibular third molars) on cone-beam CT images. It was most commonly seen mesial to the tooth (43%) and above the third molars (55%), and was least common lingual to the tooth (3%) and at the distoangular third molar (3%) (p = 0.005). There was no significant relation between the JAR and the mandibular canal, but JAR was most likely to be detected superiorly to the mandibular canal (59% of cases). JAR can be seen and evaluated with cone-beam CT. It was most commonly seen mesial to the tooth and above the third molar. No significant relation was found between JAR and the mandibular canal, cortical plate, or condition of the apex. Future studies on the assessment of JAR should be done with a larger sample size as prospective cone-beam CT studies.

Qualitative and morphological evaluation of the mandibular bone using computed tomography.

Determining the amount of cortical and cancellous bone present in the mandible is an important criterion for the selection of proper implant size and reduction of post implant placement complications. It becomes difficult to manage the presence of lingual undercuts when there is perforation of either the buccal or lingual cortical plates. Computed tomography (CT) images of the mandible can reduce the risk of complications by evaluating the thickness of cortical and cancellous bone in the mandible. Evaluate thickness of the buccal and lingual cortical plates and cancellous bone. Gender variation in the cancellous bone and cortical bone thickness. Determine the shape of the mandible. A retrospective study was conducted using the CT scan images of pathologies pertaining to the Head and Neck region. CT scan images of 30 patients, comprising of 22 males and 8 females. The mental foramen was considered as the anatomical landmark and the vertical marking was considered at a height of 20 mm from basal bone. The thickness of both cortical and cancellous bone was noted 6 mm anterior to it and 18 mm posterior. The shape of the buccal and lingual cortical bone was also considered. Statistical analysis was done using Student's t-test or Chi-square test. The mean thickness of cortical bone was more in anterior mandible than posterior mandible and cortical bone density was thickest at height of 20 mm, whereas for cancellous bone, it was highest at 5 mm from the basal bone, thickness. Buccal concavity, type A (68.2%), was the most common in the anterior region for males, followed by round shape, type C (56-58%) in the posterior region. For females, type C (25-31%) in the posterior region and lingual concavity, type B (18-30%) were the most common types in the anterior region. Lingual concavity may pose serious problems in cases of perforations during implant placement. Lingual cortical plates were thicker than the buccal cortical plates and it is concave anterior mandible. Thus, CT imaging can help in characterizing the quantity and morphology of the mandible.

Computer guided flapless vestibular to lingual trans-alveolar implant insertion for All on four implant prosthesis in case of severely atrophied mandible: A short term clinical and radiographic study

Aim: This short-term investigation aimed to study the outcomes of computer guided flapless vestibular to lingual implant insertion for All on four implant prosthesis in case of severely atrophied mandible. Material and methods: Six (3 men and 3 women) edentulous patients (mean age of 59 years) with atrophied mandibles received four implants using the computer guided flapless surgical protocol and a stereolithographic surgical guide. The posterior implant was installed in bicuspid region lingual to mental foramen and inclined in buccolingual trans-alveolar direction to engage the lingual cortical plate. Fixtures were loaded by the old denture the same day of implant placement. Plaque and bleeding scores, probing depth, fixture mobility and loss of bone around implants were measured at baseline (immediately after loading), 6 and 12 months thereafter. Results: There was a significant increase in plaque scores, probing depth and resorption of bone with passage of time. gingival scores and stability of the implants did not change with time. Premolar implants showed significant higher plaque scores, probing depth and marginal loss of bone compared to canine implants. Two posterior implants were lost resulting in survival rate of 91.6% after one year. Conclusion:Within the limits of this study, it could be concluded that computer guided flapless vestibular to lingual trans-alveolar posterior implant insertion for All on four implant prosthesis in case of severely atrophied mandible is a predictable and reliable method as it was associated with favourable clinical and radiographic peri-implant outcomes after one year. Key words: Computer guided, flapless, implants, severely atrophied, mandible.

Prevalence of lingual foramina in the anterior mandible: A cone-beam computed tomography study

Context: Serious hemorrhagic complications can result from arterial trauma associated with perforation of the lingual cortical plate or injury to the terminal branches of the sublingual and submental arteries that pierce the lingual cortex of the mandible in the anterior region. Aim: The aim of this study is to determine the prevalence of lingual foramina (LF) in the anterior mandible by cone-beam computed tomography (CBCT) and to determine the presence and number of foramina, lingual foramina canal length (LFC), distance from the base of the mandible to the entrance of the LFC, distance from the base of the mandible to the end of the LFC, distance from the end of the LFC to the buccal cortical plate, and diameter of the LFC, and to attempt to find a relation between the data obtained to age, sex, and dental condition. Settings and Design: This study design involves a retrospective cross-sectional study. Methods: A total of 303 CBCT images were evaluated of the anterior mandible with software and recorded the measurements into a spreadsheet, which was converted into graphs and tables. The CBCTs were assessed based on sex, age, and dental condition. Statistical Analysis Used: Fisher’s exact test and Student’s t-test. Results: We found a prevalence rate of 99.3%. The foramina were evident in 102 (99.0%) men and 199 (99.5%) women. The most prevalent number of canals was two (47.5%). The superior canal presented as greater length (7.25 ± 2.04 mm) and diameter (0.95 ± 0.58 mm). Conclusion: The prevalence of LF is high, and their presence is not related to sex, age, or dental condition.

Radiographic assessment of mandibular canal in Nepalese population: a study based on cone beam computed tomography images

Background: Mandibular canal runs in the body and ramus of mandible and provides pas­sage for inferior alveolar nerve. Knowledge on spatial relationship of canal with adjacent structures prevent damage to nerve during surgical procedures. This study aims to find three-dimensional relationship of canal as well as its relation with third molar.
 Methods: This was a cross sectional and retrospective study conducted on Cone Beam Com­puted Tomography images. The relation and position of canal with third molar and position of canal in vertical and horizontal dimensions were analyzed.
 Results: Mandibular canal was found to be progressively descended in 43% of the canals. The canal was located apical to third molar in 61.9% cases and regarding contact relation, 121(56%) of the third molars had no contact with the canal. Buccal cortical plate was maxi­mum at the level of distal root of second molar and minimum at the level of mesial root of first molar and was reverse for lingual cortical plate. The highest distance between upper border of canal and inferior border of mandible was at mental foramen 13.55±2.27 mm and lowest at mesial root of second molar, 8.72±2.59 mm. Minimum distance between superior border of canal and alveolar crest was distal to second molar (13.78±3.54 mm) and maximum between first molar and second premolar (17.91±3.08 mm).
 Conclusions: It was observed that canal was interradicularly placed and was by penetrated by third molar in some cases. Thickness of cortical plates varied in various locations buccally and lingually.

RADIOGRAPHIC ASSESSMENT OF MANDIBULAR CANAL IN NEPALESE POPULATION: A STUDY BASED ON CONE BEAM COMPUTED TOMOGRAPHY IMAGES

Background: Mandibular canal runs in the body and ramus of mandible and provides pas­sage for inferior alveolar nerve. Knowledge on spatial relationship of canal with adjacent structures prevent damage to nerve during surgical procedures. This study aims to find three-dimensional relationship of canal as well as its relation with third molar.
 Methods: This was a cross sectional and retrospective study conducted on Cone Beam Com­puted Tomography images. The relation and position of canal with third molar and position of canal in vertical and horizontal dimensions were analyzed.
 Results: Mandibular canal was found to be progressively descended in 43% of the canals. The canal was located apical to third molar in 61.9% cases and regarding contact relation, 121(56%) of the third molars had no contact with the canal. Buccal cortical plate was maxi­mum at the level of distal root of second molar and minimum at the level of mesial root of first molar and was reverse for lingual cortical plate. The highest distance between upper border of canal and inferior border of mandible was at mental foramen 13.55±2.27 mm and lowest at mesial root of second molar, 8.72±2.59 mm. Minimum distance between superior border of canal and alveolar crest was distal to second molar (13.78±3.54 mm) and maximum between first molar and second premolar (17.91±3.08 mm).
 Conclusions: It was observed that canal was interradicularly placed and was by penetrated by third molar in some cases. Thickness of cortical plates varied in various locations buccally and lingually.

Thickness of Buccal and Lingual Alveolar Bone Plates According to the Position of Impacted Mandibular Third Molars on Cone-Beam Computed Tomography Scans

Objectives: This study sought to assess the thickness of buccal and lingual alveolar bone plates according to the position of impacted mandibular third molars on cone-beam computed tomography (CBCT) scans.
 Materials and Methods: Eighty-four CBCT scans of impacted mandibular third molars were evaluated in this retrospective study. All images had been obtained by ProMax 3D CBCT system with the exposure settings of 78 kVp, 12 mA, 16 s time, 0.2 mm voxel size and 10 × 9 cm field of view. The impaction angle of teeth and the thickness of buccal and lingual cortical plates were determined on images by drawing lines in the anterior, middle, posterior, superior, central and inferior regions. Thickness of bone plates was analyzed according to the position of impacted molars relative to the buccal and lingual plates using the Student t-test and relative to the second molars using one-way ANOVA and Tukey’s test.
 Results: In the buccolingual direction, the buccal plate thickness was maximum in lingual position followed by central position, and minimum in buccal position of the teeth. The lingual plate thickness was minimum in horizontal and distoangular positions and maximum in the mesioangular position of impacted teeth.
 Conclusion: Risk of lingual plate preformation is higher in surgical removal of impacted third molars with distoangular and horizontal positions. Thus, further attention must be paid by the surgeons to such cases.

Assessment of prevalence and position of mandibular incisive canal: A cone beam computed tomography study.

Objectives:To avoid anatomical and functional damage to mandibular interforaminal region during surgeries, it is necessary to detect the existence of mandibular incisive canal (MIC) and its proximity to adjacent structures. This study was aimed to evaluate the prevalence of MIC and its proximity to adjacent structures among Indian population.Materials and Methods:The images of 80 subjects with the age range of 20–60 years who had undergone cone beam computed tomography examination of the mandible were retrieved from the archival records. There was equal distribution of males and females.Results:The prevalence of MIC in the current study sample was found to be 43.89% with a slightly higher prevalence on left side as compared to right side, and higher prevalence among females as compared to males. Among different age groups, there was an increased incidence in the age group of >50 years. The distance of MIC from labial and lingual cortical plates and lower border of mandible were 4.338 ± 1.478 mm, 4.34 ± 1.53 mm and 9.417 ± 1.832 mm respectively.Conclusions:To conclude, the prevalence of MIC among Indian population was lower as compared to the prevalence among other populations. There were variations in prevalence in terms of age, gender and laterality, which could be used as a reference for further studies conducted on larger sample size. Mapping the incisive nerve canal will enable oral radiologists, to plan safely and negotiate the interforaminal region.

Automatic Segmentation of Mandibular Cortical Bone on Cone-Beam CT Images Based on Histogram Thresholding and Polynomial Fitting

Automatic segmentation of mandibular cortical bone is challenging due to the appearance of teeth that have similar intensity with the bone tissue and the variety of bone intensity. In this paper we propose a new method for automatic segmentation of mandibular cortical bone on cone-beam computed tomography (CBCT) images. The bone tissue is segmented by using Gaussian mixture model for histogram thresholding. The mandibular inferior cortical bone is obtained by incorporating several polynomial models to fit the structure of cortical bone on coronal slices. The buccal and lingual cortical plate is separated by using histogram thresholding for teeth elimination and polynomial fitting for shape extraction. After performing 3D reconstruction, the volumetric cortical bone is obtained. The proposed method gives average accuracy, sensitivity, and specificity value of 96.82%, 85.96%, 97.60%, respectively. This shows that the proposed method is promising for automatic and accurate segmentation of mandibular cortical bone on CBCT images.

Guided implant surgery risks and their prevention.

Ideal implant placement may reduce surgical complications, such as nerve injury and lingual cortical plate perforation, and minimize the likelihood of functional and prosthetic compromises. Guided implant surgery (GIS) has been used as the means to achieve ideal implant placement. GIS refers to the process of digital planning, custom-guide fabrication, and implant placement using the custom guide and an implant system-specific guided surgery kit. GIS includes numerous additional steps beyond the initial prosthetic diagnosis, treatment planning, and fabrication of surgical guide. Substantial errors can occur at each of these individual steps and can accumulate, significantly impacting the final accuracy of the process with potentially disastrous deviations from proper implant placement. Pertinent overall strategies to reduce or eliminate these risks can be summarized as follows: complete understanding of the possible risks is fundamental; knowledge of the systems and tools used is essential; consistent verification of both diagnostic and surgical procedures after each step is crucial; proper training and surgical experience are critical. This review article summarizes information on the accuracy and efficacy of GIS, provides insight on the potential risks and problems associated with each procedural step, and offers clinically relevant recommendations to minimize or eliminate these risks.

Difference in the artefacts production and the performance of the metal artefact reduction (MAR) tool between the buccal and lingual cortical plates adjacent to zirconium dental implant.

To quantify the artefacts production and the performance of the metal artefact reduction (MAR) tool, enabled before or after the acquisition, in cortical plates (buccal and lingual) and other regions adjacent to zirconium implants. Cone beam CT scans were acquired using the OP300 Maxio unit before (control group) and after (implant group) the insertion of a zirconium implant into the posterior region of a dry mandible. Three conditions of MAR tool were tested: "without MAR", with "MAR activated after acquisition", and with "MAR activated before acquisition". The standard deviation (SD), contrast-to-noise ratio (CNR) and voxel values were calculated in the buccal and lingual cortical plates, medullary bone and water region, close to the implant. The structural bone analysis was performed in the medullary bone close to the implant. Overall, in control and implant groups, the lingual cortical had higher SD, lower CNR and lower voxel values than the buccal cortical, regardless of the MAR condition (p < 0.05). Implant caused higher SD values and lower voxel values in adjacent regions "without MAR" (p < 0.05). MAR activation decreased SD and changed voxel values when the implant was present, regardless of MAR activation mode (p < 0.05). The activation of MAR increased the trabecular thickness values for the implant group (p < 0.05). The expression of artefacts adjacent to zirconium implants is greater in the lingual than in the buccal cortical. The greater the expression of artefacts in this region, the greater the effectiveness of the MAR tool in homogenizing the grey values, regardless of the time of its activation.

2D and 3D radiographic outcome assessment of the effect of guided tissue regeneration using resorbable collagen membrane in the healing of through-and-through periapical lesions - a randomized controlled trial.

To evaluate the effect of collagen membrane on the healing of through-and-through periapical lesions using 2-dimensional (2D) and 3-dimensional (3D) imaging techniques. Thirty-two patients with periapical radiolucencies measuring at least 10mm and with confirmed loss of buccal and lingual cortical plates were randomly divided into GTR and control groups. Periapical surgery was performed in both groups, using a resorbable collagen membrane in the GTR group only. 2D healing was evaluated according to Molven's criteria, while 3D healing was assessed using modified PENN 3D criteria, RAC indices and the B index, 12months after surgery. Data were analysed using Chi-square, Mann-Whitney and Wilcoxon signed rank tests. Thirty patients were analysed at the 12months follow-up. Both groups had a significant reduction in the size of lesions [92±12% (control) and 86±14% (GTR) in 2D and 85±19% (Control) and 82±13% (GTR) in 3D], with no significant difference between the groups (P>0.05). A total of 29(14 control, 15 GTR) teeth and 26(13 control, 13 GTR) teeth were classified as success according to Molven's (2D) and modified PENN 3D criteria, respectively, with no significant difference in success between 2D and 3D assessments. RAC indices of 3D images revealed the greatest percentage of complete healing in R scores (55% for Control, 41% for GTR), whereas cortical plate had the lowest percentage of healing (30% for Control, 27% for GTR) (P>0.05). Only 2 (13%) patients in each group had complete healing using the B index. Periapical surgery with or without GTR was a predictable and viable solution for through-and-through lesions. There was no benefit in using a collagen membrane with regard to the outcome of periapical surgery in through-and-through lesions. Both cone beam computed tomography (CBCT) and periapical radiographs (PA) allowed similar assessment of healing after periapical surgery.

Analysis of mandibular premolar root position in relation to adjacent cortical plates and mental foramen using cone beam computed tomography in the Saudi population.

Objectives:To evaluate the horizontal and vertical location of the mental foramen (MF), as well as the relationship of lower premolars to buccal and lingual cortical plates using cone beam computed tomography (CBCT).Methods:Retrospective cross-sectional study conducted using CBCT scans that were obtained between early 2014 and late 2016 from King Saud University Dental hospital database in Riyadh, Kingdom of Saudi Arabia; 94 patients (53 males and 41 females) were included. Three examiners independently performed one-sided measurements for each patient. Data analyzed statistically and a p<0.05 was considered significant.Results:The mean distances from the outer boundary of the buccal cortex to the first and second premolars (R1) were 1.55 mm and 1.98 mm. The mean distances from the outer boundary of the lingual cortical plate to the first and second premolars (R2) were 4.06 mm and 4.73 mm. The respective mean total bone thicknesses, including the roots of the first and second premolars (R3), were 9.32 mm and 10.08 mm. The mean distance between the MF and the mandibular second premolar apex was 3.13 mm.Conclusion:Mandibular premolars are in close proximity to MF especially mandibular second premolar. Presurgical assessment is essential when surgical treatment is planned at this area.

An analysis of the first and second mandibular molar roots proximity to the inferior alveolar canal and cortical plates using cone beam computed tomography among the Saudi population

Objectives:To evaluate the relationship of the first and second mandibular molar roots to the inferior alveolar canal (IAC) and cortical plates using cone beam computed tomography (CBCT) in the Saudi population.Methods:Scans of 60 patients were collected retrospectively from the dental hospital database in King Saud University, Riyadh, Kingdom of Saudi Arabia. Measurements of the right and left first and second mandibular molars for each dental root and the mandibular bone thickness were determined. The position of the IAC was estimated using axial, coronal, and sagittal views. Three examiners performed the measurements independently.Results:The mean distance between the root apices of the mandibular molars and the IAC ranged from 1.68-4.79 mm, whereas the mean distance from the outer surface of the buccal cortical plate to the buccal root surface ranged from 2.33-6.72 mm. Similarly, the mean distance from the outer surface of the lingual cortical plate to the lingual root surface ranged from 2.62-4.80 mm. Finally, the mean distance from the outer surface of the lingual cortical plate to the outer surface of the buccal cortical plate was 11.93-13.19 mm.Conclusion:The measurements reported in this study may be of value to practitioners treating Saudi patients, as they need to be familiar with the distance of the mandibular first and second molars in relation to the IAC and surrounding cortical plates to accurately assess and plan endodontic surgeries, surgical extractions, and implant placements.

Thickness of Buccal and Lingual Alveolar Bone Plates according to the Position of Impacted Mandibular Third Molars on Cone-Beam Computed Tomography Scans.

Objectives:This study sought to assess the thickness of buccal and lingual alveolar bone plates according to the position of impacted mandibular third molars on cone-beam computed tomography (CBCT) scans.Materials and Methods:Eighty-four CBCT scans of impacted mandibular third molars were evaluated in this retrospective study. All images had been obtained by ProMax 3D CBCT system with the exposure settings of 78 kVp, 12 mA, 16 s time, 0.2 mm voxel size and 10 × 9 cm field of view. The impaction angle of teeth and the thickness of buccal and lingual cortical plates were determined on images by drawing lines in the anterior, middle, posterior, superior, central and inferior regions. Thickness of bone plates was analyzed according to the position of impacted molars relative to the buccal and lingual plates using the Student t-test and relative to the second molars using one-way ANOVA and Tukey’s test.Results:In the buccolingual direction, the buccal plate thickness was maximum in lingual position followed by central position, and minimum in buccal position of the teeth. The lingual plate thickness was minimum in horizontal and distoangular positions and maximum in the mesioangular position of impacted teeth.Conclusion:Risk of lingual plate preformation is higher in surgical removal of impacted third molars with distoangular and horizontal positions. Thus, further attention must be paid by the surgeons to such cases.

Which impacted mandibular third molar positions or bone morphology shapes can have greater risk of accidental displacement of tooth roots into the sublingual soft tissues?

Aim: We aimed to find out which impacted mandibular third molar (3M) positions or bone morphology types at the 3M site could lead to the potential risk of accidental displacement of 3M root fragments into the sublingual soft tissues. Materials and Methods: The sample consisted of 103 patients with an impacted mandibular 3M (vertical, mesioangular, or horizontal position) seen on at least one side using cone beam computed tomography images. The bone morphology at the 3M sites were classified as round shape, lingual concavity, and lingual extended. The relationship between the roots and the sublingual soft tissues was classified as: 1) type A, in which some amount of bone appears between the root and the soft tissues; 2) type B, in which the root apex is located at the lingual cortical plate; and 3) type C, in which the root apex has penetrated into the soft tissues. Results: Binary logistic regression analysis showed that the odds of lingual extended bone morphology are 2.61 times greater for potential root displacement in combined types B and C, compared to round shape. Conclusion: These results suggest that impacted mandibular 3Ms with the lingual extended morphology type are more likely to cause root fragment displacement into the sublingual soft tissues. Keywords: Third molar; mandible; cone beam computed tomography; iatrogenic displacement; sublingual space.

Risk Factor in Endodontic Treatment: Topographic Evaluation of Mandibular Posterior Teeth and Lingual Cortical Plate Using Cone Beam Computed Tomography (CT).

BackgroundTopographic relationships of mandibular posterior teeth with mandibular cortical plate are extremely important both in terms of infection spread and endodontic and surgical procedures to be performed. The aim of this study was to determine the relationship between root apex of the mandibular posterior teeth and lingual plate of the mandible.Material/MethodsCBCT data of 138 patients were retrospectively analyzed. The topographic relationship between root apex and lingual plate was classified as non-contact, contact, or perforation. Morphology of the mandibular lingual plate was classified into the 4 types (convex, parallel, undercut, slanted) and recorded for each tooth region. The prevalence of each group was calculated.ResultsIn 6.2% of all mandibular posterior teeth, the lingual plate was perforated by at least 1 root of the corresponding tooth. The teeth with the highest perforation rate were the third molar tooth (31.6%) and the second molar tooth (14.7%). The most common mandibular lingual plate morphology type was “undercut type” (61.3%) in the molar teeth region, while “parallel type” (55.7%) was most common in the premolar teeth region.ConclusionsIn conclusion, a high percentage of mandibular second and third molars root apex have topographically close relationships to the lingual plate of the mandible. Hence, endodontic consultants must be aware by this anatomical relationship and be aware of possible complications during endodontic and surgical procedures using radiographical modalities.

Evaluation of Mandibular Incisive Canal using Cone Beam Computed Tomography in Malaysians.

The risk of damaging the mandibular incisive canal (MIC) during surgery in the anterior mandible should not be overlooked. Hence, preoperative radiographic assessment is essential to avoid complications. This study was aimed to estimate the length of the MIC in the interforaminal safe zone, to analyse its course in relation to the lingual and the buccal cortical plates of the mandible using cone beam computed tomography (CBCT) scans and to relate the above findings to age, gender, dental status and Malaysian races. Retrospective analysis of 100 CBCT scans (n = 200) was performed on both sides of the mandible. Cross-sectional and panoramic images were reconstructed. The length of the MIC and the horizontal distances between the MIC and the buccal and the lingual cortical plates were measured at the three different points (starting, mid-, end points). Independent samples t-test and one-way ANOVA test were used to analyse the variation in the length and course of the MIC in gender, age, dental status and Malaysian races. The mean length of the MIC was 11.31 ± 2.65mm, with the Malays having the longest MIC, followed by the Chinese and the Indians (p < 0.05). The MIC deviated towards the lingual cortical plate, with significance seen in the Indian and the male patients (p < 0.05). No significant difference was noticed with respect to patient age and dental status. Assessment of the MIC should be performed using CBCT on a case-by-case basis as it provides essential information during preoperative planning of surgery in the anterior mandible.