Identification of the mandibular vital structures: practical clinical applications of anatomy and radiological examination methods

Gintaras Juodzbalys, Hom-Lay Wang, Gintaras Juodzbalys, Hom-Lay Wang

Abstract

Objectives: The purpose of this article was to review the current available clinical techniques and to recommend the most appropriate imaging modalities for the identification of mandibular vital structures when planning for oral implants.

Material and methods: The literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, mandibular incisive canal, mental foramen, anterior loop of the mental nerve, radiography, dental implants. The search was restricted to English language articles, published from January 1976 to January 2010.

Results: In total 111 literature sources were obtained and reviewed. The peculiarities of the clinical anatomy of mandibular canal, mandibular incisive canal, mental foramen and anterior loop of mental nerve were discussed. Radiological diagnostic methods currently available for the identification of the mandibular vital structures when planning for oral implants were presented. Guidelines for the identification of the mandibular vital structures in dental implantology were made.

Conclusions: The proposed guideline provides clinicians a tool in proper identifying the important mandibular vital structures thus minimizing the potential complications during implant surgery.

Keywords: chin; cross-sectional anatomy; dental implants.; inferior alveolar nerve; mandible; radiography.

Figures

Figure 1
Figure 1
A = mandible is divided into edentulous jaw segments that consists of alveolar and basal bone for planned implant bed. B = the vertical dimension (H) of the planned implant is determined by the distance between the alveolar ridge crest and mental foramen. C = the vertical dimension (H) of the planned implant is determined by the distance between the alveolar crestal ridge and mandibular canal. The horizontal EJS dimensions: length (L) in all cases is determined by the distance between neighbouring teeth or implants and width (W) is determined by the alveolar process width measured at the level of 3 mm (W1) and 6 mm (W2) from the crest of alveolar ridge.
Figure 2
Figure 2
A = Thin crestal ridge was reduced to create wide recipient bed for planned implant installation. In such cases, the heights of EJS would have been shortened by 1 to 3 mm at least. B and C = another implant treatment option: crestal ridge preservation and dental implant surgical placement with subsequent alveolar process augmentation.
Figure 3
Figure 3
Asymmetry or reshape of the crestal bone influences the height (H1 and H2) of bone, apparently available for the implant accommodation above the canal (C), as it was seen on the panoramic film.
Figure 4
Figure 4
The position of mandibular canal (C1 and C2) in horizontal plane influences the apparent height (H1 and H2) of bone available for implant accommodation.
Figure 5
Figure 5
The orthopantomograph shows the disrupted (arrows) superior border of mandibular canal and cancellous bone which has few and thin trabecullae.
Figure 6A
Figure 6A
Computed tomographic images: mental foramen (arrow) detection.
Figure 6B
Figure 6B
Computed tomographic images: mandibular canal detection (arrow).

References

    1. Givol N, Taicher S, Halamish-Shani T, Chaushu G. Risk management aspects of implant dentistry. Int J Oral Maxillofac Implants. 2002 Mar-Apr;17(2):258-62.
    1. Kalpidis CD, Setayesh RM. Hemorrhaging associated with endosseous implant placement in the anterior mandible: a review of the literature. J Periodontol. 2004 May;75(5):631-45.
    1. Abarca M, van Steenberghe D, Malevez C, De Ridder J, Jacobs R. Neurosensory disturbances after immediate loading of implants in the anterior mandible: an initial questionnaire approach followed by a psychophysical assessment. Clin Oral Investig. 2006 Dec;10(4):269-77.
    1. Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol. 2006 Dec;77(12):1933-43.
    1. Monsour PA, Dudhia R. Implant radiography and radiology. Aust Dent J. 2008 Jun;53 Suppl 1:S11-25.
    1. Greenstein G, Cavallaro J, Romanos G, Tarnow D. Clinical recommendations for avoiding and managing surgical complications associated with implant dentistry: a review. J Periodontol. 2008 Aug;79(8):1317-29.
    1. Juodzbalys G, Wang HL, Sabalys G. Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in relation with Dental Implantology. J Oral Maxillofac Res 2010;1(1):e2. URL: .
    1. Juodzbalys G, Wang HL, Sabalys G. Part II: Mandibular Incisive Canal, Mental Foramen and Associated Neurovascular Bundles in Relation with Dental Implantology. J Oral Maxillofac Res 2010;1(1):e3 URL: .
    1. Garg AK, Vicari A. Radiographic modalities for diagnosis and treatment planning in implant dentistry. Implant Soc. 1995;5(5):7-11.
    1. Harris D, Buser D, Dula K, Grondahl K, Haris D, Jacobs R, Lekholm U, Nakielny R, van Steenberghe D, van der Stelt P. European Association for Osseointegration. E.A.O. guidelines fo the use of diagnostic imaging in implant dentistry. A consensus workshop organized by the European Association for Osseointegration in Trinity College Dublin. Clin Oral Implants Res. 2002 Oct;13(5):566-70.
    1. Schropp L, Wenzel A, Kostopoulos L. Impact of conventional tomography on prediction of the appropriate implant size. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Oct;92(4):458-63.
    1. White SC, Heslop EW, Hollender LG, Mosier KM, Ruprecht A, Shrout MK. American Academy of Oral and Maxillofacial Radiology, ad hoc Committee on Parameters of Care. Parameters of radiologic care: An official report of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 May;91(5):498-511.
    1. Pharoah MJ. Imaging techniques and their clinical significance. Int J Prosthodont. 1993 Mar-Apr;6(2):176-9.
    1. BouSerhal C, Jacobs R, Quirynen M, van Steenberghe D. Imaging technique selection for the preoperative planning of oral implants: a review of the literature. Clin Implant Dent Relat Res. 2002;4(3):156-72.
    1. Almog DM, Romano PR. CT-based dental imaging for implant planning and surgical guidance. N Y State Dent J. 2007 Jan;73(1):51-3.
    1. Vazquez L, Saulacic N, Belser U, Bernard JP. Efficacy of panoramic radiographs in the preoperative planning of posterior mandibular implants: a prospective clinical study of 1527 consecutively treated patients. Clin Oral Implants Res. 2008 Jan;19(1):81-5. Epub 2007 Oct 22.
    1. Lascala CA, Panella J, Marques MM. Analysis of the accuracy of linear measurements obtained by cone beam computed tomography (CBCT-NewTom). Dentomaxillofac Radiol. 2004 Sep;33(5):291-4.
    1. Sato S, Arai Y, Shinoda K, Ito K. Clinical application of a new cone-beam computerized tomography system to assess multiple two-dimensional images for the preoperative treatment planning of maxillary implants: case reports. Quintessence Int. 2004 Jul-Aug;35(7):525-8.
    1. Almog DM, LaMar J, LaMar FR, LaMar F. Cone beam computerized tomography-based dental imaging for implant planning and surgical guidance, Part 1: Single implant in the mandibular molar region. J Oral Implantol. 2006;32(2):77-81.
    1. Garg AK. Dental implant imaging: TeraRecon's Dental 3D Cone Beam Computed Tomography System. Dent Implantol Update. 2007 Jun;18(6):41-5.
    1. Periago DR, Scarfe WC, Moshiri M, Scheetz JP, Silveira AM, Farman AG. Linear accuracy and reliability of cone beam CT derived 3-dimensional images constructed using an orthodontic volumetric rendering program. Angle Orthod. 2008 May;78(3):387-95.
    1. Liang X, Jacobs R, Hassan B, Li L, Pauwels R, Corpas L, Souza PC, Martens W, Shahbazian M, Alonso A, Lambrichts I. A comparative evaluation of Cone Beam Computed Tomography (CBCT) and Multi-Slice CT (MSCT): Part I. On subjective image quality. Eur J Radiol. 2009 Apr 30. [Epub ahead of print]
    1. Liang X, Lambrichts I, Sun Y, Denis K, Hassan B, Li L, Pauwels R, Jacobs R. A comparative evaluation of Cone Beam Computed Tomography (CBCT) and Multi-Slice CT (MSCT). Part II: On 3D model accuracy. Eur J Radiol. 2009 May 5. [Epub ahead of print]
    1. Juodzbalys G, Raustia AM. Accuracy of clinical and radiological classification of the jawbone anatomy for implantation--a survey of 374 patients. J Oral Implantol. 2004;30(1):30-9.
    1. Tammisalo T, Happonen RP, Tammisalo EH. Stereographic assessment of mandibular canal in relation to the roots of impacted lower third molar using multiprojection narrow beam radiography. Int J Oral Maxillofac Surg. 1992 Apr;21(2):85-9.
    1. Anderson LC, Kosinski TF, Mentag PJ. A review of the intraosseous course of the nerves of the mandible. J Oral Implantol. 1991;17(4):394-403.
    1. Nortjé CJ, Farman AG, Grotepass FW. Variations in the normal anatomy of the inferior dental (mandibular) canal: a retrospective study of panoramic radiographs from 3612 routine dental patients. Br J Oral Surg. 1977 Jul;15(1):55-63.
    1. Miller CS, Nummikoski PV, Barnett DA, Langlais RP. Cross-sectional tomography. A diagnostic technique for determining the buccolingual relationship of impacted mandibular third molars and the inferior alveolar neurovascular bundle. Oral Surg Oral Med Oral Pathol. 1990 Dec;70(6):791-7.
    1. Obradović O, Todorovic L, Vitanovic V. Anatomical considerations relevant to implant procedures in the mandible. Bull Group Int Rech Sci Stomatol Odontol. 1995 Jan-Feb;38(1-2):39-44.
    1. Davis H. Mobilization of the Alveolar Nerve to Allow Placement of Osseointegratible Fixtures. In: Advanced Osseointegration Surgery: Application in the Maxillofacial Region. Chicago: Quintessence Publishing Co.: 2000. p. 129–41.
    1. Levine MH, Goddard AL, Dodson TB. Inferior alveolar nerve canal position: a clinical and radiographic study. J Oral Maxillofac Surg. 2007 Mar;65(3):470-4.
    1. Worthington P. Injury to the inferior alveolar nerve during implant placement: a formula for protection of the patient and clinician. Int J Oral Maxillofac Implants. 2004 Sep-Oct;19(5):731-4.
    1. Wyatt WM. Accessory mandibular canal: literature review and presentation of an additional variant. Quintessence Int. 1996 Feb;27(2):111-3.
    1. Kim IS, Kim SG, Kim YK, Kim JD. Position of the mental foramen in a Korean population: a clinical and radiographic study. Implant Dent. 2006 Dec;15(4):404-11.
    1. Rueda S, Gil JA, Pichery R, Alcañiz M. Automatic segmentation of jaw tissues in CT using active appearance models and semi-automatic landmarking. Med Image Comput Comput Assist Interv. 2006;9(Pt 1):167-74.
    1. Naitoh M, Hirukawa A, Katsumata A, Ariji E. Evaluation of voxel values in mandibular cancellous bone: relationship between cone-beam computed tomography and multislice helical computed tomography. Clin Oral Implants Res. 2009 May;20(5):503-6.
    1. van der Stelt PF. Filmless imaging: the uses of digital radiography in dental practice. J Am Dent Assoc 2005;136(10):1379–87.
    1. Denio D, Torabinejad M, Bakland LK. Anatomical relationship of the mandibular canal to its surrounding structures in mature mandibles. J Endod. 1992 Apr;18(4):161-5.
    1. Misch CE. Diagnostic imaging techniques. In: Misch CE, editor. Contemporary Implant Dentistry, 3nd ed. St Louis: CV Mosby Company; 2008. p. 38-67.
    1. Wadu SG, Penhall B, Townsend GC. Morphological variability of the human inferior alveolar nerve. Clin Anat. 1997;10(2):82-7.
    1. Gijbels F, De Meyer AM, Bou Serhal C, Van den Bossche C, Declerck J, Persoons M, Jacobs R. The subjective image quality of direct digital and conventional panoramic radiography. Clin Oral Investig. 2000 Sep;4(3):162-7.
    1. Lindh C, Petersson A, Klinge B. Measurements of distances related to the mandibular canal in radiographs. Clin Oral Implants Res. 1995 Jun;6(2):96-103.
    1. Klinge B, Petersson A, Maly P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computed tomography. Int J Oral Maxillofac Implants. 1989 Winter;4(4):327-32.
    1. Misch CE. Bone density: A key determinant for clinical success. In: Misch CE, editor. Contemporary Implant Dentistry, 2nd ed. St Louis: CV Mosby Company; 1999. p. 109-18.
    1. Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res. 2001 Feb;12(1):79-84.
    1. Naitoh M, Kurosu Y, Inagaki K, Katsumata A, Noguchi T, Ariji E. Assessment of mandibular buccal and lingual cortical bones in postmenopausal women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Oct;104(4):545-50.
    1. Naitoh M, Katsumata A, Hiraiwa Y, Aimiya H, Ohsaki C, Ariji E. Can mandibular depiction be improved by changing the thickness of double-oblique computed tomography images? Implant Dent. 2008 Sep;17(3):271-7.
    1. Peker I, Alkurt MT, Michcioglu T. The use of 3 different imaging methods for the localization of the mandibular canal in dental implant planning. Int J Oral Maxillofac Implants. 2008 May-Jun;23(3):463-70.
    1. Rouas P, Nancy J, Bar D. Identification of double mandibular canals: literature review and three case reports with CT scans and cone beam CT. Dentomaxillofac Radiol. 2007 Jan;36(1):34-8.
    1. Claeys V, Wackens G. Bifid mandibular canal: literature review and case report. Dentomaxillofac Radiol. 2005 Jan;34(1):55-8.
    1. Grover PS, Lorton L. Bifid mandibular nerve as a possible cause of inadequate anesthesia in the mandible. J Oral Maxillofac Surg. 1983 Mar;41(3):177-9.
    1. Langlais RP, Broadus R, Glass BJ. Bifid mandibular canals in panoramic radiographs. J Am Dent Assoc. 1985 Jun;110(6):923-6.
    1. Sanchis JM, Peñarrocha M, Soler F. Bifid mandibular canal. J Oral Maxillofac Surg. 2003 Apr;61(4):422-4.
    1. Naitoh M, Hiraiwa Y, Aimiya H, Ariji E. Observation of bifid mandibular canal using cone-beam computerized tomography. Int J Oral Maxillofac Implants. 2009 Jan-Feb;24(1):155-9.
    1. Angelopoulos C, Thomas SL, Hechler S, Parissis N, Hlavacek M. Comparison between digital panoramic radiography and cone-beam computed tomography for the identification of the mandibular canal as part of presurgical dental implant assessment. J Oral Maxillofac Surg. 2008 Oct;66(10):2130-5.
    1. Kamburoğlu K, Kiliç C, Ozen T, Yüksel SP. Measurements of mandibular canal region obtained by cone-beam computed tomography: a cadaveric study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Feb;107(2):e34-42.
    1. Neiva RF, Gapski R, Wang HL. Morphometric analysis of implant-related anatomy in Caucasian skulls. J Periodontol. 2004 Aug;75(8):1061-7.
    1. Apinhasmit W, Chompoopong S, Methathrathip D, Sansuk R, Phetphunphiphat W. Supraorbital Notch/Foramen, Infraorbital Foramen and Mental Foramen in Thais: anthropometric measurements and surgical relevance. J Med Assoc Thai. 2006 May;89(5):675-82.
    1. Gershenson A, Nathan H, Luchansky E. Mental foramen and mental nerve: changes with age. Acta Anat (Basel). 1986;126(1):21-8.
    1. Yosue T, Brooks SL. The appearance of mental foramina on panoramic radiographs. I. Evaluation of patients. Oral Surg Oral Med Oral Pathol. 1989 Sep;68(3):360-4.
    1. Mbajiorgu EF, Mawera G, Asala SA, Zivanovic S. Position of the mental foramen in adult black Zimbabwean mandibles: a clinical anatomical study. Cent Afr J Med. 1998 Feb;44(2):24-30.
    1. Igbigbi PS, Lebona S. The position and dimensions of the mental foramen in adult Malawian mandibles. West Afr J Med. 2005 Jul-Sep;24(3):184-9.
    1. Fabian FM. Position, shape and direction of opening of the mental foramen in dry mandibles of Tanzanian adult black males. Ital J Anat Embryol. 2007 Jul-Sep;112(3):169-77.
    1. Al-Khateeb T, Al-Hadi Hamasha A, Ababneh KT. Position of the mental foramen in a northern regional Jordanian population. Surg Radiol Anat. 2007 Apr;29(3):231-7.
    1. Green RM. The position of the mental foramen: a comparison between the southern (Hong Kong) Chinese and other ethnic and racial groups. Oral Surg Oral Med Oral Pathol. 1987 Mar;63(3):287-90.
    1. Fishel D, Buchner A, Hershkowith A, Kaffe I. Roentgenologic study of the mental foramen. Oral Surg Oral Med Oral Pathol. 1976 May;41(5):682-6.
    1. Wang TM, Shih C, Liu JC, Kuo KJ. A clinical and anatomical study of the location of the mental foramen in adult Chinese mandibles. Acta Anat (Basel). 1986;126(1):29-33.
    1. Shankland WE 2nd. The position of the mental foramen in Asian Indians. J Oral Implantol. 1994;20(2):118-23.
    1. al Jasser NM, Nwoku AL. Radiographic study of the mental foramen in a selected Saudi population. Dentomaxillofac Radiol. 1998 Nov;27(6):341-3.
    1. Ngeow WC, Yuzawati Y. The location of the mental foramen in a selected Malay population. J Oral Sci. 2003 Sep;45(3):171-5.
    1. Mraiwa N, Jacobs R, Moerman P, Lambrichts I, van Steenberghe D, Quirynen M. Presence and course of the incisive canal in the human mandibular interforaminal region: two-dimensional imaging versus anatomical observations. Surg Radiol Anat. 2003 Nov-Dec;25(5-6):416-23.
    1. Cranin AN. Implant surgery: the management of soft tissues. J Oral Implantol. 2002;28(5):230-7.
    1. Solar P, Frey G, Ulm C, Gruber H, Matejka M. A Classification of the intraosseous paths of the mental nerve. Int. J. oral max. Fac. Implant. 1994;9(3): 339-44.
    1. Kieser J, Kuzmanovic D, Payne A, Dennison J, Herbison P. Patterns of emergence of the human mental nerve. Arch Oral Biol. 2002 Oct;47(10):743-7.
    1. Sawyer DR, Kiely ML, Pyle MA. The frequency of accessory mental foramina in four ethnic groups. Arch Oral Biol. 1998 May;43(5):417-20.
    1. Katakami K, Mishima A, Shiozaki K, Shimoda S, Hamada Y, Kobayashi K. Characteristics of accessory mental foramina observed on limited cone-beam computed tomography images. J Endod. 2008 Dec;34(12):1441-5.
    1. Naitoh M, Hiraiwa Y, Aimiya H, Gotoh K, Ariji E. Accessory mental foramen assessment using cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Feb;107(2):289-94.
    1. Morrison A, Chiarot M, Kirby S. Mental nerve function after inferior alveolar nerve transposition for placement of dental implants. J Can Dent Assoc. 2002 Jan;68(1):46-50.
    1. Babbush CA. Transpositioning and repositioning the inferior alveolar and mental nerves in conjunction with endosteal implant reconstruction. Periodontol 2000. 1998 Jun;17:183-90.
    1. Hori M, Sato T, Kaneko K, Okaue M, Matsumoto M, Sato H, Tanaka H. Neurosensory function and implant survival rate following implant placement with nerve transpositioning: a case study. J Oral Sci. 2001 Jun;43(2):139-44.
    1. Nocini PF, De Santis D, Fracasso E, Zanette G. Clinical and electrophysiological assessment of inferior alveolar nerve function after lateral nerve transposition. Clin Oral Implants Res. 1999 Apr;10(2):120-30.
    1. Ellies LG, Smiler DG, Quadland MW, Babbush CA, Krogh PH, Shepherd NJ. Inferior alveolar nerve repositioning: is there cause for concern? Dent Implantol Update. 1995 May;6(5):37-9.
    1. Phillips JL, Weller RN, Kulild JC. The mental foramen: 1. Size, orientation, and positional relationship to the mandibular second premolar. J Endod. 1990 May;16(5):221-3.
    1. Moiseiwitsch JR. Avoiding the mental foramen during periapical surgery. J Endod. 1995 Jun;21(6):340-2.
    1. Jacobs R, Mraiwa N, Van Steenberghe D, Sanderink G, Quirynen M. Appearance of the mandibular incisive canal on panoramic radiographs. Surg Radiol Anat. 2004 Aug;26(4):329-33.
    1. Sonick M, Abrahams J, Faiella RA. A comparison of the accuracy of periapical, panoramic, and computerized tomographic radiographs in locating the mandibular canal. Int J Oral Maxillofac Implants 1994;9:455-460.
    1. Lindh C, Petersson A. Radiologic examination for location of the mandibular canal: a comparison between panoramic radiography and conventional tomography. Int J Oral Maxillofac Implants. 1989 Fall;4(3):249-53.
    1. Bou Serhal C, Jacobs R, Flygare L, Quirynen M, van Steenberghe D. Perioperative validation of localization of the mental foramen. Dentomaxillofac Radiol 2002;31:39-43.
    1. Ekestubbe A, Gröndahl K, Gröndahl HG. The use of tomography for dental implant planning. Dentomaxillofac Radiol. 1997 Jul;26(4):206-13.
    1. Sakakura CE, Morais JA, Loffredo LC, Scaf G. A survey of radiographic prescription in dental implant assessment. Dentomaxillofac Radiol. 2003 Nov;32(6):397-400.
    1. Loubele M, Guerrero ME, Jacobs R, Suetens P, van Steenberghe D. A comparison of jaw dimensional and quality assessments of bone characteristics with cone-beam CT, spiral tomography, and multi-slice spiral CT. Int J Oral Maxillofac Implants. 2007 May-Jun;22(3):446-54.
    1. Arai Y, Tammisalo E, Iwai K, Hashimoto K, Shinoda K. Development of a compact computed tomographic apparatus for dental use. Dentomaxillofac Radiol. 1999 Jul;28(4):245-8.
    1. Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8(9):1558-64.
    1. Jalbout Z, Tabourian G. Glossary of Implant Dentistry. Upper Montclair, NJ: International Congress of Oral Implantologists; 2004:16.
    1. Arzouman MJ, Otis L, Kipnis V, Levine D. Observations of the anterior loop of the inferior alveolar canal. Int J Oral Maxillofac Implants. 1993;8(3):295-300.
    1. Bavitz JB, Harn SD, Hansen CA, Lang M. An anatomical study of mental neurovascular bundle-implant relationships. Int J Oral Maxillofac Implants. 1993;8(5):563-7.
    1. Misch CE. Root form surgery in the edentulous mandible: Stage I implant insertion. In: Misch CE, editors. Implant Dentistry, 2nd ed. St. Louis: The CV Mosby Company; 1999. p. 347-70.
    1. Kuzmanovic DV, Payne AG, Kieser JA, Dias GJ. Anterior loop of the mental nerve: a morphological and radiographic study. Clin Oral Implants Res. 2003 Aug;14(4):464-71.
    1. Rosenquist B. Is there an anterior loop of the inferior alveolar nerve? Int J Periodontics Restorative Dent. 1996 Feb;16(1):40-5.
    1. Mardinger O, Chaushu G, Arensburg B, Taicher S, Kaffe I. Anterior loop of the mental canal: an anatomical-radiologic study. Implant Dent. 2000;9(2):120-5.
    1. Misch CE, Crawford EA. Predictable mandibular nerve location - a clinical zone of safety. Int J Oral Implantol. 1990;7(1):37-40.
    1. Jacobs R, Mraiwa N, vanSteenberghe D, Gijbels F, Quirynen M. Appearance, location, course,and morphology of the mandibular incisive canal: an assessment on spiral CT scan. Dentomaxillofac Radiol. 2002 Sep;31(5):322-7.
    1. Rothman SLG. Dental Applications of Computerized Tomography. Chicago: Quintessence; 1998:42-45.
    1. Uchida Y, Noguchi N, Goto M, Yamashita Y, Hanihara T, Takamori H, Sato I, Kawai T, Yosue T. Measurement of anterior loop length for the mandibular canal and diameter of the mandibular incisive canal to avoid nerve damage when installing endosseous implants in the interforaminal region: a second attempt introducing cone beam computed tomography. J Oral Maxillofac Surg. 2009 Apr;67(4):744-50.
    1. Obradovic O, Todorovic L, Pesic V, Pejkovic B, Vitanovic V. Morphometric analysis of mandibular canal: clinical aspects. Bull Group Int Rech Sci Stomatol Odontol. 1993 Jul-Sep;36(3-4):109-13.
    1. De Andrade E, Otomo-Corgel J, Pucher J, Ranganath KA, St George N Jr. The intraosseous course of the mandibular incisive nerve in the mandibular symphysis. Int J Periodontics Restorative Dent. 2001 Dec;21(6):591-7.
    1. Romanos GE, Greenstein G. The incisive canal. Considerations during implant placement: case report and literature review. Int J Oral Maxillofac Implants. 2009 Jul-Aug;24(4):740-5.
    1. Kohavi D, Bar-Ziv J. Atypical incisive nerve: clinical report. Implant Dent. 1996 Winter;5(4):281-3.
    1. Wismeijer D, van Waas MA, Vermeeren JI, Kalk W. Patients' perception of sensory disturbances of the mental nerve before and after implant surgery: a prospective study of 110 patients. Br J Oral Maxillofac Surg. 1997 Aug;35(4):254-9.
    1. Pires CA, Bissada NF, Becker JJ, Kanawati A, Landers MA. Mandibular Incisive Canal: Cone Beam Computed Tomography. Clin Implant Dent Relat Res. 2009 Aug 6. [Epub ahead of print]
    1. Tyndall DA, Brooks SL. Selection criteria for dental implant site imaging: a position paper of the American Academy of Oral and Maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 May;89(5):630-7.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa