Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of bifid and trifid mandibular canals with unusual patterns of nerve branching using cone beam computed tomography

  • Original Article
  • Published:
Odontology Aims and scope Submit manuscript

Abstract

Lack of knowledge concerning the inferior alveolar canal anatomical variations had proven to increase the incidence of surgical complications, so the study aimed to assess the configuration and prevalence of bifid and trifid mandibular canals using cone beam CT in Egyptian subpopulation. Cone beam CT scans of 278 patients (530 hemi-mandibles) were included in the study, in which bifid and trifid mandibular canals or any other branching patterns were recorded and evaluated. Bifid canals were categorized following Naitoh classification, and the diameter of the main mandibular and accessory canals was measured. Bifid canals were detected in 181 canals (34%) while trifid canals in 46 canals (8.7%). Upon classifying the bifid canals, 78 canals showed forward type, 40 retromolar type, 33 dental type, and 7 canals showed buccolingual type. Two special bifid canals subtypes were reported in 23 canals and nine distinct patterns of trifid canals were reported in our study. In addition, unusual patterns of canal branching were reported in 5 cases. The mean diameter of the accessory canals was 1.18 ± .54 mm and the main canal was 3.98 ± 1.31 mm. This study reported a high prevalence (54%) of canal branching, which reinforces the importance of cone beam CT in pre-surgical planning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and materials

Not applicable.

Code availability

Not applicable.

References

  1. Wamasing P, Deepho C, Watanabe H, Hayashi Y, Sakamoto J, Kurabayashi T. Imaging the bifid mandibular canal using high resolution MRI. Dentomaxillofac Radiol. 2019;48(3):20180305.

    Article  Google Scholar 

  2. Lee SK, Kim YS, Oh HS, Yang KH, Kim EC, Chi JG. Prenatal development of the human mandible. Anat Rec. 2001;263(3):314–25.

    Article  Google Scholar 

  3. Chávez-Lomeli M, Mansilla Lory J, Pompa J, Kjaer I. The human mandibular canal arises from three separate canals innervating different tooth groups. J Dent Res. 1996;75(8):1540–4.

    Article  Google Scholar 

  4. Juodzbalys G, Wang H-L, Sabalys G. Injury of the inferior alveolar nerve during implant placement: a literature review. J Oral Maxillofac Res. 2011;2(1): e1.

    Article  Google Scholar 

  5. Linares C, Mohindra A, Evans M. Haemorrhage following coronectomy of an impacted third molar associated with a bifid mandibular canal: a case report and review of the literature. Oral Surg. 2016;9:248–51. https://doi.org/10.1111/ors.12206.

    Article  Google Scholar 

  6. Malamed SF. Handbook of local anaesthesia, chapter 14, techniques of mandibular anaesthesia. N. Delhi: Elsevier Publishers; 2007.

    Google Scholar 

  7. Kumar JS, Ganapathy D, Visalakshi R. Awareness of incidence and management of nerve injuries during implant treatment. Drug Inven Today. 2019;12(5):1032.

    Google Scholar 

  8. Auluck A, Pai KM, Shetty C. Pseudo bifid mandibular canal. Dentomaxillofac Radiol. 2005;34(6):387–8.

    Article  Google Scholar 

  9. Muinelo-Lorenzo J, Suárez-Quintanilla J, Fernández-Alonso A, Marsillas-Rascado S, Suárez-Cunqueiro M. Descriptive study of the bifid mandibular canals and retromolar foramina: cone beam CT vs panoramic radiography. Dentomaxillofac Radiol. 2014;43(5):20140090.

    Article  Google Scholar 

  10. de Castro MAA, Barra SG, Vich MOL, Abreu MHG, Mesquita RA. Mandibular canal branching assessed with cone beam computed tomography. Radiol Med (Torino). 2018;123(8):601–8.

    Article  Google Scholar 

  11. Fu E, Peng M, Chiang CY, Tu HP, Lin YS, Shen EC. Bifid mandibular canals and the factors associated with their presence: a medical computed tomography evaluation in a Taiwanese population. Clin Oral Implants Res. 2014;25(2):e64–7.

    Article  Google Scholar 

  12. Auluck A, Pai KM, Mupparapu M. Multiple mandibular nerve canals: radiographic observations and clinical relevance. Report of 6 cases. Quintessence Int. 2007;38(9):781–7.

    PubMed  Google Scholar 

  13. Mizbah K, Gerlach N, Maal T, Bergé S, Meijer GJ. The clinical relevance of bifid and trifid mandibular canals. Oral Maxillofac Surg. 2012;16(1):147–51.

    Article  Google Scholar 

  14. Reda R, Zanza A, Mazzoni A, Cicconetti A, Testarelli L, Di Nardo D. An update of the possible applications of magnetic resonance imaging (MRI) in dentistry: a literature review. J Imaging. 2021;7(5):75.

    Article  Google Scholar 

  15. Rashsuren O, Choi J-W, Han W-J, Kim E-K. Assessment of bifid and trifid mandibular canals using cone-beam computed tomography. Imaging Sci Dent. 2014;44(3):229–36.

    Article  Google Scholar 

  16. Ngeow WC, Chai WL. The clinical anatomy of accessory mandibular canal in dentistry. Clin Anat. 2020;33(8):1214–27.

    Article  Google Scholar 

  17. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121.

    Article  Google Scholar 

  18. Field A. Discovering statistics using IBM SPSS statistics. London: Sage; 2013.

    Google Scholar 

  19. Naitoh M, Hiraiwa Y, Aimiya H, Ariji E. Observation of bifid mandibular canal using cone-beam computerized tomography. Int J Oral Maxillofac Implants. 2009;24(1):155–9.

    PubMed  Google Scholar 

  20. Kuribayashi A, Watanabe H, Imaizumi A, Tantanapornkul W, Katakami K, Kurabayashi T. Bifid mandibular canals: cone beam computed tomography evaluation. Dentomaxillofac Radiol. 2010;39(4):235–9.

    Article  Google Scholar 

  21. Lew K, Townsend G. Failure to obtain adequate anaesthesia associated with a bifid mandibular canal: a case report. Aust Dent J. 2006;51(1):86–90.

    Article  Google Scholar 

  22. Orhan K, Aksoy S, Bilecenoglu B, Sakul BU, Paksoy CS. Evaluation of bifid mandibular canals with cone-beam computed tomography in a Turkish adult population: a retrospective study. Surg Radiol Anat. 2011;33(6):501–7.

    Article  Google Scholar 

  23. de Oliveira-Santos C, Souza PHC, de Azambuja B-C, Stinkens L, Moyaert K, Rubira-Bullen IRF, et al. Assessment of variations of the mandibular canal through cone beam computed tomography. Clin Oral Invest. 2012;16(2):387–93.

    Article  Google Scholar 

  24. Badry MSM, El-Badawy FM, Hamed WM. Incidence of retromolar canal in Egyptian population using CBCT: a retrospective study. Egypt J Radiol Nucl Med. 2020;51:1–8.

    Article  Google Scholar 

  25. Yang X, Lyu C, Zou D. Bifid mandibular canals incidence and anatomical variations in the population of Shanghai area by cone beam computed tomography. J Comput Assist Tomogr. 2017;41(4):535–40.

    Article  Google Scholar 

  26. Villaça-Carvalho MFL, Manhães LRC, de Moraes MEL, de Castro Lopes SLP. Prevalence of bifid mandibular canals by cone beam computed tomography. Oral Maxillofac Surg. 2016;20(3):289–94.

    Article  Google Scholar 

  27. Naitoh M, Nakahara K, Suenaga Y, Gotoh K, Kondo S, Ariji E. Comparison between cone-beam and multislice computed tomography depicting mandibular neurovascular canal structures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):e25–31.

    Article  Google Scholar 

  28. Okumuş Ö, Dumlu A. Prevalence of bifid mandibular canal according to gender, type and side. J Dent Sci. 2019;14(2):126–33.

    Article  Google Scholar 

  29. Zhang Y-Q, Zhao Y-N, Liu D-G, Meng Y, Ma X-C. Bifid variations of the mandibular canal: cone beam computed tomography evaluation of 1000 Northern Chinese patients. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;126(5):e271–8.

    Article  Google Scholar 

  30. Von Arx T, Hänni A, Sendi P, Buser D, Bornstein MM. Radiographic study of the mandibular retromolar canal: an anatomic structure with clinical importance. J Endod. 2011;37(12):1630–5.

    Article  Google Scholar 

  31. Filo K, Schneider T, Kruse AL, Locher M, Grätz KW, Lübbers H-T. Frequency and anatomy of the retromolar canal-implications for the dental practice. Swiss Dent J. 2015;125(3):278–92.

    PubMed  Google Scholar 

  32. de Castro MAA, Vich MOL, Abreu MHG, Mesquita RA, De Castro M, Vich M, et al. Cross-sectional study of mandibular canal branching in regions affected by dental inflammation with cone beam computed tomography. Int J Odontostomatol. 2019;13:142–9.

    Article  Google Scholar 

  33. Kang J-H, Lee K-S, Oh M-G, Choi H-Y, Lee S-R, Oh S-H, et al. The incidence and configuration of the bifid mandibular canal in Koreans by using cone-beam computed tomography. Imaging Sci Dent. 2014;44(1):53–60.

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Oral Medicine, Periodontology, Oral Diagnosis and Oral radiology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt

    Esraa Anwer Elnadoury, Yousria Salah El-Din Gaweesh & Souzy Kamal Anwar

  2. Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain-Shams University, Cairo, Egypt

    Shaimaa Mohamed Abu El Sadat

Authors
  1. Esraa Anwer Elnadoury
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yousria Salah El-Din Gaweesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shaimaa Mohamed Abu El Sadat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Souzy Kamal Anwar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

E. E.: data collection and examination (first radiologist), data analysis, and manuscript writing. G. Y.: project development, supervision of the work, and manuscript editing. A. S.: data examination (second radiologist), manuscript editing, and supervision of the work. K. S.: data analysis, manuscript editing, and supervision of the work.

Corresponding author

Correspondence to Esraa Anwer Elnadoury.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Ethical approval was granted by the local Ethics Committee of University in Alexandria university (IRB NO: 00010556-IORG0008839) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

All work was done in the Oral Radiology Department Faculty of Dentistry, Alexandria University, Egypt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elnadoury, E.A., Gaweesh, Y.SD., Abu El Sadat , S.M. et al. Prevalence of bifid and trifid mandibular canals with unusual patterns of nerve branching using cone beam computed tomography. Odontology 110, 203–211 (2022). https://doi.org/10.1007/s10266-021-00638-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10266-021-00638-9

Keywords

Search

Navigation