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Prevalence, Patterns and Variations of Anterior Loop of Inferior Alveolar Nerve—A CBCT Based Retrospective Study

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Abstract

The fragment of inferior alveolar nerve (IAN) existing anterior to the mental foramen (MF), before dividing the canal, is known as the “Anterior Loop of the IAN”. The presence of anterior loop (AL) is important when placing the implant in inter foraminal area of the mandible or during any other surgical procedure. It is imperative to precisely determine the position and dimensions of these anatomical variations on a cone-beam CT (CBCT) scan. To estimate the prevalence and pattern of anterior loop of IAN and establish any corelation between dimension of the MF with length and angulation of the AL of the IAN. Total 178 CBCT samples were collected fulfilling the inclusion criteria from a private diagnostic centre in Bhubaneswar, Odisha. The greatest diameter of the mental foramen was measured along with anterior loop length and angulation in the panoramic section of the CBCT scan. The angulation formed and the length was corelated with the greatest diameter of the mental foramen and analysed. Our study reveals that the AL was more frequently seen among males, predominantly on the left side of the mandible. The relationship between length of the anterior loop and diameter of the mental foramen demonstrated a mild negative corelation. There was no possible corelation present between angle formed by anterior loop with inferior alveolar canal and diameter of mental foramen. A small positive corelation was established between length of anterior loop and angle formed by the anterior loop with inferior alveolar canal. CBCT scans should be recommended for pre-surgical evaluation of anatomical variations in the mandibular region. Also, a safe margin of 3–4 mm anterior to mental foramen should be maintained while working in the premolar area.

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References

  1. Arai Y, Tammisalo E, Iwai K, Hashimoto K, Shinoda K (1999) Development of a compact computed tomographic apparatus for dental use. Dento Maxillo Facial Radiol 28(4):245–248

    Article  CAS  Google Scholar 

  2. Shaban B, Khajavi A, Khaki N, Mohiti Y, Mehri T, Kermani H (2017) Assessment of the anterior loop of the inferior alveolar nerve via cone-beam computed tomography. J Korean Assoc Oral Maxillofac Surg 43(6):395–400

    Article  Google Scholar 

  3. Makris N, Stamatakis H, Syriopoulos K, Tsiklakis K, Van der Stelt PF (2010) Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone-beam computed tomography. Clin Oral Implants Res 21(7):766–771

    Article  Google Scholar 

  4. Kaya Y, Sencimen M, Sahin S, Okcu KM, Dogan N, Bahcecitapar M (2008) Retrospective radiographic evaluation of the anterior loop of the mental nerve: comparison between panoramic radiography and spiral computerized tomography. Int J Oral Maxillofac Implants 23:919–925

    Google Scholar 

  5. Bavitz JB, Harn SD, Hansen CA, Lang M (1993) An anatomical study of mental neurovascular bundle - implant relationship. Int J Oral Maxillofac Implants 8:563–567

    CAS  Google Scholar 

  6. Misch CE (1999) Root form surgery in the edentulous mandible: Stage I implant insertion. In: Misch CE (ed) Implant Dentistry, 2nd edn. The CV Mosby Company, St. Louis, pp 347–370

    Google Scholar 

  7. Solar P, Ulm C, Frey G, Matejka M (1994) A classification of the intraosseous paths of the mental nerve. Int J Oral Maxillofac Implant 9:339–344

    Google Scholar 

  8. Roshene R, Jayanth KV (2019) Radiological study on the anterior loop of inferior alveolar nerve. Indian J Public Health Res Develop 10(11):595–599

    Article  Google Scholar 

  9. Apostolakis D, Brown JE (2012) The anterior loop of the inferior alveolar nerve: Prevalence, measurement of its length and a recommendation for interforaminal implant installation based on cone beam CT imaging. Clin Oral Implants Res 23:1022–1030

    Article  Google Scholar 

  10. Greenstein G, Tarnow D (2006) The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol 77:1933–1943

    Article  Google Scholar 

  11. Mraiwa N, Jacobs R, Moerman P, Lambrichts I, van Steenberghe D, Quirynen M (2003) Presence and course of the incisive canal in the human mandibular interforaminal region: two-dimensional imaging versus anatomical observations. Surg Radiol Anat 25:416–423

    Article  CAS  Google Scholar 

  12. Jacobs R, Mraiwa N, Van Steenberghe D, Sanderink G, Quirynen M (2004) Appearance of the mandibular incisive canal on panoramic radiographs. Surg Radiol Anat 26:329–333

    Article  CAS  Google Scholar 

  13. Ngeow WC, Dionysius DD, Ishak H, Nambiar P (2009) A radiographic study on the visualization of the anterior loop in dentate subjects of different age groups. J Oral Sci 51:231–237

    Article  Google Scholar 

  14. do Nascimento EHL, dos AnjosPontual ML, dos AnjosPontual A, da Cruz Perez DE, Figueiroa JN, Marco Antônio Gomes-Frazao MA, et al (2016) Assessment of the anterior loop of the mandibular canal: a study using cone-beam computed tomography. Imaging Sci Dent 46:69–75

    Article  Google Scholar 

  15. Vujanovic-Eskenazi A, Valero-James J-M, Sanchez-Garces M-A, Gay- EC (2015) A retrospective radiographic evaluation of the anterior loop of the mental nerve: comparison between panoramic radiography and cone beam computerized tomography. Medicina Oral, Patologıa Oral y Cirugıa Bucal 20:239–245

    Article  Google Scholar 

  16. Zitzmann NU, Margolin MD, Filippi A, Weiger R, Krastl G (2008) Patient assessment and diagnosis in implant treatment. Aust Dent J. 53(1):3–10

    Article  Google Scholar 

  17. Vazquez L, Saulacic N, Belser U, Bernard JP (2008) 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 19:81–85

    Google Scholar 

  18. Parnia F, Moslehifard E, Hafezeqoran A, Mahboub F, Mojaver-Kahnamoui H (2012) Characteristics of anatomical landmarks in the mandibular interforaminal region: a cone-beam computed tomography study. Med Oral Patol Oral Cir Bucal 17(3):420–425

    Article  Google Scholar 

  19. Chen Z, Chen D, Tang L, Wang F (2015) Relationship between the position of the mental foramen and the anterior loop of the inferior alveolar nerve as determined by cone beam computed tomography combined with mimics. J Comput Assist Tomogr 39:86–93

    Article  Google Scholar 

  20. Lu CI, Won J, Al-Ardah A, Santana R, Rice D, Lozada J (2015) Assessment of the anterior loop of the mental nerve using cone beam computerized tomography scan. J Oral Implantol 41:632–639

    Article  Google Scholar 

  21. Rosenquist B (1996) Is there an anterior loop of the inferior alveolar nerve? Int J Periodontics Restorative Dent 16:40–45

    CAS  Google Scholar 

  22. Cohen J (1988) Set correlation and contingency tables. Appl Psychol Meas 12(4):425–434

    Article  Google Scholar 

  23. Kalpidis CD, Setayesh RM (2004) Hemorrhaging associated with endosseous implant placement in the anterior mandible: a review of the literature. J Periodontol 75(5):631–645

    Article  Google Scholar 

  24. Uchida Y, Yamashita Y, Goto M, Hanihara T (2007) 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. J Oral Maxillofac Surg 65:1772–1779

    Article  Google Scholar 

  25. Uchida Y, Noguchi N, Goto M, Yamashita Y, Hanihara T, Takamori H, Sato I, Kawai T, Yosue T (2009) 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 67:744–750

    Article  Google Scholar 

  26. Arzouman MJ, Otis L, Kipnis V, Levine D (1993) Observations of the anterior loop of the inferior alveolar canal. Int J Oral Maxillofac Implants 8(3):295–300

    CAS  Google Scholar 

  27. Yonchak T, Reader A, Beck M, Meyers WJ (2001) Anaesthetic efficacy of unilateral and bilateral inferior alveolar nerve blocks to determine cross innervation in anterior teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92(2):132–135

    Article  CAS  Google Scholar 

  28. Velasco-Torres M, Padial-Molina M, Avila-Ortiz G, García-Delgado R, Catena A, Galindo-Moreno P (2017) Inferior alveolar nerve trajectory, mental foramen location and incidence of mental nerve anterior loop. Med Oral Patol Oral Cir Bucal 22(5):630–635

    Google Scholar 

  29. Rosa MB, Sotto-Maior BS, Machado Vde C, Francischone CE (2003) Retrospective study of the anterior loop of the inferior alveolar nerve and the incisive canal using cone beam computed tomography. Int J Oral Maxillofac Implants 28:388–392

    Article  Google Scholar 

  30. de Oliveira-Santos C, Souza PH, de Azambuja B-C, Stinkens L, Moyaert K, Rubira-Bullen IR et al (2012) Assessment of variations of the mandibular canal through cone beam computed tomography. Clin Oral Investig 16(2):387–393

    Article  Google Scholar 

  31. Neiva RF, Gapski R, Wang HL (2004) Morphometric analysis of implant-related anatomy in Caucasian skulls. J Periodontol 75(8):1061–1067

    Article  Google Scholar 

  32. Panjnoush M, Rabiee ZS, Kheirandish Y (2016) Assessment of location and anatomical characteristics of mental foramen, anterior loop and mandibular incisive canal using cone beam computed tomography. J Dent (Tehran) 13(2):126–132

    Google Scholar 

  33. Al-Mahalawy H, Al-Aithan H, Al-Kari B, Al-Jandan B, Shujaat S (2017) Determination of the position of mental foramen and frequency of anterior loop in Saudi population. A retrospective CBCT study. Saudi Dent J 29(1):29–35

    Article  CAS  Google Scholar 

  34. Alfaleh WM (2020) Location of the mental foramen using volumetrically rendered CBCT images. J Pak Dent Assoc 29(1):19–23

    Article  Google Scholar 

  35. Shalash M, Khallaf ME, Ali AR (2020) Position and dimensions of the mental foramen and presence of the anterior loop in the Egyptian population: a retrospective CBCT study. Bull Natl Res Cent 44(1):110. https://doi.org/10.1186/s42269-020-00364-2

    Article  Google Scholar 

  36. Khojastepour L, Mirbeigi S, Mirhadi S, Safaee A (2015) Location of mental foramen in a selected iranian population: A CBCT assessment. Iran Endod J 10(2):117–121

    Google Scholar 

  37. Sinha S, Kandula S, Sangamesh NC, Rout P, Mishra S, Bajoria AA (2019) Assessment of the anterior loop of the mandibular canal using cone-beam computed tomography in Eastern India: a record-based study. J Int Soc Prev Community Dent 9(3):290–295

    Article  Google Scholar 

  38. Von Arx T, Friedli M, Sendi P, Lozanoff S, Bornstein MM (2013) Location and dimensions of the mental foramen: a radiographic analysis by using cone-beam computed tomography. J Endod 39(12):1522–1528

    Article  Google Scholar 

  39. Chappidi V, Swapna LA, Dheeraj V, Nikitha GR, Kanakagiri M (2019) Evaluation of morphometric variations in mental foramen and prevalence of anterior loop in South Indian population – A CBCT study. J Indian Acad Oral Med Radiol 31:134–139

    Article  Google Scholar 

  40. Kieser J, Kuzmanovic D, Payne A, Dennison J, Herbison P (2002) Patterns of emergence of the human mental nerve. Arch Oral Biol 47:743–747

    Article  Google Scholar 

  41. Sahman H, Sisman Y (2016) Anterior loop of the inferior alveolar canal: a cone-beam computerized tomography study of 494 cases. J Oral Implantol 42(4):333–336

    Article  Google Scholar 

  42. Kheir MK, Sheikhi M (2017) Assessment of the anterior loop of mental nerve in an Iranian population using cone beam computed tomography scan. Dent Res J 14:418–422

    Article  Google Scholar 

  43. Siddiqui Z, Rai S, Ranjan V (2018) Efficacy and evaluation of cone beam computed tomography in determining the prevalence and length of anterior loop of inferior alveolar nerve in North Indian population. J Indian Acad Oral Med Radiol 30:32–37

    Article  Google Scholar 

  44. Alok A, Singh S, Bhattacharya PT, Kishore M, Piyush K, Shukla AK (2019) A radiographic study on the visualization of the anterior loop in Darbhanga population. Int J Contemp Med Res 6(5):11–14

    Google Scholar 

  45. Kastala RK, David CM, Jayapal N (2017) Momentousness of the mental loop: a comparative study. Contemp Clin Dent 10:86–92

    Article  Google Scholar 

  46. Moghddam MR, Davoudmanesh Z, Azizi N, Rakhshan V, Shariati M (2017) Prevalence and length of the anterior loop of the inferior alveolar nerve in Iranians. J Oral Implantol 43(5):333–336

    Article  Google Scholar 

  47. Prakash O, Srivastava PK, Jyoti B, Mushtaq R, Vyas T, Usha P (2018) Radiographic evaluation of anterior loop of inferior alveolar nerve: a cone-beam computer tomography study. Niger J Surg 24:90–94

    Article  Google Scholar 

  48. Demir A, Izgi E, Pekiner FN (2015) Anterior loop of the mental foramen in a Turkish subpopulation with dentate patients: a cone beam computed tomography study. J Marmara Univ Inst Health Sci 5:231–238

    Google Scholar 

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Authors and Affiliations

  1. Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India

    Suvranita Jena, Rajat Panigrahi & Abhishek Ranjan Pati

  2. Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

    Shamimul Hasan

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  1. Suvranita Jena
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Jena, S., Panigrahi, R., Pati, A.R. et al. Prevalence, Patterns and Variations of Anterior Loop of Inferior Alveolar Nerve—A CBCT Based Retrospective Study. Indian J Otolaryngol Head Neck Surg 74 (Suppl 3), 5424–5431 (2022). https://doi.org/10.1007/s12070-021-02691-w

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