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      Assessment of bifid and trifid mandibular canals using cone-beam computed tomography

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          Abstract

          Purpose

          To investigate the prevalence of bifid and trifid mandibular canals using cone-beam computed tomography (CBCT) images, and to measure their length, diameter, and angle.

          Materials and Methods

          CBCT images of 500 patients, involving 755 hemi-mandibles, were used for this study. The presence and type of bifid mandibular canal was evaluated according to a modified classification of Naitoh et al. Prevalence rates were determined according to age group, gender, and type. Further, their diameter, length, and angles were measured using PACSPLUS Viewer and ImageJ 1.46r. Statistical analysis with chi-squared and analysis of variance (ANOVA) tests was performed.

          Results

          Bifid and trifid mandibular canals were found in 22.6% of the 500 patients and 16.2% of the 755 sides. There was no significant difference between genders and among age groups. The retromolar canal type accounted for 71.3% of the identified canals; the dental canal type, 18.8%; the forward canal type, 4.1%; and the trifid canal type, 5.8%. Interestingly, seven cases of the trifid canal type, which has been rarely reported, were observed. The mean diameter of the bifid and trifid mandibular canals was 2.2 mm and that of the main mandibular canal was 4.3 mm. Their mean length was 16.9 mm; the mean superior angle was 149.2°, and the mean inferior angle was 37.7°.

          Conclusion

          Bifid and trifid mandibular canals in the Korean population were observed at a relatively high rate through a CBCT evaluation, and the most common type was the retromolar canal. CBCT is suggested for a detailed evaluation of bifid and trifid mandibular canals before mandibular surgery.

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          Most cited references21

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          Assessment of variations of the mandibular canal through cone beam computed tomography.

          The neurovascular bundle may be vulnerable during surgical procedures involving the mandible, especially when anatomical variations are present. Increased demand of implant surgeries, wider availability of three-dimensional exams, and lack of clear definitions in the literature indicate that features of anatomical variations should be revisited. The objective of the study was to evaluate features of anatomical variations related to mandibular canal (MC), such as bifid canals, anterior loop of mental nerve, and corticalization of MC. Additionally, bone trabeculation at the submandibular gland fossa region (SGF) was assessed and related to visibility of MC. Cone beam computed tomography exams from 100 patients (200 hemimandibles) were analyzed and the following parameters were registered: diameter and corticalization of MC; trabeculation in SGF region; presence of bifid MC, position of bifurcations, diameter, and direction of bifid canals; and measurement of anterior loops by two methods. Corticalization of the MC was observed in 59% of hemimandibles. In 23%, MC could be identified despite absence of corticalization. Diameter of MC was between 2.1 and 4 mm for nearly three quarters of the sample. In 80% of the sample trabeculation at the SGF was either decreased or not visible, and such cases showed correlation with absence of MC corticalization. Bifid MC affected 19% of the patients, mostly associated with additional mental foramina. Clinically significant anterior loop (>2 mm of anterior extension) was observed in 22-28%, depending on the method. Our findings, together with previously reported limitations of conventional exams, draw attention to the unpredictability related to anatomical variations in neurovascularization, showing the contribution of individual assessment through different views of three-dimensional imaging prior to surgical procedures in the mandible.
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            Evaluation of bifid mandibular canals with cone-beam computed tomography in a Turkish adult population: a retrospective study.

            Knowing the anatomic location and also variations of the mandibular canal is especially important for surgical procedures on mandible such as dental implant surgery, impacted molar extraction and sagittal split ramus osteotomy. The purpose of this study was to clarify the incidence and location of bifid mandibular canals in an adult Turkish population to avoid complications during surgical procedures. A retrospective study using cone beam CT images was performed to evaluate bifid mandibular canal in mandible of 242 patients. Both right and left sides were studied (n = 484). Axial, sagittal, cross-sectional and panoramic images were evaluated, and three-dimensional (3D) images were also reconstructed and evaluated, as necessary. The course and length of bifid mandibular canals and the superior and inferior angles between canals were measured. Bifid mandibular canals were observed in 225 (46.5%) of 484 sides examined. The most frequently encountered type of bifid canal was the forward canal (29.80%), followed by the retromolar (28.10%) the buccolingual (14.50%) and the dental canal type (8.30%). Mean lengths of bifid canals were 13.6 mm in the right side and 14.1 mm in the left side. Mean superior angles were 139° on the right and 141° on the left side, whereas mean inferior angles were 38° on the right side and 32° on the left side. No statistically significant differences were found in the lengths or angles between the right and left sides and also for gender (p < 0.05). This study, which utilized CBCT images, uncovered a higher prevalence of bifid mandibular canals than what has been reported in previous studies using conventional radiography techniques.
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              The intramandibular course of the inferior alveolar nerve.

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                Author and article information

                Journal
                Imaging Sci Dent
                Imaging Sci Dent
                ISD
                Imaging Science in Dentistry
                Korean Academy of Oral and Maxillofacial Radiology
                2233-7822
                2233-7830
                September 2014
                17 September 2014
                : 44
                : 3
                : 229-236
                Affiliations
                [1 ]Department of Oral and Maxillofacial Radiology, School of Dentistry, Mongolian National University Medical Science, Ulaanbaatar, Mongolia.
                [2 ]Department of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, Cheonan, Korea.
                Author notes
                Correspondence to: Prof. Eun-Kyung Kim. Department of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Korea. Tel) 82-41-550-1924, Fax) 82-41-556-7127, ekkim@ 123456dankook.ac.kr
                Article
                10.5624/isd.2014.44.3.229
                4182358
                25279344
                f57dd40e-af2b-46fc-91de-52c01db68131
                Copyright © 2014 by Korean Academy of Oral and Maxillofacial Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 April 2014
                : 01 May 2014
                : 04 May 2014
                Funding
                Funded by: National Research Foundation of Korea
                Award ID: NRF-2010-0012131
                Categories
                Original Article

                Dentistry
                mandibular nerve,cone-beam computed tomography,anatomic variation
                Dentistry
                mandibular nerve, cone-beam computed tomography, anatomic variation

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