Dişli Hasta Grubundan Oluşan Türk Subpopülasyonunda Konik Işınlı Bilgisayarlı Tomografi ile Mental Foramende Anterior Loop Değerlendirmesi

Amaç: Bu retrospektif çalışmanın amacı mental foramende anterior lup varlığının Türk subpopülasyonundaki sıklığını ve tiplerini konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirmektir. Yöntemler: Çalışmada 20-69 yaşları arasında 138 kadın, 141 erkek olmak üzere 279 dişli hasta değerlendirilmiştir. Mandibular kanalın mental foramende sonlanma şekli 3 tip olarak sınıflandırılmıştır. Buna göre Tip 1; mental dalın inferior alveolar siniri mental foramenin posteriorunda kalacak şekilde terk etmesi olarak tanımlanmıştır. Tip 2; mental dalın inferior alveolar siniri mental foramene dik olacak şekilde terk etmesi olarak tanımlanmıştır. Tip 3; mental dalın inferior alveolar siniri mental foramenin anteriorunda kalacak şekilde terk etmesi olarak tanımlanmıştır. Tip 1 ve 2 de anterior lup varlığından bahsedilmezken Tip 3’ ün anterior lup varlığını gösterdiği belirtilmiştir. Bulgular: Tip 3, Tip2 ve Tip1 sonlanma şekillerinin dağılımı sırasıyla %59.5, %31.9 ve %8.6 olarak belirlenmiştir. Aynı hastada sağ ve sol tarafta aynı anda Tip 1, Tip 2 ya da Tip 3 sonlanma şekli dağılımları ise sırasıyla %1.8, %17.2 ve %45.5 olarak bulunmuştur. Sağ ve sol tarafta kadınlar ve erkekler arasında istatistiksel olarak anlamlı bir farklılık tespit edilmemiştir. Sonuç: KIBT; mental sinirin inferior alveolar sinirden ayrılıp mental foramene ulaşmak için izlediği yolu üç-boyutlu olarak değerlendirmek için güvenle kullanılabilir. Foramenler arası bölgeyi ilgilendiren bir çok cerrahi operasyon öncesinde, mental foramenin meziyalinde mental sinir dalına ait olası bir lup varlığı kolaylıkla tanımlanabilir.

Anahtar Kelimeler:

Konik ışınlı bilgisayarlı tomografi, mandibular kanal, inferior alveoler sinir, mental foramen, anterior lup

Anterior Loop of the Mental foramen in a Turkish Subpopulation with Dentate Patients: a Cone Beam Computed Tomography Study

Objective: The aim of this retrospective study was to evaluate the frequency and types of the mental foramen’s anterior loop in a Turkish subpopulation on cone-beam computed tomography (CBCT).Methods: 279 dentate patients (138 females, 141 males, age range 20- 69 years) were evaluated for both side of mandible. Type 1 was described as the mental branch leaved the inferior alveolar nerve posterior to the opening of the mental foramen. Type 2 was described as the mental branch leaved the inferior alveolar nerve perpendicular to the opening of the mental foramen. Type 3 was described as the mental branch leaved the inferior alveolar nerve anterior to the mental foramen. It was assumed that there was no loop in type 1 and 2. Type 3 indicated the presence of anterior loop.Results: The distribution of type 3, type 2 and type 1 were noted 59.5%, 31.9% and 8.6% respectively. If the type was same on both sides distribution of type 1, type 2 and type 3 were noted 1.8%, 17.2% and 45.5% respectively. There was no statistically significant difference on the left side and right side between males and females.Conclusions: CBCT can be used safely to observe three-dimensionally the track of mental nerve from the inferior alveolar nerve to the mental foramen. Thus the divergence of mental nerve can be evaluated if there is a loop mesially from the mental foramen for various surgical operations involving interforaminal area.

Keywords:

Cone beam computed tomography, mandibular canal, inferior alveolar nerve, mental foramen, anterior loop,

PDF

___

1. Ngeow WC, Dionysius DD, Ishak H, Nambiar P. A radiographic study on the visualization of the anterior loop in dentate subjects of different age groups. J Oral Sci. 2009; 2: 231-237.
2. Chen JCH, Lin LM, Geist JR, Chen JY, Chen CH, Chen YK. A retrospective comparison of the location and diameter of the inferior alveolar canal at the mental foramen and length of the anterior loop between American and Taiwanese cohorts using CBCT. Surg Radiol Anat. 2013; 35: 11-18.
3. Parnia F, Moslehifard E, Hafezeqoran A, Mahboub F, Mojaver- Kahnamoui H. Characteristic of anatomical landmarks in the mandibular interforaminal region: A cone-beam computed tomography study. Med Oral Pathol Oral Cir Bucal. 2012; 17: e420-425.
4. Kajan ZD, Salari A. Presence and course of the mandibular incisive canal and presence of the anterior loop in cone-beam computed tomography images of an Iranian population. Oral Radiol. 2012; 28: 55-61.
5. 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; 107: 289-294.
6. 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 Raiol Anat. 2003; 25: 416-423.
7. Bavitz JB, Harn SD, Hansen CA, Lang M. An anatomical study of mental neurovascular bundle – implant relationship. Int J Oral Maxillofac Implants. 1993; 8: 563-567.
8. Misch CE, Crawford EA. Predictable mandibular nerve location. A clinical zone of safety. Int J Oral Implantol. 1990; 7: 37-40.
9. Kuzmanovic DV, Payne AGT, Kieser JA, Dias GJ. Anterior loop of the mental nerve: a morphological and radiographic study. Clin Oral Implants Res. 2003; 14: 464-471. 10. Chavez-Lomeli ME, Lori JM, Pompa JA, Kjaer I. The human mandibular canal arises from three separate canals innervating different tooth groups. J Dent Res. 1996; 75: 1540-1544.
11. de Villiers H. A Biometrical and Morphological Study. In: The skull of the South African Negro. 1st ed. Johannesburg: Witwatersrand University Press; 1968.
12. Haktanır A, Ilgaz K, Turhan-Haktanır N. Evaluation of mental foramina in adult living crania with MDCT. Surg Radiol Anat. 2010;32:351-356. 13. Arzouman MJ, Otis L, Kipnis V, Levine D. Observations of the anterior loop of the inferior alveolar canal. Int J Oral Maxillofac Implants. 1993;8:295-300.
14. Misch CE. Root form surgery in the edentulous mandible: stage 1 implant insertion. In: Misch CE, ed. Implant Dentistry. 2nd ed. St Louis, Mo: CV Mosby Co. 1999; p: 347-370.
15. Wismeijer D, van Waas MAJ, Vermeeren JIJF, 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; 35: 254-259.
16. Hirsch JM, Branemark PI. Fixture stability and nerve function after transposition and lateralization of the inferior alveolar nerve and fixture installation. Br J Oral Maxillofac Surg. 1995; 33: 276-281.
17. Kohavi D, Bar-Ziv J. A typical incisive nerve: clinical report. Imp Dent. 1996; 5: 281-283. 18. Benninger B, Miller D, Maharathi A, Carter W. Dental implant placemen investigation: is the anterior loop of the mental nerve clinically relevant? J Oral Maxillofac Surg. 2011; 69: 182-185.
19. Kieser J, Kuzmanovic D, Payne A, Dennison J, Herbison P. Patterns of emergence of the human mental nerve. Arch Oral Biol. 2002; 47: 743- 747.
20. Neiva RF, Gapski R, Wang HL. Morphometric analysis of implant-related anatomy in Caucasian skulls. J Periodontol. 2004; 75: 1061- 1067.
21. Polland KE, Munro S, Reford G, Lockhart A, Logan G, Brocklebank L. The mandibular canal of the edentulous jaw. Clin Anat. 2001; 14: 445- 452.
22. Yosue T, Brooks SL. The appearance of mental foramina on panoramic radiographs. I. Evaluation of patients. Oral Surg Oral Med Oral Pathol. 1989; 68: 360-364. 23. Solar P, Ulm C, Frey G, Matejka M. A classification of the intraosseous paths of the mental nerve. Int J Oral Maxillofac Implants. 1994; 9: 339- 344. 24. Mardinger O, Chaushu G, Arensburg B, Taicher S, Kaffe I. Anterior loop of the mental canal: an anatomical radiologic study. Imp Dent. 2000; 9: 120-125. 25. Jacobs R, Mraiwa N, van Steenberghe D, Sanderink G, Quirynen M. Appearance of the mandibular incisive canal on panoramic radiographs. Surg Radiol Anat. 2004; 26: 329-333.
26. Yosue T, Brooks SL. The appearance of mental foramina on panoramic radiographs. II. Experimental evaluation. Oral Surg Oral Med Oral Pathol. 1989; 68: 488-492.
27. Vujanovic-Eskenazi A, Valero-James JM, Sánchez-Garcés MA, Gay- Escoda C. A retrospective radiographic evaluation of the anterior loop of the mental nerve: comparison between panoramic radiography and cone beam computerized tomography. Med Oral Patol Oral Cir Bucal. 2015; 20(2): e239-245.
28. Kaya Y, Sencimen M, Sahin S, Okcu KM, Dogan N, Bahcecitapar M. Retrospective radiographic evaluation of the anterior loop of the mental nerve: comparison between panoramic radiography and spiral computerized tomography. Int J Oral Maxillofac Implants. 2008; 23: 919-925.
29. Rosenquist B. Is there an anterior loop of the inferior alveolar nerve? Int J Periodontics Restorative Dent. 1996; 16: 41-45. 30. Yu SK, Kim S, Kang SG, Kim JH, Lim KO, Hwang SI, Kim HJ. Morphological assessment of the anterior loop of the mandibular canal in Koreans. Anat Cell Biol. 2015; 48(1): 75-80. 31. Uchida Y, Noguchi N, Goto M, Yamashita Y, Hanihara T, Takamori H et al. 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; 67: 744-750. 32. Oğuz O, Bozkır MG. Evaluation of location of mandibular and mental foramina in dry, young, adult human male, dentulous mandibles. West Indian Med. 2002; 51: 14-16. 33. Rosa MB, Sotto-Maior BS, Machado VC, Francischone CE. 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. 2013; 28(2): 388-392. 34. Apostolakis D, Brown JE. The dimensions of the mandibular incisive canal and its spatial relationship to various anatomical landmarks of the mandible: a study using cone beam computed tomography. Int J Oral Maxillofac Implants. 2013; 28(1): 117-124.