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Evaluation of Mandibular Lingual Foramina Related to Dental Implant Treatment with Computerized Tomography: a Multicenter Clinical Study

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Evaluation of Mandibular Lingual Foramina Related to Dental Implant Treatment with Computerized Tomography: a Multicenter Clinical Study IMPLANT DENTISTRY / V OLUME 23, NUMBER 1 2014 57 Evaluation of Mandibular Lingual Foramina Related to Dental Implant Treatment With Computerized Tomography: A Multicenter Clinical Study Yagmur D. Yildirim, DDS, PhD,* Güliz N. Güncü, DDS, PhD, † Pablo Galindo-Moreno, DDS, PhD,‡ Miguel Velasco-Torres, DDS, PhD,§ Gintaras Juodzbalys, DDS, PhD, k Marius Kubilius, DDS,¶ Albinas Gervickas, DDS, PhD,# Khalid Al-Hezaimi, DDS, MS,** Ra ’ed Al-Sadhan, DDS, MS, †† Hasan Güney Yilmaz, DDS, PhD, ‡‡ Neset Volkan Asar, DDS, PhD,§§ Erdem Karabulut, PhD, kk Hom-Lay Wang, DDS, MS, PhD,¶¶ and Tolga F. Tözüm, DDS, PhD## ental implant placement is Background: Bleeding can be larger measurements. The mean a routine and predictable tech- one of the severe complications diameter of lingual foramina was D nique for the replacement of during implant placement or other 0.89 6 0.40 mm; 76.8% canal type missing teeth. Interforaminal region surgeries. Presurgical assessment was mono; 51.8% patients presented is a good choice for the implant place- fi of the area should be performed with median lingual canal-foramen ment to support xed partial dentures precisely. Thus, we examined lin- (MLC) and 21.1% with lateral lin- or overdentures. Symphysis is one of the autologous donor graft area in the gual vascular canals of the mandi- gual foramen. Diameter of MLC ble using dental computerized was statistically larger. tomography (CT); de fine the ana- Conclusions: With a large sam- *Clinical Instructor, Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey. tomical characteristics of canals ple group, results represented that †Associate Professor, Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey. and the relationship with mandibu- lingual foramina could be visual- ‡Associate Professor, Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain. lar bone. ized with dental CT, providing use- §Assistant Professor, Department of Oral Radiology, University of Granada, Granada, Spain. Methods: One thousand sixty- ful data for mandibular implant kProfessor, Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. ¶Research Investigator, Department of Maxillofacial Surgery, one foramina in 639 patients, in 5 surgeries. Findings suggest that Lithuanian University of Health Sciences, Kaunas, Lithuania. #Assistant Professor, Department of Maxillofacial Surgery, dental clinics, were included in this vascular canals and several anas- Lithuanian University of Health Sciences, Kaunas, Lithuania. **Associate Professor and Engineer Abdullah Bugshan multicenter study. Distance between tomoses exist in the anterior man- Research Chair for Growth Factors and Bone Regeneration, Department of Periodontics, College of Dentistry, King Saud crest and lingual foramen, tooth dible extending through premolar University, Riyadh, Saudi Arabia. †† Associate Professor, Department of Oral Medicine and apex and lingual foramen, distance and molar regions as well. It is Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. from mandibular border, diameter of imperative to consider these vessels ‡‡ Associate Professor, Department of Periodontology, Faculty of Dentistry, Near East University, Mersin 10, Turkey. lingual foramen, canal type, anasto- with the dental CT before and §§Clinical Instructor, Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey. mosis, and location of foramen were during the mandibular surgery to kk Associate Professor, Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey. examined. prevent threatening hemorrhage. ¶¶Professor and Director, Department of Periodontics and Oral Medicine, School of Dentistry, The University of Michigan, Ann Results: Foramen was 18.33 6 (Implant Dent 2014;23:57 –63) Arbor, MI. ##Professor, Department of Periodontology, Faculty of 5.45 mm below the bony crest and Key Words: dental implant, man- Dentistry, Hacettepe University, Ankara, Turkey. 17.40 6 7.52 mm from the mandib- dibula, anatomy, tomography, Reprint requests and correspondence to: Tolga F. ular border, with men showing humans, surgery Tözüm, DDS, PhD, Department of Periodontology, Faculty of Dentistry, Hacettepe University, 3rd Floor, Sihhiye, Ankara 06100, Turkey, Phone: +90-312-305- 2237, Fax: +90-312-310 4440, E-mail: [email protected] oral cavity in need of excessive ridge including the sublingual gland, mylo- ISSN 1056-6163/14/02301-057 1,2 Implant Dentistry augmentations. Submental branch of hyoid, geniohyoid and genioglossus Volume 23 Number 1 Copyright © 2014 by Lippincott Williams & Wilkins the facial artery and sublingual branch muscles, mucous membranes of the 3,4 DOI: 10.1097/ID.0000000000000012 of the lingual artery supplies this area, mouth floor, and the lingual gingiva. 58 EVALUATION OF MANDIBULAR LINGUAL FORAMINA CANALS YILDIRIM ET AL Fig. 1. Dimensional measurements on axial Fig. 3. Arrows: A, LLC, B, anastomosis between lingual and inferior alveolar artery. mandibular CT sections. A, Distance between crest and lingual foramen. B, Distance between tooth apex and lingual foramen. C, region of the internal mandible. 7 between 0.3 and 1.1 mm (mean, 0.6 6 Vertical distance from the mandibular border Although interforaminal region is a rela- 0.2 mm). 34 Katakami et al 18 reported the to the lingual foramen. Arrow: diameter of lin- tively safe area to place implants, per- presence of arterial in the molar area and gual foramen. foration of the lingual cortex while measured a mean diameter of 0.88 6 placing dental implants can cause 0.2 mm. Position of the foramen was re- The submental artery supplies the severe hemorrhage. 8–17 Additionally portedtobe7.06mmfromtheborderofthe lymph nodes of the submandibular tri- with the arterial wound, if drilling rup- mandible. 18 Someauthorsclassi fiedthelin- angle, the anterior belly of the digas- tures lingual periosteum, damage to gual foramina of the mandible as median tric muscle, and the mylohyoid anatomical structures in the sublingual lingual canal-foramen (MLC) and lateral muscle. 3,5 Important arterial anastomo- space may enhance the bleeding, result- lingual canal-foramen (LLC). 5,21,34,35 ses are formed between sublingual and ing in the hematoma of the floor of the LLC diameters were found slightly submental arteries and between sublin- mouth. 8 Besides the interforaminal lower than the midline values. 5,6,22 gual and incisive arteries through mul- region, the presence of lingual foramen After tooth extraction, bone loss is tiple accessory lingual foramina. 6 in molar area has been reported as primarily horizontal from the labial side. Mental artery, the branch of the inferior well. 18 Severe hemorrhage was reported This resorption pattern results in a lin- alveolar artery, was found to communi- during drilling in molar and premolar gually angulated trajectory of mandible. cate with sublingual artery in the mental areas. 19,20 If atrophic inclined mandible is not Lingual vascular canals of the man- considered well before implant place- dible have been investigated anatomi- ment, risk of lingual perforations may cally or by means of computerized increase. Moreover, there is an existing tomography (CT). 21 –35 Cadaver studies osseous concavity, sublingual fossa, ex- depicted that both submental and sublin- tending to the first premolar region. gual arteries perforate into the mandible Dental CT is a well-known and fre- through lingual foramen/foramina. 4,30 quentlyused imaging technique todepict Longoni et al 34 examined the interfora- bony architecture and surrounding ana- minal area in 100 CTs of the Caucasian tomical structures. It is a valuable tool for patients. They reported 61% vascular ca- ridge mapping and diagnosis of pathol- nals ranging in entrance diameters ogies of the jaws, teeth, and maxillofacial Table 1. Descriptive Statistics Women Men P Total Distance between crest 17.64 6 5.27 19.30 6 5.57 0.000* 18.33 6 5.45 and artery mm Vertical distance from 16.98 6 8.35 17.97 6 6.15 0.034* 17.40 6 7.52 mandibular border mm Distance between tooth 9.44 6 4.32 10.94 6 4.33 0.000* 10.06 6 4.38 apex and artery mm Vertical size (diameter) of 0.87 6 0.42 0.91 6 0.37 0.086 0.89 6 0.40 foramen mm Fig. 2. Bi fid lingual canal in the anterior One thousand sixty-one lingual foramen on axial mandibular CT sections were examined for the following measurements in Table 1. mandible. Statistically signi ficant differences between men and women were detected in all parameters, except vertical size of the foramen. *P , 0.05. IMPLANT DENTISTRY / V OLUME 23, NUMBER 1 2014 59 Table 2. Vertical Size (Diameter) of Foramen Men Women Total #1 mm .1 mm #1 mm .1 mm #1 mm .1 mm n%n%n%n%n%n% Cyprus 23 27.1 62 72.9 23 26.4 64 73.6 46 26.7 126 73.3 Saudi Arabia 25 59.5 17 40.5 44 91.7 4 8.3 69 76.7 21 23.3 Spain 162 91.5 15 8.5 209 91.3 20 8.7 371 91.4 35 8.6 Lithuania 29 61.7 18 38.3 61 67 30 33 90 65.2 48 34.8 Turkey 85 88.5 11 11.5 141 88.7 18 11.3 226 88.6 29 11.4 Total 324 72.5 123 27.5 478 77.9 136 22.1 802 75.6 259 24.4 The distribution of diameters in 5 different countries was shown in this table. The diameter of foramina was classi fied as #1 and .1 mm to determine the risk of severe hemorrhage. Of the 1061 foramina, 75.6% were #1 mm and 24.4% were .1 mm. Table 3. Artery Type According to investigator (Y.D.Y., H.G.Y., M.V.-T., is detected, the mean measurements Gender R.A.-S., and G.J.) at each center per- were calculated and recorded as 1 mea- formed all the measurements. Spiral surement. Occurrence of lingual fora- Mono Bi fid Triple (Siemens AR-SP 40; Siemens, Munich, men on both the sides of mandible was (%) (%) (%) Germany) and cone-beam CT scans noted as bilateral, if not, unilateral.
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