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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 31  |  Issue : 1  |  Page : 17-23

Comparison between conventional radiograph and 3D volumetric radiograph for determining the morphology and morphometry of mental foramen


1 Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Sciences and Research (Deemed to be University), Haryana, India
2 Department of Public Health Dentistry, Maharishi Markandeshwar College of Dental Sciences and Research (Deemed to be University), Haryana, India
3 Department of Oral Medicine and Radiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Maharashtra, India
4 Department of Oral Medicine and Radiology, Yogita Dental College and Hospital, Dental School in Vetalwadi, Maharashtra, India

Date of Submission04-Oct-2018
Date of Acceptance22-Dec-2018
Date of Web Publication23-Apr-2019

Correspondence Address:
Dr. Rakashree Chakraborty
Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Sciences and Research (Deemed to be University), Mullana, Amabala - 133 207, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_169_18

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   Abstract 


Objective: Mental foramen is a vital anatomical structure in human mandible as they are important for dental surgeons for extraction, implant placement, osteotomy procedures, anesthetists in nerve block, and surgical procedures to avoid injury to neurovascular bundle in mental foramen area. The aim of this study was to compare the position, shape, size, and distinctness of mental foramen using orthopantomogram (OPG) and digitalized volumetric tomography (DVT). Materials and Method: This study was conducted on 25 individuals for both the genders. Position, shape, size, and distinctness of mental foramen were compared using OPG and DVT and were evaluated by Expert three-dimensional (3D) software in DVT and Annotation software in OPG. Results: Mental foramen was found to be on the vicinity of the second premolar region with respect to apices of premolars and molars and was more common in the middle third region of the jaw bone with respect to superoinferior cortex of the mandible in vertical plane. There was no significant difference in the position of the mental foramen using OPG and DVT. The commonest shape of mental foramen was found to be oval and was better defined in DVT. The size of the mental foramen was observed to be 0.49 ± 0.05 and 0.51 ± 0.06 cm in OPG and DVT, respectively, and more distinctly visible in DVT. There was no significant difference in the position, shape, size, and distinctness of the mental foramen among genders. Conclusion: Conventional radiography can be initially done for the position of the mental foramen but the details must be confirmed using 3D volumetric radiography to avoid any kind of procedural complications.

Keywords: Digitalized volumetric tomography, 3D volumetric radiograph, mental foramen, orthopantomography


How to cite this article:
Chakraborty R, Sen S, Panchbhai A, Bhowate RR, Dupare A. Comparison between conventional radiograph and 3D volumetric radiograph for determining the morphology and morphometry of mental foramen. J Indian Acad Oral Med Radiol 2019;31:17-23

How to cite this URL:
Chakraborty R, Sen S, Panchbhai A, Bhowate RR, Dupare A. Comparison between conventional radiograph and 3D volumetric radiograph for determining the morphology and morphometry of mental foramen. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2019 Jun 17];31:17-23. Available from: http://www.jiaomr.in/text.asp?2019/31/1/17/256891




   Introduction Top


Mental foramen is an anatomical landmark located on the anterolateral surface of the body of the mandible.[1] It transmits the mental nerves and vessels.[2] The mental foramen varies in position with race and age.[3] The superoinferior position varies with age.[4] It lies at the lower border of the mandible at infancy, at the midway between the alveolar crest and lower border of the mandible at the middle age, and near the alveolar crest at old age.[4] Hence, the most common noninvasive method for assessing the mental foramen is radiography which will lead to minimal postprocedural complications. The shape of the mental foramen varies from being oval, round, or even irregular.[5] The exact shape of the mental foramen should be properly analyzed for minimal postoperative complications. The size of the mental foramen varies according to various races, and hence its accurate identification leads to effective nerve blocks and prevention of postoperative neurovascular complications in the mental region such as neurosensory disturbances, paralysis, hemorrhage, altered sensation, orofacial pain, and atypical neuralgia. Appropriate distinctness of the mental foramen facilitates better morphometry. There are various general dental surgeries which are performed on patients with poor socioeconomic status. Hence, ideal radiographic techniques with accurate exposure parameters can give a basic idea of the position of the mental foramen. Extensive procedures such as implant placement and osteotomy need accurate morphometry, and therefore three-dimensional (3D) volumetric imaging is preferred over conventional radiographs. This research on living human beings aims to elucidate the normal morphology of the mental foramen and its position, shape, size, and distinctness with a view to facilitate the accurate identification using orthopantomogram (OPG) and digitalized volumetric tomography (DVT) and comparing between the two radiographic methods during invasive procedures of the lower face, thereby limiting postprocedural complications.


   Materials and Methods Top


This was a cross-sectional in vivo study. The Institutional Ethical Committee–approved study included 25 subjects recruited from patients attending the outpatient department in the Department of Oral Medicine and Radiology.

The inclusion criteria were as follows:

  • Age group of patients between 15 and 65 years
  • Patients with edentulous areas in the posterior region of the mandible.


The exclusion criteria were as follows:

  • Patients with systemic disease (rheumatoid arthritis, osteomalacia, osteogenesis imperfecta, osteoporosis) which can affect bone integrity
  • Patients suffering from bleeding disorders (hemorrhagic diathesis, drug-induced
  • Anticoagulation
  • Patients with pathologies in the upper and lower jaws and oral mucous membrane
  • Immunocompromised patients (HIV, immunosuppressive medications)
  • Drug abusers, alcohol consumers, and heavy smokers
  • Psychological and mental disorders
  • Noncompliant patients
  • Patients who underwent radiotherapy
  • Patients with habit of bruxism
  • Patients on IV bisphosphonates.


For examination of the patients, the things used were physiological dental chair with illumination, mouth mask, sterile gloves, plain mouth mirror, straight probe, explorer, kidney tray, cotton, gauze, 0.2% chlorhexidine gluconate solution, and cheek retractor.

OPG was taken using orthopantomogram machine (Planmeca Proline CC Panoramic X-ray; Planmeca OY, Helsinki, Finland). For 3D volumetric imaging, Philips Allura Xper FD20 3D RA, digital subtraction angiography unit (The Netherlands) was used.

Methodology

After attaining a written consent from all the participants, a thorough case history and general and oral examination of participants were carried out and findings were noted. For the purpose of radiographic evaluation of mental foramen in the jaw bone, OPG and DVT were done for the mandibular posterior region. The position, shape, size, and distinctness of the mental foramen were evaluated using Expert 3D software in DVT and Annotation software in OPG. The radiographic image was analyzed and then the findings were noted. Further comparison was made between the readings of the two radiographic techniques. Statistical analysis was done using SPSS software version 16, and Chi-square test and unpaired t-test were used. Statistical significance level was set at P > 0.05.

Position of the mental foramen

The position of the mental foramen was analyzed by Expert 3D software in DVT and Annotation software in OPG.[4]

  1. Position with respect to apices of premolars and molars


    • Position 1: situated anterior to first premolar
    • Position 2: situated at the apex of first premolar
    • Position 3: situated in between first and second premolar
    • Position 4: situated at the apex of second premolar
    • Position 5: situated in between second premolar and first molar
    • Position 6: situated apex in the of first molar


  2. Position with respect to superoinferior cortex of mandible in vertical plane


    • Position 0: at the superior third of the jaw
    • Position 1: at the middle third of the jaw
    • Position 2: at the inferior third of the jaw.


Shape of the mental foramen

The shape of the mental foramen was then analyzed using Expert 3D software in DVT and Annotation software in OPG. The shapes considered were round, oval, or irregular.[5]

Size of the mental foramen

The size of the mental foramen was then measured using Expert 3D software in DVT and Annotation software in OPG.[6] A horizontal diameter was measured from the mesial aspect of the mental foramen to the distal aspect of the mental foramen.

Distinctness of the mental foramen

The distinctness of the mental foramen was analyzed using Expert 3D software in DVT and Annotation software in OPG.[7]

  • Position 0: indistinct
  • Position 1: distinct.



   Results Top


This study was conducted to determine the location shape, size, and distinctness of the mental foramen by conventional and digitalized radiography. After following strict inclusion and exclusion criteria, a total of 25 subjects were included having edentulous areas in the mandibular posterior region of the jaw. Of the total 25 patients, 9 were males and 16 were females who were clinically not significant. The age of patients ranged from 15 to 65 years with a mean age of 35.48 ± 12.69 years. In this study, it was observed that comparing OPG and DVT for the position of the mental foramen in the anteroposterior dimension of jaw bone, it was observed that there was no mental foramen observed anterior to the first premolar and in line with the first molar in OPG and DVT. The most common position of the mental foramen was in line with the second premolar in OPG and DVT [Table 1], [Graph 1] and [Figure 1]. Comparing OPG and DVT for the position of the mental foramen in the superoinferior dimension of the jaw bone, it was observed that the most common position of the mental foramen in the mandibular cortex was in the middle third region of the jaw [Table 2], [Graph 2] and [Figure 2]. There was no significant difference for the position of the mental between OPG and DVT. Gender-wise comparisons revealed that there was no significant difference for the position of the mental foramen.
Table 1: Position of the mental foramen (with respect to apices of premolar and molar)

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Figure 1: OPG showing location, shape, size, and distinctness of mental foramen

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Table 2: Position of the mental foramen (with respect to superoinferior cortex of mandible in vertical plane)

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Figure 2: DVT image showing location, shape, and distinctness of mental foramen

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The most common shape of the mental foramen was oval for both OPG and DVT. There was a significant difference between OPG and DVT for the shape of the mental foramen [Table 3] and [Graph 3]. Gender-wise comparisons revealed that there was no significant difference for the shape of the mental foramen.
Table 3: Shape of the mental foramen

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The mean size of the mental foramen using OPG was 0.49 ± 0.05 cm. The mean size of the mental foramen using DVT was 0.51 ± 0.06 cm [Figure 3]. Hence, there was no significant difference between OPG and DVT for the size of the mental foramen [Table 4] and [Graph 4]. Gender-wise comparisons revealed that there was no significant difference for the size of the mental foramen.
Figure 3: DVT image showing size of mental foramen

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Table 4: Size of the mental foramen

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The mental foramen was distinctly visible in DVT compared with OPG [Table 5] and [Graph 5]. Gender-wise comparisons revealed that there was no significant difference for the distinctness of the mental foramen.
Table 5: Distinctness of mental foramen

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   Discussion Top


Position, shape, size, and distinctness of mental foramen

Mental foramen was found on the anterolateral aspect of the mandible in the vicinity of the second premolar region and transmits mental nerves and vessels. It is an important anatomical landmark to facilitate surgeries, local anesthesia, and other invasive procedures in the periapical region of the mandible.[1] The location of the mental foramen is important both as a diagnostic procedure and any surgical procedure of the mandible. Since paresthesia, bleeding, and inadvertent nerve damages are common in case of positional misjudgments of mental foramen, it is therefore recommended to accurately localize the mental foramen radiographically prior to any attempt of administration of routine mental nerve blocks or other interventions at its location.[2]

Position of the mental foramen

In our study, the most common position of the mental foramen was in line with the second premolar in the mandibular using both OPG and DVT. There was no significant difference between these two radiographic analyses for the position of the mental foramen [Table 1] and [Graph 1]. This was in agreement with the study conducted by Juodzbalys et al.,[7] Afkhami et al.,[8] Ngeow and Yuzawati,[9] Greenstein and Tarnow,[10] YeÕilyurt et al.,[4] Al-Jasser and Nwoku,[11] Shankland,[12] Wang et al.,[13] Kekere-Ekun TA,[14] Kay LW,[15] Oliveira et al.,[16] and Gungor et al.[17]

The study conducted by Singh and Srivastav[6] on dry mandibles evaluated that the most common position of the mental foramen was below the apex of second premolar tooth in 68.8% of cases. Similar results on dried mandible were obtained by Agarwal and Gupta,[1] Gupta and Soni,[18] Hasan T,[3] Pokhrel and Bhatnagar,[19] Bhandari et al.,[20] Budhiraja et al.,[21] Roy et al.,[22] Nimje et al.,[23] and Vimala et al.[24]

Studies by Babshet et al.,[25] Fishel et al.,[26] Olasoji et al.,[27] Dehghani and Ghanea,[28] Al-Khateeb et al.,[29] and Neiva et al.[30] were in disagreement where they observed that the mental foramen was located between the first and second premolars. Dissimilar results were obtained by Rai et al.[31] where the mental foramen was located between the second premolar and first molar on the right side and between first and second premolars on the left side. Kjaer[32] reported that during the early prenatal life, mental foramen is located in the alveolar bone between the primary canine and first molar.

On gender-wise comparison, our study showed that there was no difference in the position of the mental foramen between males and females. Similar results were obtained by Pokhrel and Bhatnagar[19] and Jamdade et al.[33]

Assessing the position of mental foramen with respect to superoinferior dimension of the mandible in vertical plane, it was observed that the mental foramen was located in the middle third of the mandibular jaw in most of the cases [Table 2] and [Graph 2]. Ngeow et al.[9] reported in their study that the position of the mental foramen changed with age, alveolar bone loss, and loss of teeth. Gupta and Soni[18] reported, in adults with the advancement of age, that mental foramen moves toward the superior border of the mandible. This was mainly because of the loss of teeth and alveolar bone resorption. There was a significant variation in the position of mental foramen seen with age.

Studies performed by Fishel et al.[26] classified the mental foramen according to the periapex, apical, and coronal to periapex of tooth. For second premolar, mental foramen was coronal to the apex in 24.5% of cases, 13.9% at the apex, and 61.6% apical to the apex.

Budhiraja et al.[21] reported that variability in mental foramen position may be related to different feeding habits subsequently affecting mandibular development. Green[34] reported a clear racial trend in the anteroposterior position of the mental foramen, it being more anterior in the Caucasoid groups.

Seema et al.[35] reported that at birth, mental foramen lies close to the lower border; in adults, it lies midway between the upper and lower borders after eruption of permanent teeth. In old age, resorption of alveolar margin after loss of teeth brought the mental foramen nearer to the upper border.

Shape of the mental foramen

In our study, it was observed that the most prominent shape of the mental foramen was oval in both OPG and DVT. But there was a significant difference between the analysis obtained from OPG and DVT although the shape was evident to be oval in both the techniques [Table 3] and [Graph 3]. Similar results were obtained by Juodzbalys et al.[7] and Agarwal and Gupta.[1]

Greenstein and Tarnow[10] in their study reported that the mental foramen may be round or oval in shape. Similarly, studies on dried mandibles by Hasan T,[3] Bhandari et al.,[20] Udhaya et al.,[36] Roy et al.,[22] Nimje et al.,[23] and Vimala et al.[24] reported that the most predominant shape was oval. While the studies by Singh and Srivastav,[6] Gupta and Soni,[18] and Rai et al.[31] on dried mandibles mentioned that the most common shape of the mental foramen was round.

In our study, there was no difference in the shape of the mental foramen between males and females. On reviewing literatures, there has been no study performed on the gender-wise comparison for the shape of the mental foramen using OPG and DVT.

Size of the mental foramen

In our study, the size of the mental foramen was measured to be 0.49 ± 0.05 cm using OPG and 0.51 ± 0.06 cm using DVT. There was no significant difference between OPG and DVT for the analysis of the size of the mental foramen [Table 4] and [Graph 4]. Similar results were obtained by Juodzbalys et al.[7]

Singh and Srivastav[6] reported that the dimension of mental foramen was 2.8 mm on dried mandibles. Oguz and Bozkir[37] evaluated the size of the mental foramen to be 2.93–3.14 mm, Hasan T[3] reported the mean width of the mental foramen to be approximately 3.6 mm, and Roy et al.[22] reported the mean width of the mental foramen to be approximately 3.01 mm. Rai et al.,[31] on dried mandibles, reported the mean diameter of the mental foramen to be 2.63 ± 0.85 mm.

In our study, there was no difference between males and females for the size of the mental foramen using OPG and DVT. To the best of our knowledge, none of the studies included the gender-wise comparison for the size of the mental foramen.

Distinctness of the mental foramen

In this study, it was observed that the mental foramen was more distinct when observed in DVT compared with OPG [Table 5], [Graph 5]. There has hardly been any study conducted for the distinctness of the mental foramen using 3D volumetric imaging. Greenstein and Tarnow[10] in their study reported 24% of the mental foramen as observed in OPG with indistinct borders. Yosue and Brooks[38] conducted similar studies to assess the distinctness of the mental foramen in panoramic radiographs where they detected mental foramen in 87.5% of panoramic radiographs, and it was distinct in 64% of cases. Studies conducted by Jacobs et al.[39] detected the mental foramen in 94% of cases on OPG, but a clear visibility was attained only in 49% of cases.

In this study, there was no difference between males and females for the distinctness of the mental foramen using OPG and DVT. Again none of the previous studies included the gender-wise comparison to best of our knowledge.

The mental foramen being a vital anatomic structure in the posterior region of the mandible, this study has also analyzed the mental foramen with respect to position, shape, size, and distinctness using OPG and DVT. For the position of the mental foramen, there has been very less studies conducted in India using radiographs where most of the studies had been conducted on dried mandibles. But in our study we have evaluated the foramen initially on OPG, and for more accurate results DVT had been used, so that this can be used in living human beings. We had also evaluated the position of the mental foramen in the superoinferior dimension of the jaw bone. This is because the position of the mental foramen varies with age. This study has provided insight into the precise location of mental foramen which will be of great help in planning the implant, osteotomy procedures, and other interventions in mandibular posterior region without affecting the neurovascular bundle in the mental region.


   Conclusion Top


The most common position of the mental foramen in OPG and DVT was along the line of the second premolar with respect to apices of premolars and molars and was more common in the middle third region of the jaw bone with respect to superoinferior cortex of mandible in vertical plane, and there was no significant difference in the position of the foramen between males and females.

The most common shape of the mental foramen was found to be oval and was better defined in DVT compared with OPG. There was no significant difference in the shape of the foramen between males and females.

The size of the mental foramen was observed to be 0.49 ± 0.05 cm in OPG and 0.51 ± 0.06 cm in DVT. There was no significant difference in the size of the foramen between males and females.

The mental foramen was more distinctly visible with DVT rather than OPG and there was no significant difference in gender.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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