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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 32  |  Issue : 1  |  Page : 22-26

Evaluation of the depth of submandibular gland fossa and its correlation with mandibular canal in vertical and horizontal locations using CBCT


Department of Oral Medicine and Radiology, St.Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India

Date of Submission20-Sep-2019
Date of Decision19-Nov-2019
Date of Acceptance24-Dec-2019
Date of Web Publication17-Apr-2020

Correspondence Address:
Dr. Davuluri Divya Teja
Department of Oral Medicine and Radiology, St.Joseph Dental College, Duggirala, Eluru, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_170_19

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   Abstract 


Introduction: Dental implant is the most preferable option for the replacement of missing teeth because of its advantage of maintaining the structural and functional integrity of bone, like that of a natural tooth. Aim and Objectives of the Study: Aim of this study is to evaluate the depth of submandibular gland fossa and its relationship with the mandibular canal, based on gender and side of the mandible. Materials and Methods: 100 CBCT scans of both males and females were acquired. The deepest region of submandibular gland fossa and the superior, parallel, and the inferior relationship of the mandibular canal to submandibular gland fossae were obtained. Results: The mean ± SD of the depth of the submandibular gland fossa on the right side in males and females were 1.69 ± 0.73 mm and 1.62 ± 0.58mm, respectively, and those on the left were 1.69 ± 0.61 mm and 1.56 ± 0.42 mm, respectively. The deepest region in both the genders was above the infra-alveolar canal. Conclusion: Males showed greater depths when compared to females, Right side of the mandible showed greater depth when compared to the left side in both genders. Therefore, careful evaluation of alveolar bone thickness during implant placements is of great importance in males.

Keywords: CBCT, Mandibular canal, submandibular gland fossa


How to cite this article:
Ramaswamy P, Saikiran C, Raju B M, Swathi M, Teja DD. Evaluation of the depth of submandibular gland fossa and its correlation with mandibular canal in vertical and horizontal locations using CBCT. J Indian Acad Oral Med Radiol 2020;32:22-6

How to cite this URL:
Ramaswamy P, Saikiran C, Raju B M, Swathi M, Teja DD. Evaluation of the depth of submandibular gland fossa and its correlation with mandibular canal in vertical and horizontal locations using CBCT. J Indian Acad Oral Med Radiol [serial online] 2020 [cited 2020 Jun 4];32:22-6. Available from: http://www.jiaomr.in/text.asp?2020/32/1/22/282607




   Introduction Top


Dental implant therapy is widely used in clinical practice for the replacement of missing teeth.[1] Assessment of the presurgical bone site before the placement of dental implants is essential.[2] The factors that are most critical in implant planning are the morphological features of the bone and the relationship between implants and vital anatomical structures. Bone perforation, followed by inflammation, infection, mandibular fracture, and loss of the implant are the result of improper implant planning.[3]

The posterior region of the mandible, inferior alveolar nerve, and the submandibular gland fossaare the most critical anatomic regions, assubmental and sublingual arteries pass-through this region.[3] The damage to the inferior alveolar canal during implant placements more commonly results in paresthesia or chin numbness and corner of the mouth. It can also further lead to the loss of tooth vitality within a quadrant as the neurovascular bundle within the canal supplies to all teeth.[4]

Damage to submandibular gland fossa by lingual plate perforation during the surgery may lead to severe hemorrhage and subsequent hematoma which have life-threatening consequences due to upper airway obstruction.[1]

Various assessments like the osteometry, diagnostic casts, and palpation of the ridges are done before implant placement to assess the anatomical areas of various regions, but this cannot be applicable for the assessment of the posterior mandible.[5] It is necessary to employ an appropriate imaging technique, such as cone-beam computed tomography (CBCT) for medical purposes to evaluate the status of concavities and to select a proper fixture.[1]

CBCT is used widely for implant planning.[1] It provides high resolution and accurate three-dimensional images and is a vital tool for computer-guided implant surgeries.[6] Computer software is used to place the dental implants virtually, followed by transferring the implant position and angulation to the surgical sites by either computer-generated surgical guides or the use of navigation systems.[6]

The submandibular gland fossa concavity evaluation by different studies in various methods has reported mixed results.

Aim of the study

  • To evaluate the depth of the submandibular gland fossa.
  • To correlate between the depth of submandibular gland fossa and the location of the mandibular canal in both vertical and horizontal directions using CBCT.


Objectives of the study

  • To evaluate the depth of submandibular fossa based on gender.
  • To evaluate the depth of submandibular fossa based on the side of the mandible.



   Materials and Methods Top


The ethical committee clearance has been obtained from the Institutional Ethical Committee of St. Joseph Dental College, Eluru on 27/08/2019. The ethical committee clearance number is CEC/10/2/2018-19.

The following is a retrospective studyon 100 CBCT scans of the patientswith complete or partially edentulous posterior mandibles within the age range of 16-70 years, which includes 50 males and 50 females. Congenital and developmental disorders, abnormal morphology resulting from trauma and pathologic conditions affecting the area of interest have been excluded from the study.

All the CBCT scans were taken using a CS 9300 3D apparatus (CARESTREAM/GERMANY) and subsequently evaluated by the CS 3DIMAGINGDental software.[3]

The CBCT images were acquired using specific parameters, i.e. 10 mA (current), 75 kVp (voltage), 0.2 mm (voxel size), 16 × 9-12 field of view (FOV), slice thickness of 90μm.[3]

The status of the infra-alveolar canal was determined using the CBCT image [Figure 1] The submandibular gland fossa was determined in cross-sections at -1mm intervals and with 1mm thickness and the deepest regions of the fossa was identified [Figure 2]. A line was drawn in sections to connect the upper and lower points of the submandibular gland fossa [Figure 2]. Another line was drawn perpendicular to the first line from the deepest region of the submandibular gland fossa [Figure 2]. Slicing of each image into five slices of 1 mm thickness has been done [Figure 3]. The position of this regionwhen compared with the infra-alveolar canal has been evaluated [Figure 4] into the following three groups:
Figure 1: Mapped Mandibular canal

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Figure 2: Line connecting the upper and lower points of the submandibular gland fossa. Another line drawn perpendicular to first line

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Figure 3: 5 slices of 1 mm thickness

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Figure 4: Superior relation

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  1. Superiorrelation
  2. Parallel relation
  3. Inferior relation[3]


  1. Superior relation: In this type of relationship, the mandibular canal is above the deepest point of submandibular gland fossa [Figure 4].
  2. Parallel relation: In this type of relationship, the mandibular canal is adjacent to the deepest point of submandibular gland fossa [Figure 5].
  3. Inferior relation: The mandibular canal is below the deepest point of submandibular gland fossa in this type of relationship [Figure 6]. The data has been entered into an excel sheet and is subjected to statistical analysis using SPSS software.
Figure 5: Parallel relation

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Figure 6: Inferior relation

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The Student t-test is done to compare the mean values of both the genders. Chi-square test is done to correlate the mandibular canal with the submandibular gland fossa depth.


   Results Top


In females, the mean value of the depth of the submandibular gland fossa on the right side is 1.62 ± 0.58mm and on the left side, it is 1.56 ± 0.42 mm. The P'-value is 0.065 (<0.05), which is statistically significant [Table 1].
Table 1: Depicting depth of submandibular gland fossa based on the side of mandible in females

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In males, the mean value of the depth of the submandibular gland fossa on the right side is 1.690 ± 0.73mm and on the left side it is 1.697 ± 0.61mm. The P value is 0.972 (>0.05), which is not statistically significant [Table 2].
Table 2: Depicting depth of submandibular gland fossa based on the side of mandible in males

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In females, on the right side, the mandibular canal is in superior relation with 2 subjects, inferior relation with 12 subjects and parallel relation with 5 subjects. On the left side, it is in superior relation with 2 subjects, inferior relation with 13 subjects and parallel relation with 16 subjects [Graph 1].



In males, on the right side, the mandibular canal is in superior relation with 3 subjects, inferior relation with 8 subjects and parallel relation with 9 subjects. On the left side, it is in superior relation with 4 subjects, inferior relation with 16 subjects and parallel relation with 10 subjects [Graph 2].




   Discussion Top


In the present study, the mean submandibular gland fossa depth is1.69 ± 0.67 mm in males and 1.59 ± 0.50 mm in females.

Depth of submandibular gland fossa was significantly higher in malepatients than inthe female patients indicating that in male patients, the width and thickness of the bone at this pointwere less when compared to that of female patients which is similar to the study conducted by Parnia et al. 2010.[7] They observed that the depth of submandibular gland fossa was more than 2 mm in 80% of the patients.[7] These differences attribute to different imaging techniques anddifferent methods of measurement.

According to the present study, the mean values of submandibular gland fossa depths in females were higher on the right side when compared to those on the left side which is similar to the study conducted by Desouza et al. 2016 in which the mean values of submandibular fossa depths were 4.7 mm on the right side and 2.69 mm on the left side (5mm section).[8]

In this study, the depth of the submandibular gland fossa is equal on both the right and the left sides in males.

In females, based on the side of the mandible, the relationship of the mandibular canal to submandibular gland fossa depth, the superior relation is equal on both the right and the left sides. But the parallel and inferior relationships are more commonly seen on the left side when compared to those on the right side [Graph 1].

In males, based on the side of the mandible, the relationship of the mandibular canal to submandibular gland fossa depth in the superior, inferior and parallel relations is equal on the left side when compared to that on the right side [Graph 2].

In this study, the submandibular gland fossa depth is more on the left side of the mandible in males (1.697 ± 0.61mm), followed by the right side in males (1.690 ± 0.73mm), which is followed by the right side of the mandible in females (1.626 ± 0.58mm). The least value is recorded for the left side of the mandible in females (1.561 ± 0.42mm).

In both males and females, the starting point of the concavity is in the middle one third. In females, the parallel relationship is most widely seen. In males, the inferior relationship is most commonly seen.

In the study conducted by Kamburoǧlu et al. 2015, the mean of the submandibular concavity depth was found to be 2.4 mm.[9] The mean for the right and left submandibular and sublingual concavity depths was 2.26 mm, 2.24 mm, and 0.58 mm for females and 2.57 mm, 2.68 mm, and 0.81 mm for males respectively.[9]

In the study conducted by Yoon et al. 2016, the mean concavity depth on the right side for females is 3.55 mm and for males it is 3.93 mm. On the left side for females, it is 3.74 mm and for males, it is 4.15 mm[10] which are similar to the present study.

In the study conducted by Chan et al. 2010, themean concavity depth for males and females is 2.4 mm[11] and this differs from the present study and attributed to racial disparities.

In the study conducted by Lin et al. 2014, the mean concavity depth was4.3 ± 1.9 mm at second premolar, 5.3 ± 1.6mm at first molar, and 6.0 ± 1.8mm at second molar.[12]

In the study conducted by Yildiz et al. 2014, themean values of the submandibular gland fossa depths were between 1.1 and 4.6 mm (2.673 ± 0.91) on the right sideand 1.1-4.5 mm (2.578 ± 0.90) on the left side of the mandibles[13] which were higher when compared to those of the present study.

In the study conducted by Herranz-Aparicio et al. 2016, the linear concavity depths were 4.5 ± 2.3 mm in males and 3.1 ± 1.7 mm in females.[14] According to the results of this study, the depth was highest in males, which is in concordance with the present study.

Adequate knowledge regarding the morphological and anatomical features of submandibular gland fossa region is essential to prevent the lingual alveolar plate perforation during implant placement, especially in males.


   Conclusion Top


Preoperative imaging is imperative for the success of implant placement. CBCT provides in detail mandibular anatomy and submandibular gland fossa depth for the preoperative assessment of the posterior mandible for dental implant placement. The depth of submandibular gland fossa is higher in males when compared to females. The right side of the mandible shows greater submandibular gland fossa depth when compared to that on the left side.[3] Hence, paramount care should be taken in males while planning implants in the right posterior region of mandible.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bayrak S, Demirturk-Kocasarac H, Yaprak E, Ustaoglu G, Noujeim M. Correlation between the visibility of submandibular fossa and mandibular canal cortication on panoramic radiographs and submandibular fossa depth on CBCT. Med Oral Patol Oral Cir Bucal 2018;23:e105-11.  Back to cited text no. 1
    
2.
Sumer AP, Zengin AZ, Uzun C, Karoz TB, Sumer M, Danaci M. Evaluation of submandibular fossa using computed tomography and panoramic radiography. Oral Radiology 2015;31:23-7.  Back to cited text no. 2
    
3.
Haghanifar S, Arbabzadegan N, Moudi E, Bijani A, Nozari F. Evaluation of lingual mandibular depression of the submandibular salivary glands using cone-beam computed tomography. Res Med Dent Sci 2018;6:563-7.  Back to cited text no. 3
    
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Nickenig HJ, Wichmann M, Eitner S, Zöller JE, Kreppel M. Lingual concavities in the mandible: A morphological study using cross-sectional analysis determined by CBCT. Craniomaxillofac Surg 2015;43:254-9.  Back to cited text no. 4
    
5.
K SG. Assessment of submandibular fossa for dental implants – A retrospective 3 dimensional cone beam computed tomographic study. Int J Curr Adv Res 2018;7:16632-5.  Back to cited text no. 5
    
6.
Chan HL, Benavides E, Yeh CY, Fu JH, Rudek IE, Wang HL. Risk assessment of lingual plate perforation in posterior mandibular region: A virtual implant placement study using cone beam computed tomography. J Periodontol 2011;82:129-35.  Back to cited text no. 6
    
7.
Parnia F, Fard EM, Mahboub F, Hafezeqoran A, Gavgani FE. Tomographic volume evaluation of submandibular fossa in patients requiring dental implants. Oral Surg Oral Med Oral Pathol Oral RadiolEndodontol 2010;109:e32-6.  Back to cited text no. 7
    
8.
de Souza LA, Assis NM, Ribeiro RA, Carvalho AC, Devito KL. Assessment of mandibular posterior regional landmarks using cone-beam computed tomography in dental implant surgery. AnnAnat 2016;205:53-9.  Back to cited text no. 8
    
9.
Kamburoǧlu K, Acar B, Yüksel S, Paksoy CS. CBCT quantitative evaluation of mandibular lingual concavities in dental implant patients. Surg Radiol Anat 2015;37:1209-15.  Back to cited text no. 9
    
10.
Yoon TY, Patel M, Michaud RA, Manibo AM. Cone beam computerized tomography analysis of the posterior and anterior mandibular lingual concavity for dental implant patients. J Oral Implantol 2017;43:12-8.  Back to cited text no. 10
    
11.
Chan HL, Brooks SL, Fu JH, Yeh CY, Rudek I, Wang HL. Cross-sectional analysis of the mandibular lingual concavity using cone beam computed tomography. Clin Oral Implants Res 2011;22:201-6.  Back to cited text no. 11
    
12.
Lin MH, Mau LP, Cochran DL, Shieh YS, Huang PH, Huang RY. Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: A virtual implant placement study. J Dent 2014;42:263-70.  Back to cited text no. 12
    
13.
Yildiz S, Bayar GR, Guvenc I, Kocabiyik N, Cömert A, Yazar F. Tomographic evaluation on bone morphology in posterior mandibular region for safe placement of dental implant. Surg Radiol Anat 2015;37:167-73.  Back to cited text no. 13
    
14.
Herranz-Aparicio J, Marques J, Almendros-Marqués N, Gay-Escoda C. Retrospective study of the bone morphology in the posterior Mandibular region. Evaluation of the prevalence and the degree of lingual concavity and their possible complications. Med Oral Patol Oral Cir Bucal 2016;21:e731-6.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2]



 

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