Is the presence of accessory mandibular canals associated with the dimensions of the mandibular canal?

Authors

DOI:

https://doi.org/10.2340/aos.v84.43600

Keywords:

Accessory mandibular canal, mandibular canal variations, mandibular canal measurements, CBCT

Abstract

Aim: The aim of this study is to classify accessory mandibular canals (AMC) and investigate their association with the dimensions of the mandibular canal (MC) to enhance surgical planning and prevent complications in dental treatments.

Methods: Cone-beam computed tomography (CBCT) images were evaluated. AMC’s frequency, length, and diameter, including dental, superior, inferior, forward-open, forward-closed, and retromolar types, were determined. Additionally, the dimensions of the MC, including its length and diameter, were measured, and the relationship between the AMC and MC was statistically analyzed. Descriptive statistics, chi-square test, independent samples t-test (for normally distributed data), Kruskal-Wallis test (for non-normally distributed data), and Tamhane post hoc test were used for statistical analysis of the data.

Results: AMC was identified in 82 of the 222 hemimandibles examined (36.9%). It was found that the length and diameter of AMCs varied significantly depending on the AMC type (p = 0.000). The diameter of the dental type AMCs (mean 0.40 ± 0.22 mm) was considerably smaller than that of other AMC types (mean 0.86 ± 0.37 mm). The length and diameter of the MC were measured as 69.20 ± 5.10 mm and 2.96 ± 0.57 mm, respectively. While MC length was not found to influence the presence of AMC (p = 0.785), MC diameter was significantly associated with the occurrence of AMC (p = 0.000).

Conclusions: AMC, which is critical for improving surgical planning and reducing the risk of complications in dental procedures, is not uncommon. Their presence should be carefully evaluated, particularly in cases where the MC has a larger diameter.

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References

Souza PRM, Dupont L, Mosena G, Dantas ML, Bulcão LA. Variations of oral anatomy and common oral lesions. An Bras Dermatol. 2024;99(1):3–18. https://doi.org/10.1016/j.abd.2023.06.001

Iwanaga J, Kikuta S, Tanaka T, Kamura Y, Tubbs RS. Review of risk assessment of major anatomical variations in clinical dentistry: accessory foramina of the mandible. Clin Anat. 2019;32(5):672–77. https://doi.org/10.1002/ca.23366

Haas LF, Dutra K, Porporatti AL, Mezzomo LA, De Luca Canto G, Flores-Mir C, et al. Anatomical variations of mandibular canal detected by panoramic radiography and CT: a systematic review and meta-analysis. Dentomaxillofac Radiol. 2016;45(2):20150310. https://doi.org/10.1259/dmfr.20150310

Valenzuela-Fuenzalida JJ, Baez-Flores B, Sepúlveda RÁ, Medina CM, Pérez R, López E, et al. Anatomical variations and abnormalities of the maxillary region and clinical implications: a systematic review and metaanalysis. Medicine. 2023;102(38):e34510. https://doi.org/10.1097/MD.0000000000034510

De Oliveira‐Santos C, Rubira‐Bullen IR, Monteiro SA, León JE, Jacobs R. Neurovascular anatomical variations in the anterior palate observed on CBCT images. Clin. Oral Implants Res. 2013;24(9):1044–8. https://doi.org/10.1111/j.1600-0501.2012.02497.x

Ngeow WC, Chai WL. The clinical anatomy of accessory mandibular canal in dentistry. Clin Anat. 2020;33(8):1214–27. https://doi.org/10.1002/ca.23567

Guzmán J, Abarca J, Navarro P, Garay I, Arnabat-Domínguez J, Betancourt P. Morphometric analysis of the mandibular canal and its anatomical variants in a Chilean subpopulation: cone beam computed tomography study. Diagnostics. 2024;14(17):1914. https://doi.org/10.3390/diagnostics14171914

Shan S, Zhong S, Li J, Wang T. Systematic review and meta-analysis of mandibular canal variations on cone beam computed tomography. Oral Radiol. 2022;38(4):445–51. https://doi.org/10.1007/s11282-022-00610-5

Al-Gabri R, Abulohoom F, Alqutaibi AY, Obiad A. Unique anomalous in the main mental foramen opening, mandibular canal pathway, and size and shape of genial tubercles: a case report. Radiol Case Rep. 2024;19(9):3934–41. https://doi.org/10.1016/j.radcr.2024.06.011

Mehta DN, Oza D, Gandhi R, Jha M, Singh N, Patel SJ. Prevalence of accessory mandibular canal variations using cone beam computed tomography in the North Gujarat population: a retrospective study. Adv Hum Biol. 2025;15(1):118–21. https://doi.org/10.4103/aihb.aihb_158_24

Öçbe M, Borahan M. Identifying the anatomical variations of the inferior alveolar nerve with magnetic resonance imaging. Niger J Clin Pract. 2024;27(1):136–42. https://doi.org/10.4103/njcp.njcp_641_23

Göller Bulut D, Kartal Yalçın G, Tanrıseven Z, Taşkın B, Aydın B. Prevalence and topography of bifid and trifid mandibular canal in Turkish Western Anatolia population: evaluation of the inferior alveolar canal with CBCT. Surg Radiol Anat. 2024;46(10):1663–72. https://doi.org/10.1007/s00276-024-03460-4

Goodarzipour D, Mosavat F, Fahimzad MS, Bayati M. Visibility of inferior alveolar canal borders using panoramic radiography and cross-sectional CBCT images. Avicenna J Dent Res. 2024;16(4):189–96. https://doi.org/10.34172/ajdr.1877

Sahman H, Sekerci AE, Sisman Y, Payveren M. Assessment of the visibility and characteristics of the mandibular incisive canal: cone beam computed tomography versus panoramic radiography. Int J Oral Maxillofac Implants. 2014;29(1):71–78. https://doi.org/10.11607/jomi.3304

Zhang Y-Q, Zhao Y-N, Liu D-G, Meng Y, Ma X-C. Bifid variations of the mandibular canal: cone beam computed tomography evaluation of 1000 Northern Chinese patients. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;126(5):e271–8. https://doi.org/10.1016/j.oooo.2018.06.008

Del Canal Mandibular RA, Muñoz G, Dias F, Weber B, Betancourt P. Anatomic relationships of mandibular canal. A cone beam CT study. Int J Morphol. 2017;35(4):1243–48. https://doi.org/10.4067/S0717-95022017000401243

Eto VM, Figueiredo NC, Eto LF, Azevedo GM, Silva AIV, Andrade Jr I. Bone thickness and height of the buccal shelf area and the mandibular canal position for miniscrew insertion in patients with different vertical facial patterns, age, and sex. Angle Orthod. 2023;93(2):185–94. https://doi.org/10.2319/060822-412.1

Karamifar K, Shahidi S, Tondari A. Bilateral bifid mandibular canal: report of two cases. Indian J Dent Res 2009;20(2):235–7. https://doi.org/10.4103/0970-9290.52889

Asghar A, Priya A, Ravi KS, Iwanaga J, Tubbs RS, Naaz S, et al. An evaluation of mandibular canal variations: a systematic review and meta-analysis. Anat Sci Int 2023;98(2):176–84. https://doi.org/10.1007/s12565-022-00682-7

Naitoh M, Hiraiwa Y, Aimiya H, Ariji E. Observation of bifid mandibular canal using cone-beam computerized tomography. Int J Oral Maxillofac Implants. 2009;24(1):155–9.

Shen E-C, Fu E, Ming-Jen Fu M, Peng M. Configuration and corticalization of the mandibular bifid canal in a Taiwanese adult population: a computed tomography study. Int J Oral Maxillofac Implants. 2014;29(4):893–7. https://doi.org/10.11607/jomi.3435

Naitoh M, Hiraiwa Y, Aimiya H, Gotoh M, Ariji Y, Izumi M, et al. Bifid mandibular canal in Japanese. Implant Dent. 2007;16(1):24–32. https://doi.org/10.1097/ID.0b013e3180312323

Olivier E. The inferior dental canal and its nerve in the adult. Br Dent J. 1928;49(5):356–8.

Rashid SA, Ali J, Al-Nakib L. Identification of bifid mandibular canals among Iraqi subjects using panoramic imaging system. J Bagh College Dent. 2011;23(4):79.

Scarfe WC, Farman AG. What is cone-beam CT and how does it work? Dent Clin N Am 2008;52(4):707–30. https://doi.org/10.1016/j.cden.2008.05.005

Zhou X, Gao X, Zhang J. Bifid mandibular canals: CBCT assessment and macroscopic observation. Surg Radiol. Anat. 2020;42:1073–9. https://doi.org/10.1007/s00276-020-02489-5

De Oliveira-Santos C, Souza PHC, De Azambuja Berti-Couto S, Stinkens L, Moyaert K, Rubira-Bullen IRF, et al. Assessment of variations of the mandibular canal through cone beam computed tomography. Clin Oral Investig. 2012;16:387–93. https://doi.org/10.1007/s00784-011-0544-9

Kang J-H, Lee K-S, Oh M-G, Choi H-Y, Lee S-R, Oh S-H, et al. The incidence and configuration of the bifid mandibular canal in Koreans by using cone-beam computed tomography. Imaging Sci Dent. 2014;44(1):53–60. https://doi.org/10.5624/isd.2014.44.1.53

Orhan K, Aksoy S, Bilecenoglu B, Sakul BU, Paksoy CS. Evaluation of bifid mandibular canals with cone-beam computed tomography in a Turkish adult population: a retrospective study. Surg Radiol Anat. 2011;33:501–7. https://doi.org/10.1007/s00276-010-0761-y

Rashsuren O, Choi J-W, Han W-J, Kim E-K. Assessment of bifid and trifid mandibular canals using cone-beam computed tomography. Imaging Sci Dent. 2014;44(3):229–236. https://doi.org/10.5624/isd.2014.44.3.229

Kuribayashi A, Watanabe H, Imaizumi A, Tantanapornkul W, Katakami K, Kurabayashi T. Bifid mandibular canals: cone beam computed tomography evaluation. Dentomaxillofac Radiol. 2010;39(4):235–9. https://doi.org/10.1259/dmfr/66254780

Okumuş Ö, Dumlu A. Prevalence of bifid mandibular canal according to gender, type and side. J Dent Sci. 2019;14(2):126–33. https://doi.org/10.1016/j.jds.2019.03.009

Dedeoglu N, Duman SB. Prevalence of bifid mandibular canals in Turkish Eastern Anatolia population: a retrospective study. J Clin Diagn Res. 2020;14(2):ZC13–7. https://doi.org/10.7860/JCDR/2020/42721.13508

Sonick M. A comparison of the accuracy of periapical, panoramic, and computerized yomographic radiogrphs in locating the mandibular canal. Int J Oral Maxillofac Implant. 1994;9:455–60.

Klinge B, Petersson A, Maly P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computed tomography. Int J Oral Maxillofac Implants. 1989;4(4):327–33.

Lindh C, Petersson A, Klinge B. Visualisation of the mandibular canal by different radiographic techniques. Clin Oral Implants Res. 1992;3(2):90–7. https://doi.org/10.1034/j.1600-0501.1992.030207.x

Motamedi MHK, Navi F, Sarabi N. Bifid mandibular canals: prevalence and implications. J Oral Maxillofac Surg. 2015;73(3):387–90. https://doi.org/10.1016/j.joms.2014.09.011

Ramanauskaite A, Becker J, Sader R, Schwarz F. Anatomic factors as contributing risk factors in implant therapy. Periodontol 2000. 2019;81(1):64–75. https://doi.org/10.1111/prd.12284

Wamasing P, Deepho C, Watanabe H, Hayashi Y, Sakamoto J, Kurabayashi T. Imaging the bifid mandibular canal using high resolution MRI. Dentomaxillofac Radiol. 2019;48(3):20180305. https://doi.org/10.1259/dmfr.20180305

Bilecenoglu B, Tuncer N. Clinical and anatomical study of retromolar foramen and canal. J Oral Maxillofac Surg. 2006;64(10):1493–97. https://doi.org/10.1016/j.joms.2006.05.043

Rossi AC, Freire AR, Prado GB, Prado FB, Botacin PR, Ferreira Caria PH: incidence of retromolar foramen in human mandibles: ethnic and clinical aspects. Int J Morphol. 2012;30(3):1074–8. https://doi.org/10.4067/S0717-95022012000300051

Shah SP, Mehta D. Mandibular retromolar foramen and canal – a systematic review and meta-analysis. Ann Maxillofac Surg. 2020;10(2):444–9. https://doi.org/10.4103/ams.ams_19_20

Vranckx M, Geerinckx H, Gaêta-Araujo H, Leite AF, Politis C, Jacobs R. Do anatomical variations of the mandibular canal pose an increased risk of inferior alveolar nerve injury after third molar removal? Clin Oral Investig. 2022;26(1):931–7. https://doi.org/10.1007/s00784-021-04076-3

Afsa M, Rahmati H. Branching of mandibular canal on cone beam computed tomography images. Singapore Dent J. 2017;38:21–5. https://doi.org/10.1016/j.sdj.2016.10.005

Von Arx T, Bornstein MM. The bifid mandibular canal in three-dimensional radiography: morphologic and quantitative characteristics. Swiss Dent J. 2021;131(1):10–28. https://doi.org/10.61872/sdj-2021-01-01

Komal A, Bedi RS, Wadhwani P, Aurora JK, Chauhan H. Study of normal anatomy of mandibular canal and its variations in Indian population using CBCT. J Maxillofac Oral Surg. 2020;19:98–105. https://doi.org/10.1007/s12663-019-01224-x

Gerlach NL, Ghaeminia H, Bronkhorst EM, Bergé SJ, Meijer GJ, Maal TJJ. Accuracy of assessing the mandibular canal on cone-beam computed tomography: a validation study. J. Oral Maxillofac Surg. 2014;72(4):666–71. https://doi.org/10.1016/j.joms.2013.09.030

Alali Y, Mohammed W, Alabulkarim M, Alshahrani A, Almawh A. Assessment of bifid mandibular canals using cone beam computed tomography in general population: a retrospective evaluation. Eur Rev Med Pharmacol Sci. 2024;28(5):1741–50. https://doi.org/10.26355/eurrev_202403_35587

Varvara G, Feragalli B, Turkyilmaz I, D’Alonzo A, Rinaldi F, Bianchi S, et al. Prevalence and characteristics of accessory mandibular canals: a cone-beam computed tomography study in a European adult population. Diagnostics. 2022;12(8):1885. https://doi.org/10.3390/diagnostics12081885

Direk F, Uysal II, Kivrak AS, Dogan NU, Fazliogullari Z, Karabulut AK. Reevaluation of mandibular morphometry according to age, gender, and side. J Craniofac Surg. 2018;29(4):1054–9. https://doi.org/10.1097/SCS.0000000000004293

Von Arx T, Hänni A, Sendi P, Buser D, Bornstein MM. Radiographic study of the mandibular retromolar canal: an anatomic structure with clinical importance. J Endod. 2011;37(12):1630–5. https://doi.org/10.1016/j.joen.2011.09.007

Saiman K, Jothi R, Nordin R, Nazimi A, Ramli R. Anatomical variations of inferior alveolar nerve as potential risk factor for nerve injury during bilateral sagittal split osteotomy. Malays J Oral Maxillofac Surg. 2010;8:159.

Maqbool A, Ali Sultan A, Battista Bottini G, Hopper C. Pain caused by a dental implant impinging on an accessory inferior alveolar canal: a case report. Int J Prosthodont. 2013;26(2);125–6. https://doi.org/10.11607/ijp.3191

Wyatt WM. Accessory mandibular canal: literature review and presentation of an additional variant. Quintessence Int. 1996;27(2):111–3.

Verea Linares C, Mohindra A, Evans M. Haemorrhage following coronectomy of an impacted third molar associated with a bifid mandibular canal: a case report and review of the literature. Oral Surg. 2016;9(4):248–51. https://doi.org/10.1111/ors.12206

Valenzuela-Fuenzalida J, Cariseo C, Gold M, Díaz D, Orellana M, Iwanaga J. Anatomical variations of the mandibular canal and their clinical implications in dental practice: a literature review. Surg Radiol Anat. 2021;43:1259–72. https://doi.org/10.1007/s00276-021-02708-7

Nicol P, Loncle T, Pasquet G, Vacher C. Surgical implications of the anatomic situation of the mandibular canal for mandibular osteotomies: a cone beam computed tomographic study. Surg Radiol Anat. 2020;42:509–14. https://doi.org/10.1007/s00276-019-02379-5

Sekerci AE, Sahman H. Cone beam computed tomographic analyses of the position and course of the mandibular canal: relevance to the sagittal split ramus osteotomy. Biomed Res Int. 2014;2014(1):945671. https://doi.org/10.1155/2014/945671

Auluck A, Pai KM, Mupparapu M. Multiple mandibular nerve canals: radiographic observations and clinical relevance. Report of 6 cases. Quintessence Int. 2007;38(9):781–7.

Published

2025-05-13