How to Avoid Hitting the Mental Foramen Nerve?

1. Dr. Mehdi Jafari Says:
   August 12th, 2007 at 11:51 am

   When we talk about the anterior loop, we mean ‘‘an extension of the inferior alveolar nerve, anterior to the mental foramen’’. Some investigators have also referred to it as the anterior loop of the mental nerve, or described it as the mental neurovascular bundle traversing inferiorly and anteriorly to the mental foramen, which then doubles or loops back to exit the mental foramen. Detection and measurement of the anterior loop was attempted using a variety of diagnostic methods e.g. panoramic films of markers in dried skulls and cadaver mandibles, periapical films of cadaver jaws, and CT scans of patients and surgical cadaver dissections. Clinicians in doubt concerning the position of the mental foramen or who are considering placing an implant in the foraminal region at a depth where there is unease about not having a 2-mm clearance coronal to a location where an anterior loop exists should obtain a CT scan prior to implant placement to avoid injury of the inferior alveolar or mental nerve, however, the mental foramen’s location can be surgically verified. Evidence indicates that an anterior loop is present. It has been detected radiographically and by cadaver dissection; however, its size is debatable. In general, radiographic studies indicated that the anterior loop may be as long as 7.5 mm. Those who are still unwilling to accept the scientific facts can be referred to the following literature:
   1) Solar P et al. A classification of the intraosseous paths of the mental nerve. Int J
   Oral Maxillofac. Implants 1994; 9:339-344
   2) Mardinger O. et al. Anterior loop of the mental canal: An anatomical-radiologic study. Implant Dent 2000; 9:120-125.
   3) Jacobs R et al. Appearance, location, course, and morphology of the mandibular incisive canal: An assessment on spiral CT scan. Dentomaxillofac. Radiol. 2002; 31:322-327.
   4) Kieser J et al. Patterns of emergence of the human mental nerve. Arch Oral Biol 2002; 47:743-747.
   5) Kuzmanovic DV et al. Anterior loop of the mental nerve: A morphological and radiographic study. Clin Oral Implants Res 2003; 14:464-471
   6) Jacobs R, et al. Appearance of the mandibular incisive canal on panoramic radiographs. Surg Radiol. Anat. 2004; 26:329-333.