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Evaluation of the distribution characteristics of the mandibular lingual foramen and its potential risks during implant surgery using cone-beam computed tomography a cross-sectional, retrospective study.

OBJECTIVES
The lingual foramen is a risk factor for implantation and other mandibular surgeries, but there are few systematic studies on the anatomical and distribution characteristics of the lingual foramen in the entire mandible.


MATERIALS AND METHODS
A retrospective study was performed using 405 CBCT images. The anatomical characteristics and symmetrical distribution of the mandibular lingual foramen were analyzed.


RESULTS
All patients had at least one lingual foramina. According to the positional relationship between the mandibular lingual foramen and the root apex of tooth, the mandibular lingual foramen is divided into the upper lingual foramen and the lower lingual foramen. Upper lingual foramen were divided into three types according to its running direction, namely Type 1 (Enters the mandible and descend in the direction of the lower edge of the mandible), Type 2 (Enters the mandible and descends in the direction of the lower edge of the mandible with branches), and Type 3 (It enters the mandible and divides into two branches, one ascends toward the crest of the alveolar ridge, and the other descends toward the lower edge of the mandible). And their respective prevalence are 84.0% [95% Tolerance Limit (TL) 81.2%-86.8%], 9.9% [95% TL 7.6%-12.1%], and 6.1% [95% TL 4.3%-8.0%]. In addition, the 81.8% [95% TL 79.0%-84.7%] of the upper lingual foramen is distributed in the central incisor area. Lower lingual foramen were divided into three categories according to the running direction, namely Category 1 (Enters the mandible and ascends toward the buccal bone plate), Category 2 (Enters the mandible and descends toward the buccal bone plate), and Category 3 (Go straight into the mandible toward the buccal bone plate). And their respective prevalence are 29.6% [95% TL 26.4%-32.7%], 50.9% [95% TL 47.5%-54.4%] and 19.5% [95% TL 16.8%-22.3%]. The frequency of lower lingual foramen distributed anteriorly to the mental foramen is 55.8% [95% TL 52.3%-59.2%], mid-mental foramen is 21.4%[95% TL 18.5%-24.2%], and posterior to the mental foramen is 22.8% [95% TL 20.0%-25.8%].


CONCLUSION
Both the upper and lower lingual foramina should be evaluated in the anterior, middle, and posterior regions of the mental foramen before implant surgeries.