• The Journal of Advanced Prosthodontics
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• v.9 no.6
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• pp.470-475
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• 2017

PURPOSE. The purpose of this study was to identify the complex course of the mandibular canal using 3D reconstruction of microCT images and to provide the diagram for clinicians to help them understand at the interforaminal region in Korean. MATERIALS AND METHODS. Twenty-six hemimandibles obtained from cadavers were examined using microCT, and the images were reconstructed. At both the midpoint of mental foramen and the tip of anterior loop, the bucco-lingual position, the height from the mandibular inferior border, the horizontal distance between two points, and position relative to tooth site on the mandibular canal were measured. The angle that the mental canal diverges from the mandibular canal was measured in posterior-superior and lateral-superior direction. RESULTS. The buccal distance from the mandibular canal was significantly much shorter than lingual distance at both the mental foramen and the tip of anterior loop. The mandibular canal at the tip of anterior loop was significantly located closer to buccal side and higher than at the mental foramen. And the mental canal most commonly diverged from the mandibular canal below the first premolar by approximately $50^{\circ}$ posterior-superior and $41^{\circ}$ lateral-superior direction, which had with a mean length of 5.19 mm in front of the mental foramen, and exited to the mental foramen below the second premolar. CONCLUSION. These results suggest that it could form a hazardous tetrahedron space at the interforaminal region, thus, the clinician need to pay attention to the width of a premolar tooth from the mental foramen during dental implant placement.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.226-229
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• 2006

The interforaminal region is usually considered as a safe region in the chin bone graft without important vital anatomical structures to be damaged. But the accurate anatomy of the interforaminal region, with its potential clinical relationships, is controversial. Moreover some complications suggesting damage of incisive terminal branches after chin bone harvesting are reported such as sensory discomfort and pain etc. In order to verify incisive innervation of symphyseal area, we examined the cross-sectional CT scan images taken for preoperative planning of implant placement with chin bone graft and some parameters were measured; (1) visuality rating of incisive canal (2) vertical and horizontal diameter of canal (3) distance from lower border of the incisive canal to the lower border of the mandible (4) shortest distance from anterior border of the incisive canal to the anterior border of the mandible. We report the positive outcome that decrease the complications related with the damages of incisive branch during bone harvesting from the chin.

• Imaging Science in Dentistry
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• v.46 no.2
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• pp.69-75
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• 2016

Purpose: Sufficient area in the interforaminal region is required for dental implant placement, and the anterior loop of the mandibular canal is located within the limits of this area. The aim of this study was to evaluate the prevalence and extent of the anterior loop in a Brazilian sample population using cone-beam computed tomography (CBCT). Materials and Methods: CBCT images from 250 patients (500 hemimandibles) obtained for various clinical indications were randomly selected and evaluated to determine the presence and length of the anterior loop. The length of the anterior loop was then compared based on gender, age, and the side of the mandible. The data were analyzed using the Pearson chi-square test and linear regression analysis. Results: An anterior loop was identified in 41.6% of the cases, and its length ranged from 0.25 mm to 4.00 mm (mean, $1.1{\pm}0.8mm$). The loop had a greater mean length and was significantly more prevalent in males (p=0.014). No significant differences were found between the right and left sides regarding length (p=0.696) or prevalence (p=0.650). Conclusion: In this study, a high prevalence of the anterior loop of the mandibular canal was found, and although its length varied greatly, in most cases it was less than 1 mm long. Although this is a prevalent anatomical variation, safety limits for the placement of implants in this region cannot be established before an accurate evaluation using imaging techniques in order to identify and preserve the neurovascular bundles.

• Imaging Science in Dentistry
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• v.46 no.3
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• pp.159-165
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• 2016

Purpose: The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. Materials and Methods: Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. Results: In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. Conclusion: CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region.

• The Journal of Korean Academy of Prosthodontics
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• v.45 no.5
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• pp.633-643
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• 2007

Statement of problem: Recently there are on an increasing trend of using implants-especially in edentulous mandible of severly alveolar bone recessed. Purpose: The aim of this study was to analyze the displacement and stress distribution of various mandibular implant-retained overdenture models supported by two implants in interforaminal region under the occlusion scheme load. Material and method: FEA models were made by the 3D scanning of the edentulous mandibular dentiform. The three models were named as Model M1, M2, and M3 accord ing to the position of implants: M1, Lt. incisor area, M2, Canine area, and M3, 1st Premolar area. Inter-implant angulation model was named as M4. Conventional complete denture was named M5 and used as a control group. Ball implant and Gold matrice were used as a retentive anchors. The occlusion type loads were applied horizontally over each tooth. Results: 1. In mandibular implant retained overdenture Canine Protected Occlusion type load resulted in higher levels of stress to the implants and female matrices than other types of loads. 2. The overdenture model M1, with implants in lateral incisor areas resulted in lower stress concentration to the implants and female matrices than other models. 3. In mandibular implant retained overdenture the stresses of the implant and female matrice were lower in mesially inclined implant than these of parallel installed implant. Conclusion: Lateral incisor areas could be the best site for the implants in mandibular implant-retained overdenture. The mandibular implant retained overdenture models mentioned above showed to the lowest stress to the implants and female matrices.

• The Journal of Korean Academy of Prosthodontics
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• v.40 no.5
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• pp.507-524
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• 2002

Load transfer of implant overdenture varies depending on anchorage systems that are the design of the superstructure and substructure and the choice of attachment. Overload by using improper anchorage system not only will cause fracture of the framework or screw but also may cause failure of osseointegration. Choosing anchorage system in making prosthesis, therefore, can be considered to be one of the most important factors that affect long-term success of implant treatment. In this study, in order to determine the effect of anchorage systems on load transfer in mandibular implant overdenture in which 4 implants were placed in the interforaminal region, patterns of stress distribution in implant supporting bone in case of unilateral vertical loading on mandibular left first molar were compared each other according to various types of anchorage system using three-dimensional photoelastic stress analysis. The five photoelastic overdenture models utilizing Hader bar without cantilever using clips(type 1), cantilevered Hader bar using clips(type 2), cantilevered Hader bar with milled surface using clips(type 3), cantilevered milled-bar using swivel-latchs and frictional pins(type 4), and Hader bar using clip and ERA attachments(type 5), and one cantilevered fixed-detachable prosthesis(type 6) model as control were fabricated. The following conclusions were drawn within the limitations of this study, 1. In all experimental models. the highest stress was concentrated on the most distal implant supporting bone on loaded side. 2. Maximum fringe orders on ipsilateral distal implant supporting bone in a ascending order is as follows: type 5, type 1, type 4, type 2 and type 3, and type 6. 3. Regardless of anchorage systems. more or less stresses were generated on the residual ridge under distal extension base of all overdenture models. To summarize the above mentioned results, in case of the patients with unfavorable biomechanical conditions such as not sufficient number of supporting implants, short length of the implant and unfavorable antero-posterior spread. selecting resilient type attachment or minimizing distal cantilever bar is considered to be appropriate methods to prevent overloading on implants by reducing cantilever effect and gaining more support from the distal residual ridge.

• The Journal of Korean Academy of Prosthodontics
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• v.45 no.1
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• pp.34-47
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• 2007

Statement of problem: Conventional mandibular complete denture lacks in support and stability for edentulous patients to use. Purpose: To enhance support and stability of mandibular complete denture, 2 implants were inserted on the inter-mental foramina space of edentulous patients. With 2 magnetic attachments on the inner side of the overdenture, we gave immediate loads and evaluated the stability of the implants, the responses of the supporting tissues, and the satisfaction of the patients. Material & methods: 6 edentulous patients (5 male, 1 female) each recieved 2 SLA implants in the inter-mental foramina region and implants were immediately loaded with overdenture with magnet attachments. To evaluate the implants stability and the peri-implant tissues, clinical exams, RFA tests and radiographic exams were preformed at the 1 week, 2wks, 6wks, 12wks, and 24wks. post- surgery. Results: The mean surgery time was $45.7{\pm}7.7mins$., while the denture delivery time was $45.5{\pm}12.6mins$. Only 2 of 14 implants were failed. Survived implants that remained were clincally and radiographically stable. Mean ISQ values were relatively stable, showing $69.71{\pm}5.55$, $69.00{\pm}9.48$, $67.92{\pm}7.86$, $67.92{\pm}9.58$, $70.08{\pm}7.61$, $71.92{\pm}6.43$ at the 1 wk, 2 wks, 6 wks, 12 wks, 24 wks. follow up check. Crestal bone changes were $-1.18mm{\pm}0.68mm$, $-1.35{\pm}0.69mm$, $-1.47{\pm}0.68mm$ at the 6wks, 12wks, 24wks. follow up check. Bleeding on probing(BOP index) was not significant. Conclusion: Mandibular ovedentures with 2 magnetic attachments over two interforaminal implants on edentulous patients for immediate function is a recommendable novel treatment for edentulous patients which shows stability on the implants and supporting tissue.