Proximity of the Mental Foramen to the Tooth Apex

Posterior mandibular endodontic surgery is commonly performed in the vicinity of the mental foramen. If the endodontic surgeon is not conscientious about the position of the mental foramen, iatrogenic neurological complications could potentially occur. Previously, many studies have been performed examining both dry skulls and conventional dental radiographs to evaluate the position of the mental foramen, wheras no study has been published utilizing CBVT to examine the position of the mental foramen. In this study fifty CBVT scans were obtained from a dental specialty practice limited to Endodontics and dental implants. These scans were taken for purposes not related to this study on a Kodak 9000 CBVT machine (Carestream Dental, Rochester, NY), and the scans were interpreted using Kodak Carestream specialized software. The mental foramen was identified and measurements made from the superior aspect of the mental foramen to the radiographic apex of the mandibular first premolar, second premolar, and mesial root of the first molar. The mental foramen was found to be most commonly located in between the mandibular first and second premolars and inferior to the apex of the mandibular second premolar. However, many exceptions were observed, and the location of the mental foramen could be described as variable. No significant differences were found based on age or gender regarding the location of the mental foramen. Therefore, due to the variable nature of the location of the mental foramen as detected by CBVT measurement, reliance upon statistical averages for the mental foramen location may mislead the clinician, potentially leading to undesirable neurological complications. Therefore, the endodontic surgeon should consider obtaining a preoperative CBVT scan prior to a posterior mandibular surgical procedure.