Assessment of the distance between root apices of mandibular posterior teeth and the mandibular canal: A cone beam computed tomographic study in an Indian subpopulation

INTRODUCTION. The mandibular canal (MC) is a critical anatomical structure that houses the inferior alveolar nerve (IAN). Its juxtaposition to the apices of the mandibular posterior teeth has significant clinical consequences for dental implant placement and endodontic procedures. Despite its importance, limited data exist on its anatomical variations in the Eastern Indian population.
AIM. This study aimed to evaluate the distances between the MC and root apices of mandibular premolars and molars, considering age and sex differences.
MATERIALS AND METHODS. This retrospective Cone Beam Computed Tomography (CBCT)-based observational study included 111 participants aged 18–50 years. Distances from the MC to the root apices of mandibular premolars and molars were measured using CBCT scans. Spearman’s correlation test was employed to assess the relationship between age and the measured distances. Distances between genders were compared using the Mann-Whitney test, and Friedman’s ANOVA analyzed intragroup variations. An alpha level of five percent was considered as a level of statistical significance.
RESULTS. A positive correlation was observed between age and the distance from the MC to root tips. Males exhibited greater distances compared to females. Significant pairwise comparisons showed differences between the second premolar and both roots of the first and second molars. No discernible differences were found between sides (right versus left). Notably, molar root tips, especially second molars were closest to the MC, with distal roots showing the greatest variability.
CONCLUSIONS. The study emphasizes the necessity of precise preoperative evaluations in endodontics and implantology to reduce the incidence of IAN injuries by highlighting age-related increases in the MC to tooth root apices distances, especially in males.

1. Drake R.L., Vogl W., Mitchell A.W.M. Gray’s Anatomy for Students. 4th ed. Elsevier; 2020. 856 p.

2. Kabak S.L., Zhuravleva N.V., Melnichenko Y.M. Topography of the inferior alveolar nerve in human embryos and fetuses. An histomorphological study. J Oral Res. 2017;(11):291–298. https://doi.org/10.17126/joralres.2017.082

3. Koivisto T., Chiona D., Milroy L.L., McClanahan S.B., Ahmad M., Bowles W.R. Mandibular canal location: Cone-beam computed tomography examination. J Endod. 2016;42(7):1018–1021. https://doi.org/10.1016/j.joen.2016.03.004

4. Bürklein S., Grund C., Schäfer E. Relationship between root apices and the mandibular canal: A cone-beam computed tomographic analysis in a German population. J Endod. 2015;41(10):1696–1700. https://doi.org/10.1016/j.joen.2015.06.016

5. Manrique P., Agurto A., Guerrero M.E. CBCT study of root apices distance to mandibular canal in Peruvian population. Odovtos. 2023;25(2):144–154. Available at: https://www.scielo.sa.cr/pdf/odovtos/v25n2/2215-3411-odovtos-25-02-144.pdf (accessed: 19.10.2024).

6. Libersa P., Savignat M., Tonnel A. Neurosensory disturbances of the inferior alveolar nerve: a retrospective study of complaints in a 10-year period. J Oral Maxillofac Surg. 2007;65(8):1486–1489. https://doi.org/10.1016/j.joms.2007.03.023

7. Sedaghatfar M., August M.A., Dodson T.B. Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg. 2005;63(1):3–7. https://doi.org/10.1016/j.joms.2004.05.217

8. Hiremath H., Verma D., Khandelwal S., Solanki A.S., Patidar S. Evaluation of titanium mesh and fibers in reinforcing endodontically treated molars: An in vitro study. J Conserv Dent. 2022;25(2):189–192. https://doi.org/10.4103/jcd.jcd_601_21

9. Yu I.H., Wong Y.K. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images. Int J Oral Maxillofac Surg. 2008;37(6):521–528. https://doi.org/10.1016/j.ijom.2008.03.003

10. Srivastava S., Alharbi H.M., Alharbi A.S., Soliman M., Eldwakhly E., Abdelhafeez M.M. Assessment of the proximity of the inferior alveolar canal with the mandibular root apices and cortical plates – A retrospective cone beam computed tomographic analysis. J Pers Med. 2022;12(11):1784. https://doi.org/10.3390/jpm12111784

11. Simonton J.D., Azevedo B., Schindler W.G., Hargreaves K.M. Age- and gender-related differences in the position of the inferior alveolar nerve by using cone beam computed tomography. J Endod. 2009;35(7):944–949. https://doi.org/10.1016/j.joen.2009.04.032

12. Swasty D., Lee J.S., Huang J.C., Maki K., Gansky S.A., Hatcher D., Miller A.J. Anthropometric analysis of the human mandibular cortical bone as assessed by cone-beam computed tomography. J Oral Maxillofac Surg. 2009;67(3):491–500. https://doi.org/10.1016/j.joms.2008.06.089

13. Dager M.M., McNamara J.A., Baccetti T., Franchi L. Aging in the craniofacial complex: Longitudinal dental arch changes through the sixth decade. Angle Orthod. 2008;78(3):440–444. https://doi.org/10.2319/031607-136.1

14. Balaji S.M., Krishnaswamy N.R., Kumar S.M., Rooban T. Inferior alveolar nerve canal position among South Indians: A cone beam computed tomographic pilot study. Ann Maxillofac Surg. 2012;2(1):51–55. https://doi.org/10.4103/2231-0746.95319

15. Oliveira A.C.S., Candeiro G.T.M., Pacheco da Costa F.F.N., Gazzaneo I.D., Alves F.R.F., Marques F.V. Distance and bone density between the root apex and the mandibular canal: A cone-beam study of 9202 roots from a Brazilian population. J Endod. 2019;45(5):538–542.e2. https://doi.org/10.1016/j.joen.2019.01.004

16. Pääsky E., Suomalainen A., Ventä I. Are women more susceptible than men to iatrogenic inferior alveolar nerve injury in dental implant surgery? Int J Oral Maxillofac Surg. 2022;51(2):251–256. https://doi.org/10.1016/j.ijom.2021.05.008

17. Shokry S.M., Alshaib S.A., Al Mohaimeed Z.Z., Ghanimah F., Altyebe M.M., Alenezi M.A. et al. Assessment of the inferior alveolar nerve canal course among Saudis by cone beam computed tomography (pilot study). J Maxillofac Oral Surg. 2019;18(3):452–458. https://doi.org/10.1007/s12663-018-1167-3

18. Pearson A.A. The early innervation of the developing deciduous teeth. J Anat. 1977;123(Pt 3):563–577.

19. Alves F.R., Coutinho M.S., Gonçalves L.S. Endodonticrelated facial paresthesia: systematic review. J Can Dent Assoc. 2014;80:e13.