Keywords
Cone-beam computed tomography, mandibular nerve, mental foramen.
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Waghadkar AR and Lohe VK. Assessment and comparison of age-related three-dimensional variation in the anterior loop of the inferior alveolar nerve for pre-surgical planning [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:1386 (https://doi.org/10.12688/f1000research.135336.1)
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Study Protocol
Assessment and comparison of age-related three-dimensional variation in the anterior loop of the inferior alveolar nerve for pre-surgical planning
[version 1; peer review: 1 approved with reservations]
PUBLISHED 20 Oct 2023
OPEN PEER REVIEW
REVIEWER STATUS
This article is included in the Datta Meghe Institute of Higher Education and Research collection.
Abstract
Corresponding author:
Abhilasha Ramesh Waghadkar
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2023 Waghadkar AR and Lohe VK.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Waghadkar AR and Lohe VK. Assessment and comparison of age-related three-dimensional variation in the anterior loop of the inferior alveolar nerve for pre-surgical planning [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:1386 (https://doi.org/10.12688/f1000research.135336.1)
First published: 20 Oct 2023, 12:1386 (https://doi.org/10.12688/f1000research.135336.1)
Latest published: 20 Oct 2023, 12:1386 (https://doi.org/10.12688/f1000research.135336.1)
Introduction
The mental neurovascular bundle crosses the inferior alveolar nerve’s anterior loop, located before the Mental Foramen (M.F) then turns around to exit the M. F. This anatomic variance must be taken into consideration when surgical operations on the anterior mandible are planned. Osteotomy, bone harvesting, and dental implant placement are all considered safe elective procedures.1
The human face has high innervations. The fifth cranial nerve, the Trigeminal nerve, regulates face sensibility. The trigeminal ganglion is located in the Middle Cranial Fossa of the Sella Turcica, and is the origin of the trigeminal nerve’s sensory branch. The Ophthalmic, Maxillary, and Mandibular branches, in turn, innervate the top, middle, and lower three-quarters of the head. The Mandibular nerveis the 3rd branch of the trigeminal nerve. Which enters the mandible via the mandibular foramen.1 The Inferior Alveolar Nerve is the nerve that passes Via use of the M.F. The inferior alveolar nerve’s terminal portion can rarely cross through the mental foramen’s lower border and continue as an intra-osseous anterior loop. Despite being a benign anatomical variation, it needs to be accurately identified in order to plan surgery that involves the insertion of implants as well as anterior mandibular operations such as genioplasty, mandibular premolar root extraction, chin bone harvesting, and surgical rehabilitation after mandibular injury.2
The standard of therapy for edentulous mandibles is to insert dental implants in the anterior mandible. There were anatomical hazards in the anterior mandible, despite the surgery being usually viewed as safe.3 With the advent of endosseus, replacing lost teeth with dental implants has become a very predictable medical option. The gold standard of treatment for edentulous mandibles was the installation of implants in the front mandible. Although the procedure is generally viewed as safe, there are some anatomical difficulties in using the front mandible.5 The most significant anatomical risk will be the potential for the IAN anterior loop, which emerges through the M.F.If the I.A.N. is not detected before surgery, there may be iatrogenic nerve harm. An injury to the A.L. would lead to damage to the mental nerves. As a result, the mental nerve can become anesthetized, experience paraesthesia, or encounter dysesthesia.6 The labiodental region and the gingiva up to the second premolar on the jaw are both detectable by the mental nerve. It could be tricky to carry out regular activities like eating, speaking, and even brushing your teeth if there is a changed sensation in this area.6
C.B.C.T. should provide a number of advantages over multi-slice computed tomography, including the capacity to assess craniofacial traits in three dimensions (3D) without distortion or overlapping pictures.7 Preventing sensorineural injury in the interforaminal region requires accurate neurovascular bundle identification and protection.
Methods
Ethical considerations
The study proposal was approved by “Institutional Ethics Committee” of DMIMSDU, Sawangi (meghe), Wardhawith Ref. No. DMIHER (DU)/IEC/2023/855 on 31/03/2023.
Materials
Patients will be selected as per the inclusions and exclusion criteria. This study will be done using Cone Beam Computed Tomography. The study will be conducted at Sharad Pawar Dental College, Sawangi (Meghe), Wardha, in the Dept. of Oral Medicine and Radiology.
Inclusion criteria
1. Patients between the ages of 16 and 65 years.
2. The CBCT scan must show teeth at the mandibular frontal region on both sides, up to 2-3 cm from the foramen mental.
3. The mandibular canal and mental foramen siteswhich cannot be altered by pathological changes.
4. There is no sign of any surgery or trauma that would have changed the mandibular canal’s or the mental foramen’s position.
Procedure
Patients reporting to the Department of Oral Medicine and Radiology will be approached to take part. Those who are willing to participate in the study and give written informed consent will be included in the study (see Extended data for the sample consent form9).
After satisfying the inclusion and exclusion criteria (via medical records), patients will be taken for C.B.C.T. imaging. The three-dimensional PLANMECA proMax C.B.C.T. equipment with an exposure period of 11.30 s, a tube voltage of 90 kV, a current in a tube of 5 mA, and a cylindrical F.O.V. measuring 17mm 13mm with a voxel size of 300 will be used to acquire the C.B.C.T. pictures. To standardize the image selection criterion, the F.O.V. will be the same throughout all scans. Each picture should be af 90μm, and a single 360-degree scan will be used. All the scans will be taken with the subject’s head in an upright position and the patient will be instructed to make molars to molars contact and to breathe from their nose.
Data analysis
The occlusal plane will be horizontally positioned to the scan plane. The cantered plane will be the midsagittal plane. The planes on the CBCT pictures’ three axes (X,Y,Z) will be analyzed in order. All of the images’ contrast and brightness will be kept constant for consistency during image analysis. All images will be evaluated under the best viewing conditions using picture viewing software PLANMECA pro-Max.Each volume’s axial slice will be rebuilt on the specified axial slice and parallel to the mandible’s lower edge. The most anterior section of the IAN and the MF most anterior segment will be marked & length will be measured using PLANMECA pro-Max software.
Sample size calculation
Cochian Formula for Sample Size:
Where;
Zαl2 is the level of significance at 5%, i.e. 95% .confidenece interval = 1.96
P = prevalence of inferior alveolar nerve anterior loop = 22% = 0.22
d = desired error of margin = 10% = 0.10
Study Reference:8
Discussion
Key Result
There are positions of the MC laterally in women, especially at the level of the premolars, that have been discovered to be significantly and clinically relevant correlated as observed on CBCT.
Interpretation
In research by Baratollah Shaban et al. 20172 71 patients’ CBCT scans were used. There are three main anatomical variations of the IAN anterior loop. Type I: The incisive branch thickness is comparable to that of the main branch, and the anatomy is Y-shaped.
Edudara Helena Leandro do Nascimento et al. 20163 employed CBCT on 250 patients; it was possible to determine the frequency and severity of anterior loop in a Brazilian population. Gender, age, and mandibular side were taken into consideration while contrasting the anterior loop’s length.
Juan Muileno Lorenzo et al. 20154 compared the MF and AMF visualization capabilities of CBCT and panoramic radiograph and used CBCT to examine the supplementary mental foramen’s existence and the anatomic characteristics of the MF. The sample for the study included CBCT and PAN tests were performed on 357 individuals. The average AMF area in the study was between 1.5 and 2 mm.
Fereidoumparnia et al. 20125 determined that it is risky to suggest any particular medial distance from the mental foramen after conducting a study on 96 patients using CBCT to evaluate the Anatomical landmarks in the mandibular: their appearance, visibility, placement, and course inter-foraminal region. The diameter of the canal and foramen should be evaluated separately for each person in order to choose the appropriate location.
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CITE
how to cite this article
Waghadkar AR and Lohe VK. Assessment and comparison of age-related three-dimensional variation in the anterior loop of the inferior alveolar nerve for pre-surgical planning [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:1386 (https://doi.org/10.12688/f1000research.135336.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Open Peer Review
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 20 Oct 2023
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How to cite this report:
Hadidi YNE. Reviewer Report For: Assessment and comparison of age-related three-dimensional variation in the anterior loop of the inferior alveolar nerve for pre-surgical planning [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:1386 (https://doi.org/10.5256/f1000research.148450.r241484)
The direct URL for this report is:
https://f1000research.com/articles/12-1386/v1#referee-response-241484
https://f1000research.com/articles/12-1386/v1#referee-response-241484
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 04 Mar 2024
Yasser Nabil El Hadidi,
Ain Shams University, Cairo, Egypt
Approved with Reservations
VIEWS 13
Dear author
The current manuscript presents an interesting study.
Pros
Detail of changes with age regarding position of anterior looping based on CBCT data.
Cons
No mention of previous similar studies.Introductions need more enriching by similar ... Continue reading
The current manuscript presents an interesting study.
Pros
Detail of changes with age regarding position of anterior looping based on CBCT data.
Cons
No mention of previous similar studies.Introductions need more enriching by similar ... Continue reading
CITE
HOW TO CITE THIS REPORT
Hadidi YNE. Reviewer Report For: Assessment and comparison of age-related three-dimensional variation in the anterior loop of the inferior alveolar nerve for pre-surgical planning [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:1386 (https://doi.org/10.5256/f1000research.148450.r241484)
The direct URL for this report is:
https://f1000research.com/articles/12-1386/v1#referee-response-241484
https://f1000research.com/articles/12-1386/v1#referee-response-241484
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Author Response 19 Dec 2024Dr. Abhilasha Waghadkar, Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India19 Dec 2024Author ResponseOk respected sir..Competing Interests: No competing interests were disclosed.
COMMENTS ON THIS REPORT
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Author Response 19 Dec 2024Dr. Abhilasha Waghadkar, Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India19 Dec 2024Author ResponseOk respected sir..Competing Interests: No competing interests were disclosed.
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