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| Year : 2011 | Volume
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| Issue : 4 | Page : 542-546 |
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| Morphometrical and morphological study of mental foramen in dry dentulous mandibles of South Andhra population of India |
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Devi K Sankar, Sharmila P Bhanu, PJ Susan
Faculty of Medicine, Department of Anatomy, Narayana Medical College, Chinthareddypalem, Nellore, Andhra Pradesh, India
Click here for correspondence address and email
| Date of Submission | 04-Jan-2010 |
| Date of Decision | 27-Apr-2010 |
| Date of Acceptance | 16-Nov-2010 |
| Date of Web Publication | 26-Nov-2011 |
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 Abstract | | |
Background: Mental foramen (MF) is an anatomical structure of particular importance in local anesthesia and surgical procedures in terms of achieving effective mandibular nerve blocks and avoiding injuries to the neurovascular bundles.
Aim: To determine the morphometry and morphology of MF in south Andhra population of India, hitherto unreported.
Materials and Methods: Ninety dry dentulous mandibles of both sexes were examined for position, size, shape and number of MF.
Results: Various parameters investigated are, the horizontal distance between (1) symphysis menti and MF was 27.2 mm on right and 27.7 mm on the left, (2) MF and posterior border of ramus was 70.7 mm on both sides, vertical distance between (3) MF and inferior border of mandible was16.5 mm on right and 14.3 mm on left, (4) alveolar crest and MF was 13.7 mm on right and 16.4 on left, (5) distance between the MF and below the apex of premolar socket was +2.8 mm on right and +3.5 mm on left and above the socket was -2.8 mm on right and -2.7 mm on left. Occurrence of MF below the second premolar tooth was found to be highest (73.2%). Average size of MF was larger on left and its way of exit was in postero-superior direction. Shape of MF was round in 79% and oval in 21% and double MF was found in 8.9% of mandibles.
Conclusions: In the present study, most common position of MF was found below the apex of second premolar in 73.2% and between the second premolar and first molar in 19% of mandibles. The other morphometrical findings of this study may be implicated by dental practitioners and maxillofacial surgeons Keywords: Mental foramen, morphometry, mental anesthesia, apicocurretage of mandibular premolar, location of mental foramen
How to cite this article:
Sankar DK, Bhanu SP, Susan P J. Morphometrical and morphological study of mental foramen in dry dentulous mandibles of South Andhra population of India. Indian J Dent Res 2011;22:542-6 |
How to cite this URL:
Sankar DK, Bhanu SP, Susan P J. Morphometrical and morphological study of mental foramen in dry dentulous mandibles of South Andhra population of India. Indian J Dent Res [serial online] 2011 [cited 2021 Oct 19];22:542-6. Available from: https://www.ijdr.in/text.asp?2011/22/4/542/90290 |
Mental foramen (MF) is situated in anterolateral aspect of the body of the mandible which transmits mental nerve, artery and vein. Sensation from the skin of chin, lower lip and the labial mucosa is carried by mental nerve, a branch of the inferior alveolar nerve. [1] MF serves as an important anatomical land mark, the orientation and position of which facilitate surgical, local anesthetic and other invasive procedures for oral and maxillofacial surgeries. Understanding the anatomy of this region is essential for performing effective nerve blocks, and avoiding injuries to the neurovascular bundles. Identification of accurate anatomical position of MF is very important in periodontal surgery, flap operation of lower teeth, apicocurretage of mandibular premolars, retrograde amalgam filling, surgical orthodontics and other lower lip surgical procedures. For example, in apicocurretage of mandibular premolars, the dentist depends on the relation of the MF to the lower premolar and to the body of ramus, otherwise operation on the lower premolar may damage the mental nerve. The mental nerve injury can cause transitory or permanent sensitive, thermal and tactile changes in the areas of its innervations. [2],[3],[4]
The position of the MF has been studied by means of direct measurement on dry mandibles or by using radiographs of dry mandibles or patients. [5],[6],[7] Standard anatomical [1] and radiological textbooks [8] contain conflicting statements regarding the location of MF. Schaeffer [9] stated that the MF was located between the spaces of mandibular premolars. The position of MF may be present between the apex of lower premolars or below the apex of second premolar. [6],[10],[11] According to Tebo and Telford, [12] location of MF is present below the apex of the second mandibular premolar which was similar to the findings of Suresh et al. [13] Numerous data on the position of MF varies in different ethnic groups like British, [10] Chinese, [6] Indian, [14] Saudi Arabian population [15] and racial difference in the position of MF was reported by Green. [16] In view of these discrepancies among the various investigations, it is no surprise that there are repeated failures to locate the MF for injections and other operative surgeries. Knowledge of the most common position of the MF of a local population gives additional information in the mental nerve blocks and related mandibular surgeries.
The present study was undertaken to provide information on anatomical location, size and shape of MF of the South Andhra population of India hither to unreported. The results of this study may furnish a reference for dentists in clinical practices.
| Materials and Methods | |  |
Ninety dry dentulous adult mandibles, irrespective of their sex belonging to South Andhra population of India comprised the subjects for this study. The mandibles with premortem tooth loss were excluded because the MF comes closer to the alveolar crest margin or sometimes alveolar area itself due to alveolar bone resorption. Before measuring, mandibles were placed on a standard horizontal plane to which the lower border of the mandible get its most contact when vertical pressure is applied to the molars. [10],[11],[17],[18]
Various parameters were measured using Vernier caliper, metallic wire and scale on both the right and left sides. The distance between the MF to symphysis menti (SF), posterior border of the ramus (FR), alveolar crest (AF) and base (FB) were taken by a metallic wire parallel to the standard horizontal plane, after which it was measured by using a standard scale. Similarly the distance between apex of the alveolar socket and upper border of the MF was measured from the values of A1 and A2.
- SF between symphysis menti and most anterior margin of MF [Figure 1]
- FR between most anterior margin of MF and posterior border of ramus of mandible [Figure 1]
- FB between inferior margin of MF and inferior border of mandible perpendicular to horizontal plane [Figure 2]
- AF between the alveolar crest and inferior margin of MF, perpendicular to horizontal plane [Figure 2]
- A1 is the distance between alveolar crest to upper most point of MF [Figure 3] and
- A2 is the distance between the alveolar margins to the apex of second premolar socket [Figure 3].
In addition, size, shape, multiple foramina and direction of exit were also noted. The average size of the foramen was measured with the help of vernier caliper by measuring its maximum length and breadth. The mean values are expressed as mean±SD with 95% confidence intervals. Mean values on left and right sides were compared applying Student's 't' test using SPSS 12.0 statistical software. Proportions were compared using Pearson's χ2 test. | Figure 1: Location of mental foramen in relation to symphysis menti (SF) and posterior border of ramus (FR)
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 | Figure 2: Location of mental foramen in relation to inferior border of mandible (FB) and alveolar crest (AF)
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 | Figure 3: Relative difference between apex of lower second premolar socket and upper most point of mental foramen (A1-A2)
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| Results | | |
In relation to mandibular tooth, the position of the MF was below the apex of the second premolar teeth in 66 mandibles (73.2%). In seven mandibles (7.8%), it was found between second premolar and first molar and in 17 mandibles (19%) it was below the apex of the first molar teeth [Figure 4]. Relative position of MF was found to be along the long axis of a teeth or interdental space [Figure 4].
The distance between the MF and symphysis menti was 27.2±2.4 mm on right side (Right SF) and 27.7±2.4 mm on left side (Left SF) and the distance between the MF and posterior border of ramus was 70.7±4.2 mm on right side (Right FR) and 70.7±4.2 mm on left side (Left FR) [Table 1]. | Table 1: Morphometrical parameters of mental foramen and values are expressed in millimetres
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The results of the measurement between the MF and alveolar crest was 13.7±2.8 mm on right side (Right AF) and 16.4±2.9 mm on left side (Left AF) and between the MF and inferior border of body of mandible was 16.5±2.1 mm and 14.3±2.1 mm on right (Right FB) and left (Left FB) sides, respectively [Table 1].
The distance between apex of lower second premolar socket and upper most point of MF (A1-A2) was +2.813 mm on the right side in 48 mandibles and +3.571 mm on the left sides in 28 mandibles, in which the position of the MF was found below the apex of the second premolar sockets. In 23 mandibles, it was -2.826 mm on right side and in 42 mandibles; it was -2.762 mm on left side, in which the MF was above the apex of the socket [Table 2]. The χ2 value is highly significant and the P value is <0.004 | Table 2: Location of mental foramen of right and left side in relation to apex of premolar sockets
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The average size of the foramen was found to be larger on left side (3.3 mm) than the right sides (2.8 mm) and its usual way of exit was in a postero-superior direction in both the sides [Table 3].
Shape of the MF was visually recognized and analysed in which out of 90 mandibles, in 71 cases (78.9%) it was found to be round or circular shape and in 19 cases (21.1%) it was oval or elliptical. Generally, the margins of the foramen were smooth [Table 3].
Double mental foramina were found in some of the mandibles in addition to the normal MF. In this study, out of 90 mandibles, single MF was found in 82 (91.1%) mandibles and accessory mental foramina was seen in eight (8.9%) mandibles, in which openings were not of equal size [Figure 5].  | Figure 5: Mandible showing the double mental foramina (arrow) on right (R) and left (L) side
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| Discussion | | |
In human being the MF is usually a single opening on each side of the body of the mandible. However, in some cases there may be complete absence of MF or it may be in multiples. [19] Being an important landmark for dental surgical procedures, the location of MF should be known accurately in relation to premolars, molars, symphysis menti, posterior border of ramus, alveolar socket, alveolar crest and mandibular body. The reason for the difference in location could be due to the shape of the foramen itself. As this study was conducted in dry dentulous mandibles, the instances of premortem tooth loss mandibles were excluded due to the reason for its alveolar resorption which may also alter the position of MF. [20],[21]
In the present study, the common position of MF was below the apex of second premolar teeth with the occurrence of 73.2%. The previous investigations of position of MF was observed to be 68.58% in North Indian population, [13] 58.9% in Chinese population, [6] 52.9% in British mandibles, [10] 55.6% in Nigerians, [22] 45.3% in Saudi population, [15] 47.2% in Iranian population [23] and 56.1% in Kenyan African mandibles [24] [Graph 1].
In relation to apex of mandibular premolar sockets, MF on right side was situated in 53.3% below the level; 25.6% above the level and the remaining 21.2% situated at the level of apex of socket. While on the left side it was situated in 31.1% below the level; 46.7% above the level and the remaining 22.2% at the level of apex of socket.
On the whole in both right and left sides, the distance between the apex of premolar socket and upper most margin of MF (A1-A2) was showing positive values (+) in 76 mandibles i.e., the MF was below the apex of socket and negative values (-) in 65 mandibles in which the MF was above the apex of socket. This indicates that MF in most of the mandibles was situated below the apex of premolar sockets which was similar to the findings of Wang et al. [6] in Chinese mandibles.
The values of difference between A1 and A2 on the left side in this study showed the position of the MF present above the level of the socket in 46.7% of mandibles which coincides with the findings of Suresh et al. [13] in North Indian populations. Owing to this small distance between the apex of tooth socket and MF, there is possibility of damaging the mental nerve or inferior dental nerve during endodontic treatment like root canal filling. [25],[26]
The ratio of distances between symphysis menti to foramen (SF) and foramen to posterior border of ramus (FR) was 1:2.6 in our study, which when compared with North Indian population was 1:1.3, [13] 1:2.6 in Chinese [6] and 1:2.7 in British mandibles. [10] Green RM [16] reported that the location of the MF is more anterior in the Caucasoid group which is similar to our findings.
In relation to the shape of MF, the ratio between oval and circular types of MF was 1:3.7 in this study. It was found to be 1:3 by Suresh et al. [13] in North Indian population and 1:1.9 by Gershchenson et al. [14] which he studied in two-thirds of Israeli and one-third of Indian mandibles.
In the present study double mental foramina were found to be 5.6% on the right and 3.3% on the left side. Triple and more than that were not found in this study. Gershchenson et al. [14] reported 7.51% of double foramina in Indian and Israeli mandibles. Suresh et al. [13] and Zografos and Mutzuri [27] studied the incidence of double foramina in 11.48% of North Indians and 6.68% of Greek population, respectively. However, in 2.17% of North Indian mandibles triple MF was also reported by Suresh et al. [13] A very rare occurrence of absence of MF was reported by de Frietas et al. [7]
Kjaer [28] has found that the prenatal location of the MF is in the alveolar bone between the primary canine and first molar which may be altered due to a lag in prenatal development. The location of the MF may also change with age and loss of teeth due to alveolar bone resorption.
Thus, size, shape, number of foramen and location may vary with population. The present study reports that the MF on an average was found to be below the second premolar which was found to be highest when compared to the findings of other authors. Other parameters showed a slight difference which is not statistically different from previous studies.
As the position of MF is usually difficult to locate, there are no accurate anatomical landmarks for the MF to be identified neither clinically nor can be palpated externally. The knowledge of exact position and various distances of MF are necessary for its anesthetic and surgical intervention. The location and other relative parameter of the MF in South Andhra population of India has not been described previously, for which this study was undertaken to determine the most common location of the MF. The results of the present study add to the information of the MF for the approach of mental nerve and have implications for dental practitioners and maxillo-facial surgeons.
| Acknowledgment | | |
We the authors sincerely thank Dr. N. Kannan, MDS, Department of Oral Medicine and Radiology, Narayana Dental College, Nellore, Andhra Pradesh for his valuable suggestions and Dr. E. Venkat Rao, MD, Department of Community Medicine, Narayana Medical College, Nellore, Andhra Pradesh for his assistance in computer aided statistical work.
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Correspondence Address:
Devi K Sankar
Faculty of Medicine, Department of Anatomy, Narayana Medical College, Chinthareddypalem, Nellore, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.90290
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3] |
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