Robert J. Miller, MA, DDS / Warren C. Edwards, DDS / Carlos Boudet, DDS / Jonathan H. Cohen, DDS

(This article originally appeared in a 2009 issue of Titanium)

Abstract: Placement of dental implants in the anterior mandible is considered by many clinicians to be a relatively low risk procedure. However, hemorrhagic episodes following implant placement in the mandibular symphysis are regularly reported and can have serious consequences. The use of high resolution focused cone beam scanners has given us the ability to visualize the intricate neurovascular network of the intraforaminal region without distortion and in greater detail. Knowledge of the arterial supply, and navigated implant placement in the mandibular symphysis, can help to avoid these potentially life-threatening emergencies. TITANIUM 2009 1(2): 0-0

Key words: incisive canal, lingual artery, mylohyoid artery, submental artery, superior genial foramen.

INTRODUCTION

Preoperative assessment of bone density and volume is a critical compo- nent of dental implant surgery. For most of the history of this discipline, periapical or panaoramic X-rays have been used to evaluate implant sites. Limitations of these radiographic modalities are distortion, magnification, and a missing third dimension of bone volume. The introduction of computed axial tomog- raphy (CT) revolutionized our ability to virtually dissect maxillofacial structures and to determine osseous architecture without distortion. However, CT imag- ing has 3 major drawbacks. First, is the relatively high radiation dose during the scanning procedure. Second, is the high degree of background scatter around metallic restorations and implants. Third, is the significant burnout of medullary bone that is directly propor tional to the radiation dose. These parameters often obscure fine osseous structures and eliminate soft tissue profile. Our lack of appreciation for the complex anatomy of the mandibular symphysis occasionally leads to unintended consequences or even life-threatening emergencies. There are many case reports in the literature describing hemorrhagic episodes fol- lowing surgical implant placement that resulted in near-fatal airway obstruc- tion. Some authors have even sug- gested that a CT scan should be routinely performed prior to the placement of implants in the intraforaminal region.

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