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Anatomical Position of the Mentonian Foramen in Relation to the
Alveolar Ridge and Mandibular Base using Cone Beam Computed
Tomography in Dentate Patients
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Posición anatómica del agujero mentoniano en relación con la cresta
alveolar y la base mandibular mediante tomografía computarizada de haz
cónico en pacientes dentados
Aguilar La Barrera, I., & García Linares, S. (2024). Anatomical position of the mentonian foramen in relation to the alveolar ridge and mandibular base using cone beam computed tomography in
dentate patients. (I. Aguilar La Barrera & S. García Linares, Trans.) Odontología Vital, 2(41), 05-14. https://doi.org/10.59334/ROV.v2i41.637 (Original work published 2024)
Abstract
Introduction:
The mentonian foramen is a crucial structure located in the anterior part of the mandible, particularly signicant in surgical
procedures involving the mandible, especially within the interforaminal area. Consequently, for a more precise analysis of
this anatomical structure, Cone Beam CT scans are employed. This imaging technique offers a three-dimensional image of
superior quality of the maxillofacial complex, devoid of overlapping images, geometric distortions, and false negatives. Such
clarity is essential for minimizing the risk of iatrogenic lesions.
Objective:
To determine the distance from the mentonian foramen to the alveolar ridge and the mandibular base using Cone Beam
Computed Tomography in dentate patients.
Methodology:
The study was descriptive, cross-sectional, and retrospective. A total of 109 Cone Beam Computed Tomography scans of
dentate patients were evaluated from March to October 2020, taken from the Maxillofacial Diagnostic Institute (IDM) in Lima,
Peru. The participants were between 18 and 50 years old and were distributed into three age groups: 18 to 28 years old, 29 to
39 years old, and 40 to 50 years old.
The analysis focused on the distances from the upper edge of the mentonian foramen to the alveolar ridge and from the
lower edge of the mentonian foramen to the mandibular base, taking into account sex and age group. For statistical analysis,
SPSS Statistics version 26.0 was used. The t-test for related samples was applied to evaluate differences between the right
and left sides, the independent t-test to analyze measures between male and female sexes, and one-way ANOVA for the
analysis across age groups. All tests were conducted at a signicance level of 5%.
Results:
The mentonian foramen is closer to the mandibular base than to the alveolar ridge, with mean distances of 13.81mm and
14mm, respectively. The average distance was shorter in the 40 to 50 years age group, and females presented shorter
distances.
Conclusion:
The mentonian foramen is positioned 13.81mm above the mandibular base. The greatest distances were found in males, while
the shortest distances were observed in the 40 to 50 years age group.
Ingrid Aguilar La Barrera1 Sixto García Linares2
1. Bachiller en Odontología, Universidad Nacional Mayor de San Marcos, Lima, Perú / ingrid.aguilar@unmsm.edu.pe
2. Profesor asociado, Universidad Nacional Mayor de San Marcos, Lima, Perú / sgarcial@unmsm.edu.pe
https://doi.org/10.59334/
Recibido: 2023-09-28
Aceptado: 2023-11-20
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Keywords:
Mentonian foramen - alveolar ridge - jaw - Cone Beam Computed Tomography.
The mentonian foramen is considered one of
the most important anatomical landmarks in
the anterolateral aspect of the mandibular body
due to the terminal neurovascular branches
running from this structure (Goyushov et al.,
2018). It is formed from the opening of the
anterior end of the lower dental canal. In adults,
it is located between 13 to 15 mm from the
lower edge of the mandible, equidistant from
the basal edge and alveolar ridge (Cabanillas
& Quea, 2014). However, its nal location will
depend on variations according to age and
other characteristics of each individual, such as
race (Fernandez, 2016; Mendoza, 2015).
To determine the location more accurately,
base and stable structures should be used, thus
relating the location of AM with other anatomical
structures such as the basilar margin and the
alveolar ridge that are used as references in
other situations of clinical practice (Andrade
et al., 2020). That is why, in this research, the
distance of the mentonian foramen in relation to
the alveolar ridge and the mandibular base was
determined by using Cone Beam CT scans of
dentate patients.
The relative vertical position of the mentonian
foramen is inuenced by the bone loss of the
alveolar ridge (Chrcanovic et al., 2011). The
mandibular bone is much more porous in its
posterior area, specically in the molar area.
Additionally, there is a greater thickness of
cortical bone in the premolar and molar areas
(Garcia, 2020; Garcia & Gálvez, 2020).
Accurate knowledge of the location, borders,
and size of the mentonian foramen is crucial in
clinical dentistry, particularly when administering
mentonian nerve block anesthesia and
performing surgical interventions affecting
the mandible, such as apical surgery, implant
treatment, and other osteotomy procedures.
This knowledge helps in avoiding iatrogenic
injuries (Goyushov et al., 2018; Orhan, 2013). The
mentonian foramen is an area with anatomical
peculiarities and complexity, which could
lead to temporary sensory consequences for
the patient, such as labiomental paresthesia.
Therefore, dentists must take all necessary
precautions to protect the mentonian nerve
during surgical interventions (Pelé et al., 2021).
Through the utilization of Cone Beam CT scans, a
high spatial resolution image of the craniofacial
complex in 3D can be obtained, demonstrating
its effectiveness in capturing images of the head
and neck for both clinical and anthropological/
forensic studies without distortion or image
overlap. This allows for real visualization and is
considered a standard method for evaluating
bone and dentoalveolar structures (Lenguas et
al., 2010; Roque et al., 2015; Angel et al., 2011; Do
Nascimento et al., 2016). The main advantages
of CBCT include lower radiation exposure for
the patient and the affordability of devices for
tomographic imaging (Angel et al., 2011; Abboud
et al., 2013).
Method
A non-probabilistic convenience sampling
method was employed to select the sample,
consisting of 109 CBCT scans from individuals
of both sexes (69 women and 40 men) aged
between 18 and 50 years. These scans were
collected from the Instituto de Diagnóstico
Maxilofacial in Lima, Peru, and were distributed
across three age groups: 18 to 28 years, 29 to
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39 years, and 40 to 50 years. The tomographies
were conducted using a Promax 3D mid device
from Planmeca, Finland, with parameters set
to 11.0 mA and 10.0 Kv, a eld of view (FOV) of
20.0x20.0mm, voxel size of 200 um, and an
exposure time of 25 seconds. For tomographic
analysis, the Planmeca Romexis Viewer 5.3.3.5
software was utilized. Tomographic readings
were performed on a computer running
Windows 10 Pro 64-bit, equipped with an Intel®
Core™ i9-9900k CPU @ 3.60 GHz and 32.0 GB
RAM.
The CT scans evaluated were of dentate
individuals who attended between March and
October 2020. Images featuring bilateral teeth
from 36 to 46, without periodontal disease or
systemic diseases compromising bone loss in
the evaluated area, were included. CT scans of
edentulous patients, those with poor quality,
distortion, or any artifacts present, along with
those wearing orthodontic appliances or dental
implants, were excluded.
To analyze the distances, measurements were
taken from the upper edge of the mentonian
foramen to the alveolar ridge and from the lower
edge of the mentonian foramen to the base of
the jaw. The data were grouped according to
sex, age group, and side (right and left) (Figure 1).
Figure 1. Transaxial CBCT slice of right mandible,
showing measurements from the superior
border of the mentonian foramen to the alveolar
ridge (BS-RA) and from the inferior bode of the
mentonian foramen to the mandibular base (BI-
BM).
The data were processed employing SPSS
Statistics version 26.0. Quantitative variables,
determined by the distance from the upper
edge of the mentonian foramen to the alveolar
ridge and from the lower edge of the mentonian
foramen to the mandibular base, were
evaluated by side and presented as minimum,
maximum, means, and standard deviations.
Student’s t-test for related samples was applied
to evaluate the differences between the right
and left sides, Student’s t-test for independent
samples to analyze the measures by sex (female
and male), and one-way ANOVA to analyze
differences across age groups were conducted.
All tests were conducted at a signicance level
of 5%.
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Table 1. Measurements of distances from the upper edge of the mental foramen to the alveolar
ridge and from the lower edge of the mental foramen to the mandibular base according to side.
Parameters
Distance from the upper edge of
the mentonian foramen to the
alveolar ridge
Distance from the lower edge
of the foramen mentonis to the
mandibular base
Side Right Left Right Left
N109 109 109 109
Mean 13.98 14.02 13.64 13.98
Minimum value 8.40 10.20 8.00 10.00
Maximum value 20.40 18.00 18.80 19.40
standard deviation ±2.53 ±1.70 ±2.29 ±1.67
P value 0.629 p ≥ 0.05 0.769 p ≥ 0.05
Table 2. Distance from the upper edge of the mental foramen to the alveolar ridge by age group
according to side.
Age group
Distance from the upper edge of the mentonian
foramen to the alveolar ridge
right side
X ± S
Left side
X ± S
18–28 years 13.97 ± 2.88 14.03 ± 1.72
29–39 years 13.84 ± 2.39 14.35 ± 1.46
40–50 years 14.22 ± 2.2 13.44 ± 1.90
P value 0.84 p ≥ 0.05 0.09 p ≥ 0.05
Table 3. Distance from the inferior border of the mentonian foramen to the mandibular base by
age group according to side.
Age group
Distance from the lower edge of the foramen mentonis
to the mandibular base
Right side
X ± S
Left side
X ± S
18–28 years 13.55 ± 2.43 14.06 ± 1.50
29–39 years 13.64 ± 2.26 14.28 ± 1.71
40–50 years 13.80 ± 2.17 13.40 ± 1.74
P value 0.90 p ≥ 0.05 0.09 p ≥ 0.05
Results
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Table 4. Distance from the upper edge of the mentonian foramen to the alveolar ridge and from
the lower edge of the mentonian foramen to the mandibular base by sex according to side.
Distance from the upper edge of the
mentonian foramen to
the alveolar ridge
Distance from the lower edge of the
foramen mentonis to
the mandibular base
Gender Right side
X ± S (mm)
Left side
X ± S (mm)
Right side
X ± S (mm)
Left side
X ± S (mm)
FEMALE 13.49 ± 2.27 13.54 ± 1.40 13.36 ± 2.14 13.63 ± 1.31
MALE 14.82 ± 2.76 14.84 ± 1.86 14.14 ± 2.47 14.59 ± 2.02
P VALUE p < 0.05 p < 0.05 0.10 p ≥ 0.05 p < 0.05
A total of 109 CBCT scans were evaluated,
comprising 69 females (63.3%) and 40 males
(36.7%), divided into three age groups: 18 to 28
years (37.6%), 29 to 39 years (38.5%), and 40 to
50 years (23.9%). In the measurement of the
distance from the upper edge of the mental
foramen to the alveolar ridge, no statistically
signicant differences were found between the
sides (p = 0.629) (Table 1).
Similarly, in the measurement of the distance
from the lower edge of the mentonian foramen
to the mandibular base, no statistically
signicant difference was found between the
sides (p = 0.769) (Table 1).
When examining distances within age groups,
no signicant differences were found in the
distance to the alveolar ridge (p ≥ 0.05) (Table
2). Similarly, there were no statistically signicant
differences between age groups in the means
for the distance to the mandibular base on both
the right and left sides of the mandible (p ≥ 0.05)
(Table 3).
When evaluating distances according to sex,
statistically signicant differences were found
between the sexes for both sides (p < 0.05)
(Table 4). Likewise, signicant differences were
found on the left side in the distance to the base
of the mandible (p < 0.05) (Table 4).
Discussion
Studies conducted in the Peruvian population
(Cabanillas & Quea, 2014; Delgadillo & Mattos,
2017; Zea, 2020; Concha, 2014), along with our
research, have established the location of the
MA using nearby anatomical structures as a
guide. Consequently, to pinpoint its location,
base and stable anatomical structures that
connect the position of the AM with those of
other anatomical features such as the basilar
border and the alveolar ridge, which are used as
a reference in other clinical practice scenarios,
should be utilized (Andrade et al., 2020).
Considering more stable anatomical
components, such as the aforementioned
references, to locate the position of the mental
foramen will provide us with results having more
accurate values. This is due to the fact that we
are a multiracial culture, thus possessing greater
knowledge of the ethnic component of our
population in relation to the mental foramen
by correlating it with adjacent anatomical
structures.
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The sample size is comparable to that employed
in other studies (Cabanillas & Quea, 2014; Zea,
2020; Delgadillo & Mattos, 2017; Concha, 2014),
while larger samples were used in other works
(Muinelo et al., 2017; Gungor et al., 2017; Çaglayan
et al., 2014; Von Arx et al., 2013).
By using a larger sample, it is possible to obtain
more knowledge of the results in different
populations; however, this research contributes
to the literature by evaluating the position
of the mentonian foramen through the use
of CBCT is reliable in the evaluation of bone
and dentoalveolar structures, which will be of
much help in diagnosis in different areas of
Dentistry because it offers greater accuracy,
no distortions, lower radiation dose, and no
overlapping of images (Do Nascimento et al.,
2016; Buitrago et al., 2020; Montoya, 2011).
When evaluating the distance from the inferior
border of the AM to the mandibular base on
each side, similar results to those obtained by
Cabanillas and Quea (2014) were found: 13.6 ±
2.0 mm on the right side and 13.9 ± 1.80 mm on
the left side.
They indicated that there were no signicant
differences between the sides. Von Arx et
al. (2013) reported 13.7 mm on the right side
and 13.5 mm on the left side. However, lower
measurements were found in other studies
(Nimigean et al., 2022; Gungor et al., 2017;
Concha, 2014).
Muinelo et al. (2017) conducted their study
according to dental status, dividing patients into
three subgroups: dentate, partially edentulous,
and edentulous. They found that in dentate
patients, the distance from the MA to the lower
border of the mandible was 13.52 ± 1.59 mm.
They determined that the position of the
mentonian foramen did not differ according to
the side. On the other hand, a small discrepancy
was found with the study by Mashyakhy et al.
(2021), who reported a total distance of 14.03 ±
1.58 mm. This difference was attributed to the
point of measurement, as they started from
the center of the MA, whereas in this study,
measurements started from the inferior margin
of the MA.
In this study, as in others, it was found that
the highest distances according to sex were
observed in men compared to women on both
sides. Generally, when differences in distances
between the sexes were identied, these values
were higher in males.
Previous studies have consistently shown the
presence of sexual dimorphism, with higher
values for males (Zea, 2020; Gungor et al., 2017;
Çaglayan et al., 2014; Villavicencio, 2018; Dos
Santos et al., 2018; Kalender et al., 2012; Pelé et
al., 2021; Cavalcante et al., 2023; Abu-Ta’a et al.,
2023).
Sex steroid hormones affect bone size, shape,
and density, with estrogen deciency increasing
bone turnover in women. Hormonal changes
during female development, such as puberty,
pregnancy, and menopause, can impact
the periodontium signicantly (Garcia, 2002).
Conversely, men exhibit a greater continuity
of bone formation (Çaglayan et al., 2014) and
typically have a wider, squarer jaw with a more
prominent chin (Concha, 2014).
According to the age group, individuals aged
40 to 50 years old presented lower values on
the left side for both sexes, a result similar to the
study conducted by Zea (2020), who obtained
that this age group has the smallest distances
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on both sexes and sides. Muinelo et al. (2017)
indicate that the mentonian foramen distance
decreases with increasing age. Çaglayan et al.
(2014) indicate that the values of the distances
will be higher in the 21 to 40 years age group,
which can be attributed to the fact that with
advancing age, the skeletal structure undergoes
qualitative, quantitative, and microarchitectural
changes.
The latter is related to the change in the shape
of the trabeculae, the increase in anisotropy,
and the decrease in the bone volume fraction
caused by the thinning of the trabeculae (Piña et
al., 2018). Likewise, Quevedo and Hernandez (2011)
indicate that past the age of 35 years, bone
mineral density in men and women gradually
decreases as age increases, mainly in females
after menopause.
Conclusions
• It is concluded that the mentonian foramen
in a dentate Peruvian population is 13.81 mm
closer to the mandibular base than to the
alveolar ridge.
• The age group of 40 to 50 years presented,
on average, lower values in the distance
of the mental foramen to the alveolar
ridge and mandibular base, although
the measurements on the right side were
greater than on the left side in both the
measurements from the upper edge of the
foramen to the alveolar ridge and from the
lower edge of the mental foramen to the
mandibular base.
• The female sex had shorter distances than
the male sex, on both sides and in both
measurements.
Conicts of interest:
The authors declare that they have no conicts
of interest.
Funding:
No funding was received to assist with the
preparation of this manuscript.
Author contribution statement:
Conceptualization and design: IAL
Literature review: IAL.
Methodology and Validation: IAL and SGL
Formal analysis: IAL
Investigation and data collection: IAL
Resources: IAL, and SGL
Data analysis and interpretation: IAL
Writing-original draft preparation: IAL and SGL
Writing-review & editing: IAL and SGL
Supervision: SGL
Project administration: IAL and SGL
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