Mylohyoid Ridge as a Predictor of Available Bone for Implant Placement: A Cone-Beam Computed Tomography (CBCT) Retrospective Observational Study

Abstract

Introduction: The posterior mandibular region, due to the presence of vital structures, poses a high risk during implant placement because of its susceptibility to neurovascular injury and perforation of the lingual cortex. A breach in implant length and available bone height may lead to serious intraoperative and postoperative complications. Prediction of the exact location of the inferior alveolar nerve and submandibular fossa anatomy is a prerequisite for ideal implant placement, which is always not possible with conventional radiographic and clinical techniques.Materials and methods: One hundred ten cone-beam computed tomographies (CBCTs) of patients were acquired from the radiological archives of a radiological center in Chennai. DICOM files from CBCT were exported to Bly Sky Plan software. Cross-sections of the second molar and first molar were extracted following the inclusion criteria. The linear dimension between the mandibular canal and mylohyoid ridge and anatomic variables of the submandibular fossa were measured digitally on the left and right sides using software measuring tools. Descriptive statistics were done. The unilateral and bilateral site and gender differences were evaluated. Bone height superior to the mandibular canal was correlated with the submandibular fossa parameters; depth of undercut in the vertical and horizontal directions; and angle of the undercut.Results: The mandibular canal was on average 5.5 mm and 4 mm inferior to the Mylohyoid ridge in the second molar region and first molar region, respectively, with the right and left sides showing no statistically significant difference. The depth of fossa undercut in vertical and horizontal dimensions was higher in the second molar region compared to the first molar region. The height of the deepest point of the undercut in the vertical dimensions showed a positive correlation with the bone available between the mandibular canal and the mylohyoid ridge.Conclusion: Keeping 2 mm of safety factor in consideration, implants can be safely placed up to the mylohyoid ridge in 100% of cases and 2 mm below the mylohyoid ridge in 78.9% of cases in the mandibular second molar region. In keeping with a safety factor of 2 mm, implants can be safely placed up to the mylohyoid ridge in 82.6% of cases and 2 mm below the mylohyoid ridge in 43.1% of cases in the first molar region. A more pronounced undercut was seen in the second molar region than in the first molar region. Deeper fossa undercuts in vertical dimension are associated with more inferior positioning of the mandibular canal.

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“…emphasize that correct interpretation of USG in the floor of mouth and perimandibular areas is possible with good knowledge of anatomical structures and its interpretation on sonograms. [16][17][18][19] In the 13 years of the surgeon's practice (I.I.F), this is the first case of subperiosteal spread of purulent material on 3 surfaces from an odontogenic focus on the lower jaw. English literature search does not reveal the similar cases as well as its ultrasound descriptions.…”