Journal of Medicine, Radiology, Pathology & Surgery (2015), 1, 58

ORIGINAL ARTICLE

Radiographic study of mental foramen type and position

in Bangalore population
Navya N. Swamy, Tejavathi Nagaraj, Noori Ghouse, C. D. Jagadish, N. Sreelakshmi, Rahul Dev Goswami
Department of Oral Medicine and Radiology, Sri Rajiv Gandhi Dental College & Hospital, Bengaluru, Karnataka, India

Keywords
Mandibular canal, mental foramen,
panoramic radiograph
Correspondence
Dr.Navya N. Swamy, Department of
Oral Medicine and Radiology, Sri Rajiv
Gandhi Dental College and Hospital,
Cholanagar, Bengaluru-560032,
Karnataka, India. Phone:+91-9686633552,
Email:drnavyanswamy@gmail.com
Received 03 November 2014;
Accepted 29 December 2014
doi: 10.15713/ins.jmrps.2

Abstract
Background: The mental foramen is defined as the entire funnel-like opening in the
lateral surface of the mandible at the terminus of the mental canal. The mental foramen
marks the termination of mandibular canal in the mandible, through which the inferior
alveolar nerve and vessels pass. Position of the mental foramen is important when
administering regional anesthesia. The aim of this study was to determine the most
common type and position of mental foramen in Bangalore population using digital
panoramic radiographs.
Materials and Methods: Atotal of 100(50 M and 50 F) digital panoramic radiographs
were collected from Department of Oral Medicine and Radiology within age of
1550years, type and position of mental foramen was analyzed.
Results: The most common occurrence is TypeI and position 4 (symmetrical) of mental
foramen. Comparison of type in males and females appears significant. Comparison of
the position in males and females appears not significant.
Conclusion: The following study suggests that clinicians should carefully identify
mental foramen thus minimizing complications during implant, orthognathic surgery
and treatment of maxillofacial injuries.

Introduction
Knowing the location of the mental foramen is very important
when considering placing implants or any other surgical
procedure in the foraminal region.[1] Mental foramen is a small
foramen situated in the anterolateral aspect of the body of the
mandible.[2]
The mental foramen is defined as the entire funnel-like
opening in the lateral surface of the mandible at the terminus
of the mental canal [Figure 1].[3] This foramen is contained
entirely within the buccal cortical plate of bone. The average
size of the foramen is 4.6mm horizontally and 3.4mm vertically
on the lateral surface of the mandible.[4] The foramen is usually
larger on the left side of the mandible.[5] Schaeffer stated that
mental foramen was located between the spaces of mandibular
premolars.[6]
Mental foramen`s anatomical position is of significant
importance in giving local anesthesia, treatments of fractures
related to parasymphysis area, osteotomies required for
orthognathic and implant placement, giving complete denture in
mandible etc.[7] Inferior alveolar nerve gives mental and incisive
branch inside the canal. Mental nerve emerges from mental

Figure 1: Orthopantomogram showing type and position of mental

foramen

foramen and supply sensory innervations to the soft tissues

of the chin, lower lip and gingival on the ipsilateral side of the
mandible.[8]
Yosue and Brooks classified into four types[9]

TypeI: Mental canal is continuous with the mandibularcanal.

TypeII: The foramen is distinctly separated from the mandibular
canal.

Journal of Medicine, Radiology, Pathology & Surgery Vol. 1:1 Jan-Feb 20155

Swamy, et al.

Radiographic study of mental foramen

TypeIII: Diffuse with a distinct border of the foramen.

TypeIV: Unidentified group.

Position 1: Situated anterior to the first premolar.

Position 2: In line with the first premolar.
Position 3: Between the first and second premolar.
Position 4: In line with second premolar.
Position 5: Between the second premolar and first molar.
Position 6: In line with the first molar.
The accurate identification of the mental foramen is important
for both diagnostic and clinical procedures. The radiographic
appearance of the mental foramen may result in a misdiagnosis
of a radiolucent lesion in the apical area of mandibular premolar
teeth.[10] Hence, the aim of this study was to determine the most
common type and position of mental foramen in Bangalore
population using digital panoramic radiographs.

Chi-square test. The most common Type I is mental canal

is continuous with the mandibular canal of mental foramen
(53.5%), followed by TypeIII diffuse with a distinct border of
the foramen (31.5%), TypeII the foramen is distinctly separated
from the mandibular canal (14.0%) TypeIV unidentified group
(1%) [Table1].
The most frequent position 4 is in line with second premolar
of mental foramen (63.5%). The second common position
was position 3 between first and second premolar (23.0%)
followed by position 5 between the second premolar and first
molar (9.0%), position 2, in line with the first premolar (3.5%),
position 1 situated anterior to the first premolar, position 6 in
line with the first molar (0%) [Table2].
Comparison of type in males and females appears significant.
Comparison of the position in males and females appears not
significant. Sex analysis showed a higher female percentage of
60% in TypeI [Graph 1]. Sex analysis showed a higher female
percentage of 84% in position 4 [Graph 2].

Materials and Methods

Discussion

The position of the image of the mental foramen was

recorded as follows[9]

The radiographs were chosen according to the following

criteria

Mental foramen is a key factor in many of the surgical as well

as clinical procedures in routine clinical practice.[11] Mental
foramen represents the termination of the mental canal.[12] The
mental nerve passes through the mental foramen, supplying
sensory innervation to the lower lip, buccal vestibule, and gingiva
mesial to the first mandibular molar.[13] The mental foramen has
been reported to vary in position in different ethnic groups.[14]
Knowing the site of the mental foramen allows for accurate
delivery of local anesthesia of terminal incisive branches
of the inferior alveolar nerve. The mental bundle can be
traumatized during surgical procedures, such as periapical

Inclusion criteria

Table1: Distribution of type in males and females

Total of 100(50 M and 50 F) digital panoramic radiographs were

collected from Department of Oral Medicine and Radiology
within age of 15-50 years who were advised for radiographs
for various purposes, ethical clearance was obtained. Type
and position of mental foramen was analyzed. All panoramic
radiographs were taken by Sirona panoramic machine. The
magnification factors reported by the manufacturers were 1.2
and 1.25, respectively.

All mandibular teeth from the right first molar to the left first
molar were present
Erupted teeth
The films must be free from any radiolucent or radiopaque
lesion in the lower arch and showed no radiographic exposure
or processing artifacts.

Type

Exclusion criteria

Total

Radiographs in which the lower teeth (between 36 and 46)

were missing, had deep caries, root canal treatment or various
restorations were eliminated because of a possible associated
periapical radiolucency
Radiographs that showed the lower canine was missing were
excluded because of the possibility of mesial premolar drift
Panoramic radiographs in which the mental foramen could
not be identified were excluded.
Results
In 100 panoramic radiographs of mental foramen, most common
type and position was studied and recorded by performing
6

Total
n (%)

P value

Gender (n (%))
Male
Female
46(46.0)
61(61.0)

107(53.5)

9.976

0.019**

13(13.0)

15(15.0)

28(14.0)

41(41.0)

22(22.0)

63(31.5)

0(0.0)

2(2.0)

2(1.0)

100(100.0)

100(100.0)

200(100.0)

**Significant

Table2: Distribution of position in males and females

Gender (n (%))
Male
Female
2(2.0)
0(0.0)
2(2.0)

Total
n (%)

P value

2(1.0)

4.296

0.371*

5(5.0)

7(3.5)

22(22.0)

24(24.0)

46(23.0)

63(63.0)

64(64.0)

127(63.5)

11(11.0)

7(7)

18(9)

100(100)

100(100)

200(100)

*Not significant

Journal of Medicine, Radiology, Pathology & Surgery Vol. 1:1 Jan-Feb 2015

Swamy, et al.

Radiographic study of mental foramen





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Graph 1: Distribution of types in male and female



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Graph 2: Distribution of position in male and female

surgery, extraction of impacted teeth, enucleation of cyst or

tumor, and so on, resulting in paresthesia or anesthesia in the
area innervated by the nerve.[15] It also aids in interpreting
anatomical landmarks in oral pathology and forensics.[16]
Although it is often possible to identify the mental foramen
radiographically, knowing the normal range of possible
locations is essential. The location of the mental foramen has
been studied in different populations.[9]
In our study, out of 100 panoramic radiographs, the
most common Type I is mental canal is continuous with the
mandibular canal of mental foramen (53.5%) followed by
TypeIII diffuse with a distinct border of the foramen (31.5%).
The most common position for the mental foramen was in line
with the second premolar in 63.5%, followed by between the
first and second premolars in 23.0%; thus these two positions
accounted for 86.5% of the cases.
Our results were in accordance with previous studies in other
populations showing that the most common type for the mental
foramen is continuous with the mandibular canal followed by
diffuse with distinct border of foramen[4] and in a position aligned
with the second premolar, followed by a position between the
first and second mandibular premolars.[17-20]

This position is consistent with findings of Yosue and

Brooks[4] in relation to types of mental foramen and in relation to
position Agarwal and Gupta,[21] Prabodha and Nanayakkara[22]
Neo[23] and Gupta and Soni.[2] The same position was observed
in Tanzanian adult black male,[24] Malay population[9]
Brazilian,[25] Sankar et al.,[26] Malawian mandible,[27] Ukoha[28]
in south eastern Nigerian Singh et al.[29] and Kanta et al. Jasser
and Nwoku observed most common position as in line with
the longitudinal axis of second premolar closely followed by
location between first and second premolar in radiographic
study of Saudi Arabians.[30]
Panoramic radiographs were used in this study because the
mental foramen was seen more consistently on the wide field
of view in panoramic radiographs of the mandible than on
periapical radiographs. A weakness of our study is the use of
panoramic radiographs for localization of the mental foramen
instead of the use of an anatomic study on skulls. panoramic
radiographs showed a greater displacement of the foramen
compared with anatomical measurements; however, the
difference in the horizontal position found by the two methods
was not statistically significant. Further anatomical studies using
skulls should be conducted in a Bangalore population. The
limitations of this study are small sample size. A larger sample
size would also enable a more detailed assessment of the position
and type of mental foramen.
Conclusion
The present study reveals valuable insights on the information
concerning the type and position of mental foramen in
Bangalore population. The following study suggests that
clinicians should carefully identify mental foramen thus
minimizing complications during implant, orthognathic surgery
and treatment of maxillofacial injuries. Hence, our study may
provide the necessary data of mental foramen among population
and may be useful for the surgeons, anesthetists, neurosurgeons
and dentists to carry out procedures without complications.
Clinical significance

Position of the mental foramen is important when administering

regional anesthesia. Mental foramen identification and
preservation of mental nerve during.
Periapical surgery
Implant surgery
Maxillofacial trauma
Orthognathic procedures.
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How to cite this article: Swamy NN, Nagaraj T, Ghouse N,

Jagadish CD, Sreelakshmi N, Goswami RD. Radiographic study
of mental foramen type and position in Bangalore population.
JMed Radiol Pathol Surg 2015;1:5-8.

Journal of Medicine, Radiology, Pathology & Surgery Vol. 1:1 Jan-Feb 2015