RESEARCH

Assessment of the Anterior Loop of the Mental Nerve Using

Cone Beam Computerized Tomography Scan
Chun-I Lu, DDS, MSD1*
John Won, DDS, MS1
Aladdin Al-Ardah, DDS, MS1
Ruben Santana, DDS, MSD1
Dwight Rice, DDS2
Jaime Lozada, DMD1

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The purpose of this study is to use cone-beam computerized tomography (CBCT) scans with oblique-transverse reconstruction modality to
measure and compare the anterior loop length (AnLL) of the mental nerve between gender and age groups and to compare the difference
between the right and left sides. Sixty-one female and 61 male CBCT scans were randomly selected for each age group: 21–40, 41–60, and
61–80 years. Both right- and left-side AnLLs were measured in each subject using i-CATVision software to measure AnLLs on the oblique
transverse plane using multiplanar reconstruction. The anterior loop was identified in 85.2% of cases, with the mean AnLL of the 366
subjects (732 hemimandibles) being 1.46 6 1.25 mm with no statistically significant difference between right and left sides or between
different gender groups. However, the mean AnLL in the 21–40 year group (1.89 6 1.35 mm) was larger than the AnLL in the 41–60 year
group (1.35 6 1.19 mm) and the 61–80 year group (1.13 6 1.08 mm). In conclusion, when placing implants in close proximity to mental
foramina, caution is recommended to avoid injury to the inferior alveolar nerve. No fixed distance anteriorly from the mental foramen
should be considered safe. Using CBCT scans with the oblique-transverse method to accurately identify and measure the AnLL is of utmost
importance in avoiding and protecting its integrity.

Key Words: cone-beam computed tomography, mental foramen, mental nerve, anterior loop length, dental implant

INTRODUCTION When planning to place implants in the mandible, one of

the most important anatomic landmarks is the mandibular

S
urgery in the anterior mandible such as implant
canal, in which the inferior alveolar nerve passes through and
placement in the interforaminal area or chin grafting
continues anteriorly as the mental nerve, exiting at the mental
may damage the anterior loop of the mental nerve,
foramen. The mental nerve may have an anterior loop, which is
resulting in neurosensory disturbances. During surgery,
described in Sicher’s Oral Anatomy.7 The anterior loop is
surgeons usually expose the mental foramen to visualize the
described as ‘‘the mental canal which rises from the mandibular
position of the mental nerve. However, without knowing the
canal and runs outward, upward and backward to open at the
anterior loop length, surgeons have a high risk of violating the
mental foramen.’’ The location of the most distal implants in the
anterior loop, when present.
interforaminal area when planning an implant-supported fixed
Preoperative radiographic examination aids in developing a
complete denture is determined by the position of the mental
comprehensive treatment plan for patients who need dental
foramen and the anterior loop of the mental neurovascular
implant surgery. It helps determine the proper size, location,
bundle.8–10 To place the implant closest to the mental foramen
and angulation for each dental implant as well as the number
with concern on the anterior loop is the key factor for
of implants to be placed.1,2 Some authors claim that 2-
increasing the A-P spread and reducing distal cantilever.11,12
dimensional (2D) radiographs are sufficient for presurgical
However, complications of surgical trauma to the mental nerve
implant planning3; however, others believe there is a need for
can result in neurosensory disturbances and altered sensation
additional cross-sectional imaging.4–6 Recently, it has been
of the lower lip and chin after implant placement.13
recommended that cross-sectional imaging be used for the
Clinically, the anterior loop cannot be seen but can be
assessment of all dental implant sites and that cone-beam
detected in panoramic radiographs, cone beam computerized
computerized tomography (CT) is the imaging method of
tomography (CBCT), spiral CT, and magnetic resonance
choice for gaining this information.4
imaging. However, in the study by Arzouman et al,14 the
authors concluded that significantly fewer loops were detected
1
Advanced Education in Implant Dentistry, Department of Restorative in panoramic radiographs as compared with anatomic assess-
Dentistry, Loma Linda University, Loma Linda, Calif. ment. Also, significantly shorter anterior loops were identified
2
Department of Oral Diagnosis, Radiology & Pathology, Loma Linda
University, Loma Linda, Calif. in panoramic radiographs than when direct measurements
* Corresponding author, e-mail: chunilu1106@gmail.com were made. Moreover, Kuzmanovic et al10 showed that 50% of
DOI: 10.1563/AAID-JOI-D-13-00346 the radiographically observed anterior loops of the mental

632 Vol. XLI / No. Six / 2015

 Lu et al

canal were misinterpreted by observers with panoramic or 13-cm field of view, 20 seconds scan time, and 0.4-mm voxel
radiography, and 62% of the anatomically identified loops size. Both right- and left-side AnLLs were measured in each
were not observed radiographically. They concluded that subject. I-CATVision software (Croall Radiography Inc, version
panoramic radiographs are unreliable and have high incidences 1.8.1.10) was used to measure the AnLL by using multiplanar
of false-positives and false-negatives in identifying the anterior reconstruction. Multiplanar reconstruction allows images to be
loop. created from the original axial plane in either the coronal,
Spiral CT and CBCT have also been used for measuring sagittal, or oblique plane.
anterior loops in the literature and tend to be more reliable. First, the axial cut in the sagittal plane was adjusted to
Kaya et al15 showed spiral CT scans demonstrated a higher identify the best view of the mental foramen in the axial plane
prevalence of mental loops than panoramic radiographs. (Figure 1).
Uchida et al16 compared the CBCT and anatomic measurements Second, the axial plane was rotated until the sagittal cut
and concluded that the average length of the anterior loop was was parallel to the buccal plate in the area of the mental
2.2 6 0.8 mm using CBCT, and no significant differences were foramen. Meanwhile, the coronal cut in the axial plane was
found between CBCT and anatomic measurements. adjusted to identify the best view of the mental foramen in the

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Ngeow et al17 investigated the visualization of the anterior coronal plane (Figure 2).
loop in ‘‘different age-groups and genders’’ using panoramic Third, the coronal plane was enlarged, and an oblique cut
radiographs, but this study did not facilitate CBCT scans. that passed through the center of the mental foramen was
Different methods of measuring the anterior loop length (AnLL) made to create an oblique plane, which allowed visualization of
on CBCT scans were described in the literature. In one study, a the mental foramen and anterior loop at the same time (Figures
software program was used to draw tracing lines of the mental 3 and 4). Fourth, this view was enlarged so that measurements
nerve to measure the length of the loop.18 Some studies could be made to the nearest 0.4 mm (Figure 4). Fifth, a line
measured by counting the first and last cross-sectional 0.5-mm- (line 1) was drawn parallel to the buccal plate, and another line
thick slices after identifying the anterior loop and mental (line 2) was made perpendicular to line 1, which passed
foramen. However, Kaya et al15 stated that assessing a through the most anterior point of the anterior loop. (It could
tomographic cross-sectional cut for the location of the be the origin of the incisive canal or the most anterior point of
mandibular or mental canals was difficult. In the present study, the mental loop curvature.) AnLL was measured from the most
we presented a simpler method using i-CATVision software to anterior point of the mental foramen to line 2 (Figure 4). When
locate the mental foramen and anterior loop on a single the anterior loop was not present or the origin of the incisive
oblique transverse view and measure the length of the anterior canal was located posterior to the mental foramen, negative
loop. values were recorded.
The objective of this study is to measure and compare the
AnLL of the mental nerve between gender and age groups and Statistical analysis
to compare the difference between the right and left sides
using CBCT. The null hypothesis is that according to the Two examiners were involved in the study. Each examiner
analysis of CBCT scans, age, gender, and right versus left sides measured AnLL on both sides of the patient 3 different times.
have no influence on the anterior loop length. Intra- and Interexaminer reliability were tested by using SPSS
intraclass correlation coefficient (Cronbach’s alpha value ..8
means optimal agreement, ..9 means excellent agreement).
MATERIALS AND METHODS The prevalence of the anterior loop (when AnLL . 0 mm) was
calculated. After calculating the mean and standard deviation,
To estimate the proper sample size for evaluating the the independent t test was used to compare AnLL between
difference between groups, StatSoft STATISTICA (power anal- gender groups. A paired t test was used to compare AnLL
ysis software) with an a of .05 and 2-tailed t test of significance between the right and left sides. One-way ANOVA was used to
was used. An estimation was made that 176 participants in compare AnLL among the 3 age groups. The a level of all the
each gender group and a total of 352 participants would statistic tests was set as .05.
provide 80% power for detecting a small-to-medium effect size
(r ¼ .3) in the relationship between AnLL and gender. After
setting a ¼ .05, root mean square standardized effect ¼ 0.2, the RESULTS
1-way analysis of variance (ANOVA) test of significance was
used to make a prior estimate that 122 participants in each age All measurements were collected for intra- and interexaminer
group (3 groups) and a total of 366 participants would provide reliability tests. A Cronbach’s alpha value of .954 and .976 was
80% power in the relationship between AnLL and age groups. obtained in the first and second examiner, showing an
Combining the results above, 61 women and 61 men in each excellent agreement. An intraclass correlation coefficient of
age group, with a total of 366 participants, were used in the .904 was obtained comparing 2 examiners, showing excellent
study. agreements as well.
Sixty-one female and 61 male patients were randomly The measurements of the AnLL comparing the right and
selected for each age group (21–40, 41–60, and 61–80 years) left side in different gender and age groups are listed in Tables
from existing Loma Linda University CBCT scans. All CBCT scans 1–4. The anterior loop was present (length .0 mm) in 624 of
were taken by I-CAT Cone-Beam 3D Dental Imaging System 732 hemimandibles (prevalence ¼ 85.2%). The AnLL of the 366
Model (Imaging Sciences International, Hatfield, Penn) under 6- subjects (732 hemimandibles) was 1.46 6 1.25 mm. The

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FIGURE 1. How to move the axial cut (red bar) in the sagittal plane until the best view of mental foramen (yellow circle) is attained in the
axial plane.

maximal and minimal AnLL were 6.67 mm and 2.87 mm that the previous investigators used 2D radiographs as the
(Figures 5 and 6). The mean AnLL on the right side was 1.47 6 measuring tools. Kuzmanovic et al10 concluded that panoramic
1.39 mm and on the left side was 1.44 6 1.39 mm. There was radiographs are unreliable and have high incidences of false-
no statistical significance between groups. The mean AnLL was positives and false-negatives in identifying the anterior loop.
1.51 6 1.24 mm for men and 1.40 6 1.26 mm for women, and They found that radiographic length of the anterior loop of the
no statistically significant differences were found. mental canal can be measured only in radiographs in which the
Among the age groups, 1-way ANOVA statistical analysis entire course of the mental canal is visualized, from the
showed a significant difference between groups (P ¼ .000). Both mandibular canal through the mental foramen (type I, or
post hoc tests, Bonferroni and Scheffé test, showed the AnLL of continuous type; Yosue and Brooks classification24). We applied
the 21–40 year group was significantly different from groups this concept on the 3D CBCT scans. We think that the most
41–60 and 61–80 years. The mean AnLL in the 21–40 year accurate way to measure the anterior loop is when the
group (1.89 6 1.35 mm) was larger than the AnLL in the 41–60 mandibular canal, the anterior loop, the incisive canal, and
year group (1.35 6 1.19 mm) and 61–80 year group (1.13 6 the mental foramen can be continuously visualized in the same
1.08 mm). view.
Cone beam computed tomography was introduced in the
early 2000s with its great decrease in dose compared with the
DISCUSSION conventional CT.25–27 Poeschl et al28 found that CBCT was as
In the literature, the average measurements of the AnLL varied. accurate as conventional multislice CT with regard to its use in
The mean AnLL varied from 0.1 mm19 to 6.92 mm.20 The reason image-guided implant surgery. Al-Ekrish and Ekram29 stated
that the results varied might be due to different diagnostic that the mean of the CBCT absolute errors was even smaller
tools (cadavers, dry skulls, 2D radiographs, and 3D radiographs) than that of the multi-detector CT absolute errors for the overall
different population, (different age, gender, race, dental status), data, as well as for the site-specific data. Moreover, Santana et
different methods of measuring (direct measurements using al30 and Uchida et al16 stated there was no statistically
probe, calipers), or different methods of interpreting the significant difference on the AnLL between anatomic measure-
radiographs. In our study, the mean AnLL of the 366 subjects ments from cadavers and measurements obtained from CBCT
on CBCT scans (732 hemimandibles) was 1.46 6 1.25 mm. This images. Although CBCT had been proven to be accurate,
corresponded with most of the cadaver studies that used direct studies using CBCT to analyze the average length of the
measurements. Solar et al21 found that the mean AnLL was 1 anterior loop still showed contrasting results from 0.89 mm31 to
mm and ranged from 0.5 to 5 mm, Kuzmanovic et al10 found 6.92 mm.20 We found that the methods of measuring the AnLL
the mean AnLL was 1.2 mm, and Uchida et al22 found it was 1.5 on CBCT were different. Rosa et al32 determined the mental
mm. All of these were cadaver studies. loop length on panoramic views from CBCT scans, which made
Studies by Arzouman et al,14 Kaya et al,15 and Misch and it similar to studies using panoramic radiographs. Chen et al20
Crawford23 found mean AnLLs of 3.45 mm, 3.75 mm, and 5 mm, mentioned that they reconstructed part of the panoramic view
respectively. A possible reason for these average AnLLs along the inferior alveolar nerve canal, but no reference point
compared with those of the current study could be the fact of measuring the loop was found. Apostolakis and Brown31

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FIGURE 2. Axial plane that is rotated until the sagittal cut (green bar) is parallel to the buccal plate in the area of the mental foramen, and
the coronal cut (blue bar) in the axial plane that is adjusted until the best view of the mental foramen (yellow square) is attained in the
coronal plane.

counted the 0.3-mm vertical cross-section slices to evaluate the voxel size might lead to a clearer image and decrease the errors
length of the loop, and we found it difficult to identify the most of measurements. However, both intra- and interexaminer
anterior part of the mental nerve on the cross-section views, reliability were analyzed in our study, and the statistic result
especially when the bone density was poor.15 The method we showed an excellent agreement. This result confirmed that the
used in our study was to locate the mental foramen and oblique transverse method was a simple and reliable way to
anterior loop on a single oblique transverse view. We believed measure the anterior loop on a CBCT scan.
that once the mandibular canal, the anterior loop, the incisive Studies that have analyzed the anterior mental loop in
canal, and the mental foramen could be simultaneously cadavers tend to consist of populations with greater age and
visualized in the same view, the measurement would be more small sample sizes. Power analysis guided us to collect at least
accurate. The presence of the anterior loop of mental nerve was 61 patients in each group, with a total of 366 patients. To the
defined as any part of the mental nerve located mesial (or best of our knowledge, this study consisted of the largest
anterior) to the mental foramen. In the present study, 85.2% sample size of all studies to report on this topic. In the present
prevalence of the loop was noted. This result was similar to the study, equal subject numbers of different genders with a wide
study of Neiva et al,33 who found 88% of anterior loop in skulls age range from 21 to 80 years were included. The statistical
using a probe, and Kieser et al,34 who found 84% in cadavers. analysis showed that there was no difference between the right
The reason that some studies showed a low prevalence (7% to and left side or between genders. Uchida et al16,22 showed no
55%)10,32,35,36 might be the difficulty of clearly identifying the difference between sides, but a larger AnLL was found in men.
most anterior portion of the mental nerve. One disadvantage in In our study, we had 5 times more subjects than the previous
the present study is that a medium-resolution CBCT with a scan study, and men showed a mean AnLL of 1.51 mm, which is
time of 20 seconds and 0.4-mm voxel size was used. Higher- slightly larger than that of women (1.40 mm) but statistically
resolution scans with a scan time of 40 seconds and 0.25-mm not significant. Moreover, we found that the AnLL of the 21–40

Journal of Oral Implantology 635

Assessment of the Anterior Loop of the Mental Nerve

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FIGURES 3–6. FIGURE 3. How to make an oblique cut using the function ‘‘line’’ to gain an ideal oblique view (Figure 4). (The cut is adjusted to
pass through the center of the mental foramen in the coronal plane and meanwhile to obtain the best view of the anterior loop in the
oblique plane.). FIGURE 4. Mental foramen, anterior loop of the mental nerve, and bifurcation at the same view. Line 1 is parallel to the
buccal plate. Line 2 is perpendicular to line 1 and passes through the most anterior point of the anterior loop. (In this case, it is the part of
the mental nerve, not the origin of the incisive canal.) Line 3 (yellow) shows the measurement of the anterior loop length. FIGURE 5.
Example of the measurement (line 3: 6.8 mm) of the maximal anterior loop length. The average of all measurements (6.8, 6.8, 6, 6.4, 6.8, 7.2
mm) was 6.67 mm. FIGURE 6. Example of the measurement (line 3: 3.2 mm) of the minimal anterior loop length. The average of all
measurements (3.2, 3.2, 3.2, 2.8, 2.4, 2.4 mm) was 2.87 mm.

TABLE 1
Prevalence and measurements of the anterior loop length of the mental nerve comparing the right and left sides
Prevalence, % Min, mm Max, mm Mean 6 SD, mm
Right 85.8 2.40 6.67 1.47 6 1.39
Left 84.7 2.87 5.27 1.44 6 1.39
Paired t test (*P , .05) .639
Total 85.2 2.87 6.67 1.46 6 1.25

TABLE 2
Prevalence and measurements of the anterior loop length of the mental nerve comparing different genders
Prevalence, % Min, mm Max, mm Mean 6 SD, mm
Male 85.5 2.87 6.67 1.51 6 1.24
Female 85.0 2.47 6.40 1.40 6 1.26
Independent t test (*P , .05) .379

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TABLE 3
Prevalence and measurements of the anterior loop length of the mental nerve comparing different age groups
Prevalence, % Min, mm Max, mm Mean 6 SD, mm
Age 21–40 y 89.3 2.87 6.67 1.89 6 1.35
Age 41–60 y 83.2 2.40 6.00 1.35 6 1.19
Age 61–80 y 83.2 2.20 6.60 1.13 6 1.08
One-way ANOVA (*P , .05) .000*

year age group was significant larger than the 41–60 and 61–80 have calculated the negative value when the anterior loop was
year groups. This is also consistent with Uchida et al22 and not present. However, Kieser et al34 in 2002 described 5
Ngeow et al,17 who indicated that the frequency of the anterior patterns of emergence of the human mental nerve. Type 1,
loops decreases with age. In 1986, Gershenson et al37 described referred to as a posterior directed emergence, type 2 an

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that with loss of teeth and bone resorption, the mental anterior directed emergence, type 3 a right-angled pattern of
foramen moves upward closer to the alveolar border. The emergence, type 4 to multiple foramina, and type 5 to the
mental nerve emerged from the mental foramen closer to or at alveolus had resorbed, and no evaluation was possible. It is also
the alveolar border, according to the degree of resorption. important to recognize type 2 of mental nerve (for which the
Therefore, when teeth are lost, bone resorption occurs, the anterior loop has a negative value) because the surgeon can
mental foramen gets closer to the anterior part of the mental place the implant closer to the mental foramen and even
loop, and the AnLL decreases. Meanwhile, we found 3.28% of posterior to the mental foramen. In the treatment of
posterior edentulous in the age 21–40 year group, 20.08% in mandibular arch involving the interforaminal area, a full arch
the 41–60 year group, and 27.87% in the 61–80 year group implant-supported restoration involving 4 to 5 implants is a
(Table 5). The mean AnLLs of the dentate and edentulous side good viable option. To place the implant closest to the mental
were 1.55 mm and 1.00 mm, respectively. Therefore, we believe foramen with concern on the anterior loop is the key factor for
that when the age increases, the number of posteriorly increasing the A-P spread and reducing distal cantilever.11,12 In
edentulous mandibles increases, the bone resorption increases, addition, placing implants in mandibular partially dentate
and the AnLL and prevalence decrease. patients involving premolar and molar areas, the mental
Complications of surgical trauma or pressure on the mental neurovascular bundle is usually the critical reference point
nerve can result in neurosensory disturbances and altered during treatment planning. Therefore, the precise location of
sensation of the lower lip and chin after implant place- the mental loop must be identified using proper radiographic
ment.13,38,39 Ellies and Hawker40 reported a retrospective techniques before surgery. We recommended using the
analysis of a multicenter study. They found altered sensation oblique transverse reconstruction modality on CBCT to
of the mandibular alveolar nerve in 36% of patients after 2 accurately locate and measure the AnLL prior to the implant
weeks and 13% after 1 year. It has been suggested in the surgery.
literature that the most distal aspect of an implant should be at
least 1 mm,19 4 mm,10 or 6 mm21 anterior to the foramen to
avoid injuring the inferior alveolar and/or mental nerves during CONCLUSION
an osteotomy based on findings of the prevalence and extent
of the anterior loop of the mental nerve. In the present study, After evaluating 366 CBCT scans of patients:
the largest AnLL was 6.67 mm. Moreover, the longest loop in
1. Of the scans, 85.2% revealed the presence of an anterior
the literature was reported by Neiva et al,33 being 11 mm,
loop of the mental nerve.
followed by Uchida et al16 with a length of 9 mm. For these
2. A wide range of measurements existed for the AnLL, ranging
cases, following the 1-, 4-, or 6-mm rule would lead us to injure
from 2.87 mm to 6.67 mm, with a mean of 1.46 mm.
the nerve when placing implants in close proximity to the
3. No statistically significant differences were found between
mental foramina.
the left- and right-side measurements or between genders,
On the other hand, if we place every implant 6 mm anterior
but the 21-40 year age group had a significantly larger AnLL
to the mental foramen, we limit the interforaminal space
than ages 41–60 and 61–80 years.
available for implant placement. The range of the AnLL found in
our study is 2.87 mm to 6.67 mm. No studies in the literature When placing implants in close proximity to the mental

TABLE 4 TABLE 5
Post hoc statistical analysis comparing different age groups Posteriorly edentulous hemimandibles in each age group
Bonferroni Test Scheffé test Posteriorly
(*P , .05) (*P , .05) Dentate Edentulous
Age 21–40 y vs 41–60 y .002* .003* Age 21–40 y 236 (96.72%) 8 (3.28%)
Age 21–40 y vs 61–80 y .000* .000* Age 41–60 y 195 (79.92%) 49 (20.08%)
Age 41–60 y vs 61–80 y .521 .396 Age 61–80 y 176 (72.13%) 68 (27.87%)

Journal of Oral Implantology 637

Assessment of the Anterior Loop of the Mental Nerve

foramina, caution is recommended to avoid injury to the mental nerve: a morphological and radiographic study. Clin Oral Implants
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during treatment planning. Because of the wide range of the implants. Int J Oral Maxillofac Implants. 1989;4:241–247.
AnLL observed in our study, no fixed distance mesially or 13. Kraut RA, Chahal O. Management of patients with trigeminal nerve
anteriorly from the mental foramen should be considered to be injuries after mandibular implant placement. J Am Dent Assoc. 2002;133:
1351–1354.
a ‘‘safe’’ distance without the use of 3D imaging. Analyzing 14. Arzouman MJ, Otis L, Kipnis V, Levine D. Observations of the
CBCT scans using the method described in this article can be a anterior loop of the inferior alveolar canal. Int J Oral Maxillofac Implants.
useful tool for avoiding implant surgical complications. 1993;8:295–300.
15. Kaya Y, Sencimen M, Sahin S, Okcu KM, Dogan N, Bahcecitapar M.
Retrospective radiographic evaluation of the anterior loop of the mental
nerve: comparison between panoramic radiography and spiral computer-
ABBREVIATIONS ized tomography. Int J Oral Maxillofac Implants. 2008;23:919–925.
16. Uchida Y, Noguchi N, Goto M, et al. Measurement of anterior loop
2D: 2-dimensional length for the mandibular canal and diameter of the mandibular incisive

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3D: 3-dimensional canal to avoid nerve damage when installing endosseous implants in the
AnLL: anterior loop length interforaminal region: a second attempt introducing cone beam computed
tomography. J Oral Maxillofac Surg. 2009;67:744–750.
ANOVA: analysis of variance 17. Ngeow WC, Dionysius DD, Ishak H, Nambiar P. A radiographic study
A-P spread: anterior-posterior spread on the visualization of the anterior loop in dentate subjects of different age
CBCT: cone-beam computerized tomography groups. J Oral Sci. 2009;51:231–237.
CT: computerized tomography 18. Gerlach NL, Meijer GJ, Maal TJ, et al. Reproducibility of 3 different
tracing methods based on cone beam computed tomography in
MDCT: multi-detector computed tomography determining the anatomical position of the mandibular canal. J Oral
RMSSE: root mean square standardized effect Maxillofac Surg. 2010;68:811–817.
19. Bavitz JB, Harn SD, Hansen CA, Lang M. An anatomical study of
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ACKNOWLEDGMENT 20. Chen JC, Lin LM, Geist JR, Chen JY, Chen CH, Chen YK. A
retrospective comparison of the location and diameter of the inferior
The authors would like to thank Ashish Sharma, the residents,
alveolar canal at the mental foramen and length of the anterior loop
and faculty members at Advanced Education in Implant between American and Taiwanese cohorts using CBCT. Surg Radiol Anat.
Dentistry, Loma Linda University School of Dentistry, for their 2013;35:11–18.
involvement in the study and Ching-Ho Leu and Udochukwu 21. Solar P, Ulm C, Frey G, et al. A classification of the intraosseous path
of the mental nerve. Int J Oral Maxillofac Implants. 1994;9:339–344.
Oyoyo for their assistance with the statistical analysis.
22. Uchida Y, Yamashita Y, Goto M, Hanihara T. Measurement of
anterior loop length for the mandibular canal and diameter of the
mandibular incisive canal to avoid nerve damage when installing endo-
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