The inferior alveolar nerve (IAN) enters the mandibular foramen on the medial ramus, traverses the mandibular canal through the mandibular body, giving off dental branches to the lower molars and premolars, and exits at the mental foramen (at the level of the apices of the premolars) as the mental nerve. The canal position relative to the tooth apices, the lingual cortex, and the lower border varies and is assessed on CBCT for implant planning and surgical risk assessment.
The inferior alveolar nerve canal is the critical structure in mandibular implant planning, wisdom tooth removal, and orthognathic surgery. Proximity of tooth roots or implant placement to the canal risks IAN injury and permanent lower lip anaesthesia. CBCT identifies the canal position with precision. In sagittal split osteotomy (BSSO) for orthognathic surgery, the canal is the key risk structure within the mandibular body split; its position relative to the bony cuts determines the nerve risk. Bifid mandibular canal (present in 0.08-8% of individuals) must be identified to avoid unexpected canal entry.
Implant placement extending below or into the inferior alveolar nerve canal produces immediate or delayed IAN neurosensory disturbance with lower lip and chin paraesthesia; immediate removal of an offending implant within hours may restore nerve function, while delayed removal of a compressing implant produces less reliable recovery due to canal pressure necrosis.
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