Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : AC06 - AC10 Full Version

Comparative Evaluation of Morphometry of Mental Foramen using Orthopantomogram and Dry Bones in North Indian Population


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56320.16483
Ravdeep Kaur, Rajan Kumar Singla, Ravi Kant Sharma, Sanju Singla

1. PhD Scholar, Department of Anatomy, Government Medical College , Amritsar, Hoshiarpur, Punjab, India. 2. Professor, Department of Anatomy, Government Medical College, Patiala, Punjab, India. 3. Professor and Head, Department of Anatomy, Government Medical College, Amritsar, Punjab, India. 4. Professor and Head, Department of Oral Maxillofacial Surgery, Luxmi Bai Institute of Dental Sciences, Patiala, Punjab, India.

Correspondence Address :
Dr. Ravdeep Kaur,
PhD Scholar, Department of Anatomy, Government Medical College, Amritsar, Punjab, India.
E-mail: kaurravd89@gmail.com

Abstract

Introduction: Mental Foramen (MF) holds strategic importance in clinical dentistry and oral surgery. Its accurate identification determines the effectiveness of nerve blocks and prevention of postoperative neurovascular complications.

Aim: To compare mental foramen on dry bones with their orthopantomogram and to find out if any difference and correlation exist between both modalities .

Materials and Methods: This descriptive, cross-sectional study was conducted at Anatomy Department of Government Medical college Amritsar, Punjab, India, from January 2018 to December 2021. It comprised of 200 dry human mandibles belonging to either sex, ranging from dentulous to partial dentulous. Orthopantomagram (OPG) of same mandibles were taken. Study was conducted in two phases. Phase I was dry bone phase and Phase II was radiographic phase. Distance of mental foramen from symphysis menti, posterior border of ramus, alveolar crest, lower border of body of mandible and distance between depth of the socket and mental foramen were evaluated. Student’s t-test for comparison and Pearson’s correlation coefficient were applied to find any correlation between two modalities .

Results: Distance of mental foramen from symphysis menti, posterior border of ramus of mandible, alveolar crest and depth of socket showed statistically significant difference (p-value <0.001) in between dry bone and orthopantomogram on both right and left sides. Actual bone length from mental foramen to symphysis menti,to posterior border of ramus and inferior border of body of mandible was more than it appeared on OPG. Distances obtained with OPG from MF to alveolar crest (dry bone: Right= 13.49±3.46 mm; Left= 13.42±3.49 mm and on OPG: Right= 16±4.15 mm; Left= 15.42±3.84 mm) and to depth of socket (dry bone: Right= 2.48±1.58 mm; Left= 2.70±1.68 mm and on OPG: Right= 3.69±2.08 mm; Left= 4.26±1.99 mm) were magnified.

Conclusion: The results of the present study depicted that structures were not equally magnified. Knowledge about magnification at particular region is important before proceeding any surgery in that region.

Keywords

Injuries, Mandible, Orthopantomography, Surgery, Tooth root

The Mental Foramen (MF) is a passageway on the outer surface of the mandible's body, it transmits the mental nerve and arteries that supply the lower lip (1). Knowledge about MF is required to avoid post-operative complication in mental region like neuro-sensory disturbances, paralysis, haemorrhage, altered sensation, orofacial pain, atypical neuralgia (2). Its knowledge is also required in surgical procedures like apical curettage of mandibular premolars, amalgam filling, periodontal surgery etc. to avoid injury to neurovascular bundle (1),(3). The level of difficulty to locate and palpate mental foramen externally increased due to lack of specific anatomical landmark. Ranging from maxillofacial to oral surgeries, knowledge about distance between surrounding structure and mental foramen is essential to fulfil successful procedure (4).

Dental implant is one of the great achievements in dentistry, due to its capability to restoring natural function of missing teeth without damaging surrounding tissue. Success of it revolves around availability of bone. The mental foramen is always at danger throughout the implant procedure. To maintain a safety margin, it is necessary to study the surrounding region of the mental foramen before proceeding with surgical treatments, especially with the rising tendency of orthognathic surgery in the mental region (5).

Panaromic radiography, Orthopantomagram (OPG) has attained popularity due to its ability to provide precise and brief view to identify the pathology and pre-planning of treatment of the entire maxillofacial region with less radiation exposure (6).

Due to absence of a specific tooth or due to misplacement of tooth sometimes it may difficult to locate mental foramen. In such circumstances, MF can be located if the distance between the symphysis menti and the mental foramen is known (7). Similarly, posterior border of mandible, lower border , upper border of body of mandible are the fixed and easily accessible anatomical landmarks, so distance from these landmarks helps to identify mental foramen.

No similar study has been conducted on north Indian population to compare mental foramina and anatomical landmarks on dry bones with OPG. Hence, this study was conducted to compare mental foramina and nearby anatomical landmarks on dry bones with their corresponding OPG in North Indian population.

Material and Methods

This descriptive, cross-sectional study was conducted in Anatomy Department at Government Medical College, Amritsar, Punjab, India, from January 2018 to December 2021. It comprised of 200 dry human mandibles belonging to either sex, ranging from dentulous to partial dentulous. Orthopantomogram of same mandibles were taken. Before starting this study, a synopsis was submitted to Institutional Ethical Committee of Institute and ethical clearance was obtained (letter No./GMC Asr/14359).

Inclusion criteria: Intact and well-formed mandible of no specific age varying from dentulous to partially dentulous mandibles were included in the study.

Exclusion criteria: Fractured, damaged and mutilated mandibles were excluded from study.

Procedure

Study was conducted in two phases.

• Phase I: Dry Bone Phase

All the mandibles were marked from number 1-200. A braided thread (Ethicon-Brand) was used to measure curved distances and a digital vernier calliper (Aerospace-Brand) with least count of 0.01 mm was used to measure the straight distances on dry bones.

• Phase II: Radiographic phase

Digital panoramic radiographs, OPG, of same dry mandibles were taken in a private lab by ADVAPEX- machine with following exposure parameters-

i) Anode voltage: 65 kvp.
ii) Tube current: 10 mA,
iii) Exposure time: 14 Seconds.

Each dry mandible was centred in the focal trough of digital panoramic machine by reference line parallel to the symphysis menti. So that every time mandible was positioned on exact location to keep the method consistently standardized. All morphometric measurements were taken with software “ImageWorks-DICOM CD Viewer” and recorded on the predesigned proforma.

Parameters Measured on Dry Bones and OPG

1. Distance between anterior border of mental foramen and symphysis menti: It was measured with unbraided silk thread. Unbraided thread was kept between anterior border of mental foramen and symphysis menti. It was marked with Indian ink pen (Luxor fine writer 05-brand) at designated points (anterior border of mental foramen and symphysis menti). Then distance between two marked points was noted by spreading it along metric scale (Nataraj-brand) (3),(8),(9) (Table/Fig 1)a,b.
2. Distance between anterior border of mental foramen and posterior border of ramus: was measured with unbraided silk thread, by the same method as mentioned above (Table/Fig 2)a,b (3),(9).
3. Distance between inferior border of mental foramen and inferior border of body of mandible: It measured with vernier calliper (Aerospace-brand) (Table/Fig 3)a,b (3),(8),(9).
4. Distance between inferior border of mental foramen and alveolar crest: It was measured with help of vernier calliper(9),(10),(11).(Table/Fig 4)a,b.
5. Distance between superior border of mental foramen and depth of the socket of tooth above: It was measured by following given steps(Table/Fig 5)a,b,c.

Step (i): First a needle was inserted into the socket of the tooth in line with mental foramen. If mental foramen was located in between the teeth, then the tooth to which mental foramen was more in line was observed and socket of that tooth was used to measure depth. (Table/Fig 5) a.

Step (ii): Needle was marked with pen at the level of upper border of socket. (Table/Fig 5)a.

Step (iii): Then the needle was kept on outer surface of socket with marked point touching alveolar crest of socket. Then another point was marked at outer surface of mandible where tip of needle touched. (Table/Fig 5)b.

Step (iv): After that distance between above marked point on outer surface and superior border of mental foramen was measured with the help of vernier calliper (Aerospace-brand).

Statistical Analysis

Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS) version 18.0. Range, mean±standard deviation were derived. Student’s t-test was used to find out any statistical significant difference in dry bones and OPG, p-value <0.05 was considered significant, Pearson’s correlation coefficient was calculated to find out correlation between dry bones and OPG.

Results

In present study, bilaterally in 124 mandible MF was located below the root of socket, followed by above the root of socket (in 28 mandibles) and at the level of root of socket (in 11 mandible) (Table/Fig 6).

Distance of mental foramen from symphysis menti (right and left p-value <0.001), posterior border of ramus of mandible (p-value <0.001 on both right and left side), alveolar crest (p-value <0.001 on right and left side), depth of socket (p-value <0.001 on both right and left side) showed statistically significant difference in between dry bone and orthopantomagram.

Distance between mental foramen and inferior border of mandible on left side did not show any statistically significant difference (p-value= 0.06). Actual bone length from mental foramen to symphysis menti, to posterior border of ramus and inferior border of body of mandible was more than it appeared on OPG. But Distances obtained from MF to alveolar crest (dry bone= Right:13.49±3.46 mm; Left:13.42±3.49 mm and on OPG= Right: 16±4.15; Left: 15.42±3.84 mm) and to depth of socket (dry bone= Right: 2.48±1.58 mm; Left: 2.70±1.68 mm and OPG= Right: 3.69±2.08 mm; Left: 4.26±1.99 mm) were more in OPG (Table/Fig 7).

Pearson’s correlation coefficient was calculated, r-values show a positive correlation between dry bones and OPG. A moderate correlation was found in distance from mental foramen to symphysis menti (right: r-value= 0.674, Left: r-value= 0.561), posterior border of mandible (right: r-value= 0.474, left: r-value= 0.530), lower border of mandible (right: r-value= 0.509, left: r-value= 0.596), alveolar crest (right: r-value= 0.735, left: r-value = 0.788), depth of socket on right side (r-value= 0.716) and depth of socket on left side, a strong correlation was found (r-value= 0.807). Mental formen was invisible bilaterally in 35 OPGs, on right side it was invisible in 14 OPGs and in 6 OPGs on left side. So, practically it was not possible to measure above mentioned parameters on these OPGs with invisible mental foramen.

Discussion

Angulation of central beam in panoramic machine compensates the curved body of mandible, still there were few parameters which were measured less on OPG than dry bones. The observed difference may be attributed to curved body of mandible and flat film cassette used to take panoramic radiograph (12). In present study, distance of mental foramen from all the considered landmarks showed statistically significant (p-value<0.001) difference on both right and left side in dry bones and OPG (except from left side of lower border of mandible). Rate of magnification depends upon angle of radiation (13). Individual jaw shape and size can also affect the magnification (14). Mental foramen with ill-defined margins was considered as invisible (15). During facial and dental surgeries, location of mental foramen is important to block mental nerve (16). In this study, maximum correlation was observed between distance from mental foramen to depth of socket and least was observed from mental foramen to posterior border of mandible.

A study conducted by Polakowska EZ et al., using cone beam computed tomography, most common location of MF was reported as below the level of apices of 1st and 2nd premolar, followed by at the level of apices of 1st and 2nd premolar and least common location was found above the level of apices of 1st and 2nd premolar. The present study was in agreement with Polakowska EZ et al’s study as researchers also found most common location as below the level of apices of socket.

In present study, bilaterally in 124 mandible MF was located below the root of socket, followed by above the root of socket (in 28 mandibles) and at the level of root of socket (in 11 mandible). Similarly on right side majority of mental foramen was located below the root of socket, followed by above the root of socket and at the level of root of socket. Correspondingly on left side it was located below root of socket, followed by above the root. On left side, none of the foramen was located at the root of MF. Measurements with OPG were on higher side than bones.

A study conducted by Aung H and Mustafa NS found mean distance between apex of premolar and mental foramen as 1.4 mm on left side and 2 mm on right side on OPG ,and 3.1mm on left and 3.7 mm on right side with CT. The difference can be attributed to racial difference (17).

Mean distance from mental foramen to symphysis menti on dry bones was found to be more in compare to OPG. Difference between two modalities being statistically highly significant on both sides (p-value< 0.001 for right; p-value< 0.001 for left).

On comparing distance between mental foramen and posterior border of ramus of mandible, on dry bones and corresponding OPGs, a statistically significant difference was found on both sides (p-value on right and left side <0.001). Findings of the present study were varying in between observed by other researchers (4),(18).Findings were recorded less on OPG as compared with dry bones.

In the present study, mean distance of mental foramen to inferior border of body of mandible on right side on OPG was less than the left side. The difference was statistically significant on right side (p-value<0.0002) only. When compared findings on dry bones of present study with earlier ones, it was found that values were near to study done by Bala SS et al., and less than observed by other authors (4),(18),(19). On OPG it was more than observed by Afkhami F et al., and Muinelo LJ et al., (20),(21). Values recorded with OPG were higher on right side and slightly lower on left side. No statistically significant difference was found on comparing right and left side of dry bones (p-value=0.35), which is representing bilateral symmetry.

On the right side, distance between mental foramen and alveolar crest was found to be 13.49±3.46 mm on dry bones and 16±4.15 mm on OPG, while on left side it was found to be 13.42±3.49 mm on dry bones and 15.42±3.84 mm on OPG. The difference between dry bones and OPG was statistically significant on right and left sides. Results of present study were in consonance with Reddy AJ et al., (18). Values obtained with OPG were more as compared with dry bones on both sides. No statistically significant difference was found on comparing right and left side of dry bones (p-value= 0.72), which is representing bilateral symmetry (18). (Table/Fig 8) presents the comparison mean distance as observed in present study with earlier authors (4),(7),(17),(19),(20),(21),(22).

It is evident that the value found in present study on dry bones was in line with Ilayperuma I et al., but less than when compared to study by Reddy AJ et al., and Parveen S et al., and more than the study done by Deivanayagi M et al., and Bala SS et al., (4),(7),(18),(19),(22). On OPG it was found much lesser than study by Afkhami F et al., (20). When dry bones and OPG were compared, findings were found less on OPG than dry bone. The difference can be attributed to curved body of mandible and flat film cassette (12).

Various divergent studies had been reported in literature in different population. So, its location in specific population plays an important role to achieve successful nerve block.

Limitation(s)

Distance between mental foramen and depth of socket in dry mandibles with retained teeth (12 bilaterally, 2 on right side and 12 on left side) could not be measured due to chances of damage to bone. Gender variations were not considered in the present study.

Conclusion

There was statistically significant difference between distance of mental foramen from all the considered landmarks on both right and left side in dry bones and orthopantomograms (p-value< 0.001), except from left side of lower border of mandible. In clinical situation where mental foramen is difficult to locate due to malposition or absence of tooth, the present study added information to literature regarding localization of mental foramen on orthopantomogram and on dry bones, and made it possible to precisely locate mental foramen from nearby anatomical landmarks. The results obtained from study could be an area of interest for clinicians and anatomists. It may play important role in developing new techniques, which will help to precisely locate mental foramen.

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DOI and Others

DOI: 10.7860/JCDR/2022/56320.16483

Date of Submission: Mar 13, 2022
Date of Peer Review: Apr 7, 2022
Date of Acceptance: May 21, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 22, 2022
• Manual Googling: May 20, 2022
• iThenticate Software: May 23, 2022 (16%)

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