Original Article

Anthropometrics of mental foramen in

dry dentate and edentulous mandibles
in Coastal Andhra population of Andhra
Pradesh State
Srinivas Moogala, Sahitya Sanivarapu, Ramanarayana Boyapati,
NarasimhaSwamyDevulapalli, Swarna Chakrapani, Laxmikanth Kolaparthy

Department of Abstract:
Periodontics, Aim: The aim of this study is to determine the morphological features and morphometrics of mental foramen
SIBAR Institute of with reference to surrounding anatomical landmarks in Coastal Andhra population of AndhraPradesh State.
Dental Sciences, Materials and Methods: Twohundred and nineteen dry dentate and edentulous mandibles are examined in this
Takkellapadu, Guntur, study. Out of these 127 were dentate and 92 were edentulous. Various morphological and morphometrical parameters
AndhraPradesh, India were measured by using digital Vernier caliper, metallic wire and metallic scale on both the right and left sides.
Results: In the present study, the distance between most anterior margin of mental foramen and posterior border of
ramus of the mandible is[MFPR], MFPR is 69.616.03mm on the right side and is 69.176. 0mm on left side
in dentate mandible. In edentulous type, MFPR is 68.396.4mm on right side and 68.816.55mm on left side. In
the present study, the distance between symphysis menti and most anterior margin of mental foramen[MFSM] in
dentate mandible is 28.245.09mm on right side and is 27.453.7mm on left side. In edentulous mandible(MFSM)
is 28.514.5mm on right side and on left side is 27.994.50mm. Conclusion: Acquiring the knowledge and
importance of anatomy of mental foramen is helpful in avoiding neurovascular complications, during regional
anesthesia, peri apical surgeries, nerve repositioning and dental implant placement.
Access this article online Key words:
Website: Anthropometrics, dry dentate mandible, dry edentulous mandible, local anesthesia, mental foramen, mental nerve,
www.jisponline.com surgical landmarks
DOI:
10.4103/0972-124X.138715
Quick Response Code: INTRODUCTION the height of the body is markedly reduced. The
mental foramen and the mandibular canal are

T he mandible is the largest and strongest

bone of the face. It develops from the first
pharyngeal arch. It has a horse shoe shaped
close to the alveolar border.[1]

The mental foramen is an important anatomical

body which lodges the teeth and a pair of rami
which project upwards from the posterior ends
of the body and provide attachment to muscles.
Each half of the mandible ossifies from only one
center which appears at about the 6thweek of
intrauterine life in the mesenchymal sheath of
meckels cartilage near the future mental foramen.
Meckels cartilage is the skeletal element of first
pharyngeal arch. At birth, the mental foramen
opens below the sockets for the two deciduous
Address for
correspondence: molar teeth near the lower border, this is because
Dr.Sahitya Sanivarapu, the bone is made up of only the alveolar part
Department of with sockets.[1]
Periodontics, SIBAR
Institute of Dental The mandibular canal runs near the lower border.
Sciences, Takkellapadu, The foramen and canal gradually shift upwards.
Guntur, AndhraPradesh, In adults, the mental foramen opens mid way
India.
between the upper and lower borders because
Email:sahityaveera@
yahoo.com the alveolar and sub alveolar parts of the bone are
equally developed. The mandibular canal runs
Submission: 15072013 parallel with the mylohyoid line. In edentulous
Accepted: 16122013 mandible the alveolar border is resorbed, so that
Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014 497
structure situated in antero lateral aspect of the
body of the mandible which transmits mental
nerve, artery and vein. Mental nerve is a terminal
branch of the inferior alveolar nerve which supplies
sensory innervations to lower lip, buccal vestibule
and gingiva mesial to the first mandibular molar.
Mental foramen serves as an important anatomical
landmark, the orientation and position of which
facilitate local anesthetic, surgical and other
invasive procedures for oral and maxillofacial
surgeries. [2] Its location and the possibility
that an anterior loop of the mental nerve
may be present mesial to the mental foramen
needs to be considered before any surgery in
the foramina area in order to avoid injuring of
the neurovascular bundles passing through these
foramina and notches.[3] The foramen may be
occasionally misdiagnosed with a radiolucent
lesion in the apical area of the mandibular
premolar teeth. So identification of accurate
anatomical position of mental foramen is very
 Moogala, etal.: Anthropometrics of mental foramen
important in periodontal surgery especially during flap surgery
in lower teeth, apical curettage of mandibular premolars,
retrograde amalgam fillings and surgical orthodontics.
Replacement of missing teeth by dental implant and the
increasing frequency of orthognathic surgery have increased
the possibility of surgical procedures near the mental foramen.
Local anesthesia of the terminal incisive branches of the inferior
alveolar and mental nerves can be obtained effectively if the
mental foramen is correctly identified.[4] Localization of mental
foramen radiographically is difficult due to lack of consistent
anatomical landmarks for reference and the foramen cannot be
clinically visualized or palpated. Therefore, variable anatomical
positions of the foramen have been described.[5]
The location of the mental foramen had been studied by
means of direct measurement on dry mandibles or by using
radiographs of dry mandibles in patients.[6] As the bone density
increases the mental foramen becomes more difficult to identify
on radiographs. Knowledge of the most common position of
the mental foramen in the population may give additional
information in the mental nerve blocks and related mandibular
surgeries. So the present study had been undertaken to
determine the morphological features and morphometrics
of mental foramen with reference to surrounding anatomical
landmarks in both dentate and edentulous mandibles in coastal
Andhra population of AndhraPradesh state.
MATERIALS AND METHODS
A total of 219 dry dentate and edentulous mandibles are
examined in this study, out of these 127 were dentulous and
Figure 1: [PR-MF] Distance between posterior border of ramus of mandible and
most anterior margin of mental foramen
Figure 3: [MF-IFB] Distance between inferior margin of mental foramen and inferior
border of Mandible
498 Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014
92 were edentulous. Various parameters were measured by
using Digital Vernier caliper, metallic wire and metallic scale on
both the right and left sides. Before measuring, the mandibles
were placed on a standard horizontal plane to which the lower
border of the mandible get its most contact when vertical
pressure is applied to the molar region.
The parameters assessed were
[PRMF] Distance between posterior border of ramus[PR]
of mandible and most anterior margin of mental
foramen[MF][Figure1]
[SMMF] Distance between symphysis menti[SM] and most
anterior margin of mental foramen[Figure2]
[MFIFB] Distance between inferior margin of mental
foramen and inferior border of Mandible. [IFB][Figure3]
[ ACMF ] Distance between alveolar crest and inferior
margin of mental foramen[Figure4]
[A1] Distance between alveolar crest to upper most point
of mental foramen[Figure5]
[A2] Distance between alveolar margins to the apex of
second premolar socket[Figure6]
[A1A2] Distance between alveolar crest to upper most
point of mental foramenDistance between alveolar margins
to the apex of second premolar socket[Figure7]
Incidence of mental foramen in relation to first premolar,
second premolar and first molar on right side in dentulous
mandibles[Figure8]
Incidence of mental foramen in relation to first premolar,
second premolar and first molar on left side in dentulous
mandibles[Figure9]
Edentulous mandible showing accessory mental
foramen [Figure10].
Figure 2: [SM-MF] Distance between symphysis menti and most anterior margin of
mental foramen
Figure 4: [AC-MF] Distance between alveolar crest and inferior margin of mental
foramen
 Moogala, etal.: Anthropometrics of mental foramen

Figure 5: [A1] Distance between alveolar crest to upper most point of mental Figure 6: [A2] Distance between alveolar margins to the apex of second premolar
foramen socket

Figure 7: [A1-A2] Distance between alveolar crest to upper most point of mental Figure 8: Incidence of mental foramen in relation to first premolar, second premolar
foramen-Distance between alveolar margins to the apex of second premolar socket and first molar-Right side of dentulous mandibles

Figure 9: Incidence of mental foramen in relation to first premolar, second premolar

and first molar-Left side of dentulous mandibles Figure 10: Edentulous mandible showing accessory mental foramen

Statistical analysis RESULTS

The mean values are expressed as mean standard deviation
with confidence interval of 95%. Mean values of right and left Morphometric features of 219 mandibles revealed the following
side were compared using student t test. results [Table 1].

Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014 499
 Moogala, etal.: Anthropometrics of mental foramen

Table1: Depicting the values of all parameters side and is 12.562.40mm on left side, whereas for edentulous
Group statistics mandibles on right side it is 11.093.41mm and on left side
Type of N MeanSD Std. error is 10.012.68mm which shows the distance has significantly
mandible mean reduced in edentulous mandibles.
MFPR Right Dentulous 127 69.616.02 0.53505
Edentulous 92 68.396.42 0.66991 Distance between alveolar margins to the apex of second
MFPR Left Dentulous 127 69.176.00 5.11215 premolar socket[A2] in dentate mandibles is 8.932.33mm
Edentulous 92 68.816.55 0.68330 on right side and is 8.752.34mm on left side whereas for
MFSM Right Dentulous 127 28.245.09 0.45171 edentulous mandibles it is 6.162.60mm on right side and is
Edentulous 92 28.514.53 0.47305 5.382.42mm on left side which reflects a decrease of values
MFSM Left Dentulous 126 27.453.70 0.33048
Edentulous 92 27.994.50 0.46987
for edentulous mandibles.
ACMF Right Dentulous 127 15.293.71 0.32994
Edentulous 92 18.0022.23 2.31782 Distance between alveolar crest to upper most point of mental
ACMF Left Dentulous 127 14.383.75 0.33305 foramendistance between alveolar margins to the apex of
Edentulous 92 14.074.43 0.46290 second premolar socket[A1A2], in dentate mandibles on right
MFIFB Right Dentulous 127 13.1810.36 0.92011 side is 4.181.71mm and on left side it is 3.851.85mm and
Edentulous 91 13.564.04 0.42374
for edentulous mandibles on right side it is 4.802.10mm and
MFIFB Left Dentulous 126 12.002.37 0.21158
Edentulous 92 13.404.00 0.41744 on left side is 5.181.92mm.
A1 Right Dentulous 127 13.182.32 0.20666
Edentulous 92 11.093.41 0.35573 The shape of mental foramen was visually observed and
A1 Left Dentulous 127 12.562.40 0.21348 analyzed in all the 219 mandibles and it was found that in
Edentulous 92 10.012.68 0.27959 87cases it is round and 40cases it is oval in dentate mandibles
A2 Right Dentulous 127 8.932.33 0.20761
and in 56cases it is round and in 36cases it is oval in edentulous
Edentulous 92 6.162.60 0.27119
A2 Left Dentulous 127 8.752.34 0.20765 mandibles on right side. On left side, it is round in 99cases and
Edentulous 92 5.382.42 0.25323 oval in 28cases in dentate mandibles and in edentulous it is
A1A2 Right Dentulous 127 4.181.71 0.15254 round in 57cases and oval in 35cases.
Edentulous 92 4.802.10 0.21924
A1A2 Left Dentulous 127 3.851.85 0.16452 The position of mental foramen on right side and left side in
Edentulous 92 5.185.92 0.61787 both dentate and edentulous mandibles in maximum cases is
SDStandard deviation in between the first and second premolars[4050%].

Distance between anterior margin of mental foramen to the DISCUSSION

posterior border of ramus of mandible[MFPR] in dentate
mandibles is 69.616.02mm on right side and 69.176mm
on left side, whereas for edentulous mandibles the values
have slightly decreased and it is 68.396.4mm on right side,
68.826.55mm on left side.
The distance between symphysis menti and most anterior
margin of mental foramen[MFSM], appears to be the same
for both dentate and edentulous mandibles. MFSM in dentate
mandibles on right side is 28.245.09mm and on left side
it is 27.453.7mm whereas for edentulous mandibles it is
28.514.53mm on right side and is 27.994.5mm on left side.
Distance between alveolar crest and inferior margin of mental
foramen[ACMF] in dentate mandibles is 15.293.71mm
on right side and is 14.383.75mm on left side whereas for
edentulous mandibles it is 15.503.71mm on right side and
on left side it is 14.704.43mm which also appears to be the
same for dentate and edentulous mandibles.
Distance between inferior margin of mental foramen and
inferior border of mandible[MFIFB] in dentate mandibles on
right side is 12 2.37mm and on left side is 12.392.74mm
whereas for edentulous mandibles on right side it is
13.404mm and on left side it is 13.56 4.04mm which
shows that the distance between these parameters is increased
in edentulous mandibles compared to dentulous mandibles.
Distance between alveolar crest to upper most point of mental
foramen[A1] in dentate mandibles is 13.182.32mm on right
500 Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014
The mental foramen is usually a single opening on the antero
lateral surface of the mandible, 13-15 mm superior to the
inferior border of the body of mandible which is generally seen
to be circular or oval in shape.[7] Through this foramen, the
mental neurovascular bundles exits. It remains incomplete till
the 12thgestational week until the mental nerve separates into
several fasciculi at that site. Identifying the precise location of
mental nerve is critical while performing peri apical surgery,
cyst enucleation, endosseous implant, periodontal surgery
and surgical orthodontic treatments such as a mandibular
body osteotomy, in order to prevent damage to the mental
nerve.[3] In addition, knowing the site of the mental foramen
allows for the accurate delivery of local anesthesia during
dental procedures.[8] There can be neuro sensory disturbances
encountered if this important landmark is ignored while doing
any invasive treatment in this region.
The interval between the two premolars is the most common
site of the mental foramen and the apex of second premolar
is the second most common site.[3,9] The results of the present
study conclude the same. In 42.5% mandibles on right side
and 40.9% on left side of dentate mandibles the common site
is the interval between the two premolars and in 18.1% of the
mandibles it is at the apex of second premolar. Santini and
Land et al.,[10] reportedthat in Chinese the mental foramen
was in line with second premolar and in British between first
and second premolars. In edentulous mandibles, 50% of the
mandibles on right side and 40.9% of the mandibles on left
side, the mental foramen was located between first and second
 Moogala, etal.: Anthropometrics of mental foramen
premolars. The second most common site is apex of second
premolar which is seen in 25.2% of the mandibles, which
is in accordance with the study conducted by Shankland,
Wang, Green.[2,3] The position of the mental foramen varies
depending on various factors like symmetry of mental triangle,
microscopic and macroscopic morphology and maturity of the
human mandible, bone remodeling activity and anthropologic
features of the facial skeleton in different populations.
According to the present study the distance between the apex
of lower second premolar socket to superior border of mental
foramen(A1-A2) is 3.8mm in dentate mandibles and 4.5mm
in edentulous mandibles. The apices of premolars are found to
be very close to the mental foramen. Thus, when endodontic
treatment is planned for these teeth, over obturation of root
canals can lead to impingement and irritation to the mental
nerve. Wang[3] reported that the average distance between the
apex of the lower second premolar socket and superior border
of mental foramen is 2.5mm. Such a short distance can harm
the mental nerve if the root canal is overfilled during root canal
treatment procedures.
In the present study, the distance between inferior margin of
mental foramen to the inferior border of mandible(MFIFB) is
12.39mm in dentate mandibles whereas 13.5mm in edentulous
mandibles which is in correlation with Chunget al.,[11] study.
They reported that the average distance from the inferior
border of the mandible to the center of mental foramen was
15.5mm for Korean males and 14.0mm for Korean females.
Gershchensonet al.,[12] reported that the location of the mental
foramen in relation to the border of the mandible and teeth
depended on age, tooth condition and the degree of resorption.
In adults as age advances, mental foramen shifts toward the
superior border of mandible. This can be attributed to tooth
loss followed by bone resorption. With the loss of teeth, there is
change in the relative position from midlevel toward the upper
border of the mandible. In severe cases of alveolar resorption
the bone loss is so much that the incisive and inferior alveolar
nerves are exposed out of bone and lie just below the mucosa
which may cause pain on denture wearing. Accordingly,
the results of the present study also showed that the values
decreased in edentulous mandibles.
Soikkonen et al.,[13] reported that the mental foramen moves
toward the lower cortex of the mandible as a result of alveolar
atrophy and was situated on average 3.8mm lower in
edentulous jaws than in dentate jaws. In our present study, the
distance between alveolar crest and inferior margin of mental
foramen[ACMF] in dentate mandibles is around 3.71mm
and in edentulous mandibles it slightly increased to 4.43mm.
The distance between the posterior border of ramus of
mandible and most anterior margin of mental foramen is very
important, as nerve and vessels pass through it and care is taken
to avoid complications during inferior alveolar nerve blocks,
peri apical surgeries, apical curettage and implant placement
and nerve repositioning.
In the present study, in dentate mandible the distance between
most anterior margin of mental foramen and posterior
border of ramus of the mandible(MFPR) on right side is
69.616.03mm, left side is 69.176.0mm and in edentulous
Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014 501
mandibles(MFPR) on right side is 68.396.4mm, left side
is 68.816.55mm. These results are similar to the study
conducted by Shankar etal.[14]
The distance between symphysis menti and most anterior margin
of mental foramen(MFSM) in dentulous mandible on right side
is 28.245.09mm, and on left side is 27.453.7mm and in
edentulous mandible(MFSM) on right side is 28.514.53mm,
and on left side are 27.994.50mm. These results are similar
to the above study conducted Shankaretal.[14] Clinically, there
may be instances where the mental foramen cannot be localized
without a fixed reference point. In such cases, it can be localized
if the distance from the symphysis menti is known.
Accessory mental foramen is a rare anatomical variation.
Even so, in order to avoid neurovascular complications,
particular attention should be paid to the possible occurrence
of one or more accessory mental foramen during surgical
procedures. Utmost care to the accessory mental foramen
and nerve is essential during dental implant surgery and
any surgical procedure involving the mandibular molar and
premolar region. This care may reduce the rate of paralysis and
hemorrhage in mental region, lower lip and gingiva from the
mental foramen to the midline of the ipsilateral side.[15]
In the present study out of 127 dentulous mandibles 13.97%
accessory mental foramens were found whereas out of 92
edentulous mandibles 2.76% of accessory mental foramen
were found. Out of these 219 mandibles none of them
presented with more than two accessory mental foraminae.
Gershchensonet al.,[12] reported 7.51% of double foramina in
Indian and Israeli mandibles. Suresh etal.,[16] and Zografos and
Mutzuri[17] studied the incidence of double foramina in 11.48%
of North Indians and 6.68% of Greek population, respectively.
In the present study, 68.5% of dentulous mandibles on right
side and 78% on left side, the foramen is round in shape and
oval in 31.5 and 22%, respectively. In edentulous mandibles,
it is found that 60.9% is round on right side and 62% is round
on left side, whereas, it is oval in 39.5 and 38%, respectively.
These values are similar to study reported by Mbajiorgu etal.,[18]
and Junior etal.[19] According to Alkhateebet al.,[20] majority of
foraminae were round in shape which is similar to the present
study.
The present analysis revealed variations in position, shape and
size of the mental foramen. The knowledge of exact position
and various distances of mental foramen are necessary for its
anesthetic and surgical intervention. Thus, it is important to
know the anatomical variations of mental foramina in order to
avoid nerve damage in connection with surgical procedures.
Since this study had been conducted in the local population,
the ethnic and racial variations are not highlighted. Further
studies focusing on racial and ethnic variations in different
population groups need to be conducted on a large scale to
substantiate this study.
CONCLUSION
The knowledge of the position of mental foramen is
important for daytoday clinical practice. This variability
of mental foramen should alert the dental surgeons while
 Moogala, etal.: Anthropometrics of mental foramen
performing periodontal or endodontic surgery. Clinicians
should not rely on panoramic radiographs for identifying
the position of mental foramen. The knowledge of the
relationship of the foramen, in surgical procedures, in
relation to anatomical landmarks can be of assistance in
the localization of important maxillofacial neurological
structures. This study highlights and adds to the current
literature of the mental foramen.
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How to cite this article: Moogala S, Sanivarapu S, Boyapati R,
Devulapalli NS, Chakrapani S, Kolaparthy L. Anthropometrics
of mental foramen in dry dentate and edentulous mandibles in
Coastal Andhra population of Andhra Pradesh State. J Indian Soc
Periodontol 2014;18:497-502.
Source of Support: Nil, Conflict of Interest: None declared.
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