Appearance of the mandibular incisive canal on panoramic radiographs

Panoramic radiographs are routinely used in the dental office for various diagnostic purposes. This study aimed to evaluate the visibility of neurovascular structures in the mandibular interforaminal region on such radiographs. Panoramic radiographs were obtained with a Cranex Tome (Soredex) from 545 consecutive patients using a standard exposure and positioning protocol. For visibility scoring of neurovascular structures, a four-point rating scale was used. The mandibular canal and the mental foramen could be observed in the majority of the cases with good visibility. The lingual foramen was visualized in 71% of the cases, with good visibility in 12%. An incisive canal was identified in 15% of the images, with good visibility in only 1%. An anatomical variation to be considered is the anterior looping of the mental nerve (in 11% of images). Panoramic radiographs can be used for visualization of the mental foramen and a potential anterior looping but not for locating the mandibular incisive canal. To verify its existence for preoperative planning purposes, cross-sectional imaging modalities (HR-CT or spiral tomography) should be preferred.