Hemorrhage Secondary to Interforamina Implant Surgery: Anatomical Considerations
Bibliographic record
Abstract
Introduction Dental implants are commonly used to replace missing teeth in the anterior mandible. However, this area is richly vascularized by the sublingual and submandibular arteries, which are branches of the lingual and facial arteries respectively. The pathways of these arteries are variable, as evidenced by the variability of the lingual foramina that they traverse through. These foramina are located in the interforaminal area, which is on the lingual surface of the anterior mandible where the genial tubercles are found. Placement of implants in the interforaminal area can lead to hemorrhage, the results of which can lead to serious complications including swelling of the submandibular floor and tongue, as well as obstruction of the airways. Objectives The objective of this research was to characterize variations in the sublingual and submandibular arteries. Secondarily, we will enumerate and describe the lingual foramina through which these arteries pass. Methods The study was performed on both dry mandibles and cadaveric samples. To characterize the variability in the lingual foramina, 50 dry mandibles were used and measurements of the lingual foramina in the interforaminal area were recorded. These measurements included the diameter of the foramina, the location of the foramina relative to the superior and inferior borders of the mandible, and their frequency of occurrence bilaterally on the mandible. The location of foramina was measured as a ratio of the distance from the superior border of the mandible over the total height of the anterior mandible, in order to account for differences in mandibular heights between specimens. To characterize paths and branching patterns of the sublingual and submandibular arteries, 15 cadaveric heads will be dissected. The arteries will then be examined for variations in their branching, asymmetry, and point of entry into the mandible (distance from superior portion of mandibular bone). Results Of the lingual foramina measured, 51% (20/39) were clustered 55–65% below the internal superior surface of the mandible. However, there was large variation in this data, with lingual foramina occurring anywhere from 30% below the internal superior border of the mandibular bone to 70% of the distance below. Additionally, 26/39 (67%) of foramina were found on the lower half of the mandibular bone surface. Examination of foramina symmetry suggest significantly more were found on the left side (Left = 2.3 ± 1.1) as opposed to the right (1.4 ± 1.1) (P=0.021). Conclusion Within the limits of this study more foramina exist on the left half of the lingual side of the anterior mandible than on the right which could imply a greater blood supply to that region. Further investigations are being carried out to determine the distribution of the sublingual and submandibular artery branches in the interforaminal area. Possible avenues will use CBCT or ultrasound in patients to define and locate these arteries as they enter the mandible, as this is difficult to see in embalmed cadavers. Enhanced knowledge of the arterial supply and variation of this area of the mandible will guide clinical practice in the future and can help avoid complication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".