Ossifying fibroma (OF) is a benign fibro-osseous lesion characterized by the proliferation of fibrous connective tissue containing immature bone and/or cementum-like hard tissue. Although the pathogenesis of OF remains unclear, trauma, previous extractions, and periodontitis are considered potential trigger factors. OF is more common in women aged from the second to fourth decades. Clinically, OF is characterized by slow-growing and asymptomatic swelling, often observed incidentally on radiological examinations. OF occurs more frequently in the mandible, particularly above the mandibular canal. Herein, we present a rare case of OF in an 18-year-old man initially misdiagnosed as a static bone cavity. The lesion was first observed as a radiolucent finding below the left mandibular canal on a panoramic radiograph. Later, cone-beam computed tomography (CBCT) imaging revealed the presence of calcifications within the lesion. Additionally, CBCT confirmed the presence of the lesion within the lingual cortical bone, revealing lingual swelling and thinning of the outer cortex. Enucleation was successfully performed under general anesthesia without any postoperative complications. Histopathological examination confirmed the diagnosis of OF, revealing mineralized tissue and proliferating fibrous connective tissue. This case underscores the challenges in diagnosing OF, particularly when it is located below the mandibular canal, emphasizing the importance of thorough imaging and differential diagnosis to avoid misinterpretation as a static bone cavity.

This clinical report presents a unique and previously unreported case of anatomical variations in the mandible, specifically involving the main mental foramen (MF), the mandibular canal (MC), and genial tubercles (GTs). The case involves a 21-year-old male seeking dental implant rehabilitation. The patient exhibited an unusual lingual exit path of the main left MF through the lingual cortical bone, with the MC following an anterior lingual direction along a lingual groove before exiting through the labial cortical bone between the apexes of the left canine and first premolar. Additionally, the patient displayed excessive enlargement and rare shape of the GTs. These rare anatomical findings presented challenges in dental implant planning. This case report emphasizes the importance of advanced imaging techniques like cone-beam computed tomography (CBCT) in evaluating mandibular structures for precise treatment planning and highlights the significance of understanding anatomical variations to prevent complications in dental procedures.

OBJECTIVE: To assess the impact of endoscope-assisted fractured roots or fragments extraction within the mandibular canal, along with quantitative sensory testing (QST) alterations in the inferior alveolar nerve (IAN).
METHODS: Six patients with lower lip numbness following mandibular third molar extraction were selected. All patients had broken roots or fragments within the mandibular canal that were extracted under real-time endoscopic assistance. Follow-up assessments were conducted on postoperative days 1, 7, and 35, including a standardized QST of the lower lip skin.
RESULTS: The average surgical duration was 32.5 min, with the IAN exposed in all cases. Two of the patient exhibited complete recovery of lower lip numbness, three experienced symptom improvement, and one patient remained unaffected 35 days after the surgery. Preoperative QST results showed that the mechanical detection and pain thresholds on the affected side were significantly higher than those on the healthy side, but improved significantly by postoperative day 7 in five patients, and returned to baseline in two patients on day 35. There were no significant differences in the remaining QST parameters.
CONCLUSIONS: All endoscopic surgical procedures were successfully completed without any additional postoperative complications. There were no cases of deterioration of IAN injury, and lower lip numbness recovered in the majority of cases. Endoscopy allowed direct visualization and examination of the affected nerve, facilitating a comprehensive analysis of the IAN.

Endodontic microsurgery has yielded highly successful outcomes in preserving teeth with persistent or recurrent cases of periapical periodontitis that could not be successfully treated by nonsurgical endodontic approaches. To avoid complications in conditions in which periapical lesions invade anatomical structures such as the nasopalatine nerve tube and mandibular canal, selective curettage has been proposed as an alternative choice of complete curettage in surgery.
The 8 cases reported herein had undergone root canal treatment and/or retreatment but still presented with symptoms, such as recurring sinus tracts and persistent dull pain. The radiographic examination indicated a large area of radiolucency that was associated with the tooth and had invaded adjacent critical anatomical structures. The patients opted for selective curettage via endodontic microsurgery, and the lesions were histologically confirmed as periapical cysts or granulomas. The follow-up results for one year or more indicated that the affected teeth were clinically asymptomatic and exhibited complete or incomplete healing radiographically.
This case series provides clinical evidence for the feasibility of selective curettage in endodontic microsurgery, which can avoid complications caused by damage to the adjacent critical anatomical structures.

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OBJECTIVE: The aim: To study the topographic variability of the left and right mandibular canals in case of bone atrophy caused by the loss of the masticatory teeth.
METHODS: Materials and methods: 136 digital scans were selected for morphometric analysis, 68 for each side taken with the Vatech PaX-i 3D Green extra-oral radiography system. The readout of absolute morphometric values, laying the left and right MC was performed in the projection of 3.7, 3.6, 4.6, 4.7 teeth using standardized Ez3D-I software.
RESULTS: Results: The alveolar part is characterized by distance to the alveolar ridge, and primarily exposed to pronounced atrophic processes of bone tissue. Distance to the lingual ridge directly proportionally indicates the morphological transposition vector of the mandibular canals for the distance to the buccal ridge, by the same length to its reduction. Morphometric analysis on a short toothless segment determines the variability of laying the mandibular canals but it is characterized by constant regular values of the ridge of the mandibular base.
CONCLUSIONS: Conclusions: Dentition defects, moving towards the missing teeth, lead to a decrease in the biophysical stimulus on bone tissue, causing pronounced morphological changes with the loss of significant volume and restructuring of its trabecular layer, which synchronously affects the topographic variability of the left and right MC.

One of the most common anatomical variations of the mandibular canal is the bifid mandibular canal (BMC), more frequently unilateral and rarely bilateral, often located at the level of the posterior mandible; according to literature, this anatomical variation presents several morphological types. The presence of the BMC must be considered prior to anesthesia and surgery performed on the ramus of the mandible (osteotomies) and on the posterior mandible (dentoalveolar surgery procedures). This study presents a clinical case of unilateral BMC on the left side, the buccolingual type, lingual variant, a rare anatomical variation illustrated radiographically in a 27-year-old male adult.

Anatomical variations of the mandibular canal as well as the presence of accessory canals and foramina are common findings in the human mandible. Here, we present a previously unreported type of anatomical variation, consisting of a large full-thickness bone defect of the right mandibular ramus, observed in a young male unearthed from a mediaeval cemetery located in North-Eastern Italy. The defect was located very close to, yet not directly connected with, the mandibular canal. Awareness of the existence of deviations from the anatomical norm such as that we describe here is strategic to avoid diagnostic misinterpretations, minimise technical hitches, and prevent clinical complications during invasive procedures in the region of the mandible.

Morphological variations of mandibular canals increase the risk of neurovascular damage and bleeding during surgical procedures by decreasing the predictability of the inferior alveolar neurovascular bundle location. To improve the predictability with such variations, the present study aimed to verify the possibility of a relationship between mandibular canal branches (MCBs) and tooth-related inflammatory lesions, using trough cone-beam computed tomography (CBCT) examinations.
The sample comprised 150 age and sex-matched examinations (50 cases and 100 controls) from two databases. The CBCT examinations were grouped by the presence of MCBs starting in the mandibular body regions as the outcome variable. Tooth-related inflammatory lesions and measurements of gray levels in the posterior region of the alveolar ridge were assessed in both groups. A multiple logistic regression analysis was applied to verify the relationships between MCBs and independent variables (p < 0.05).
Occurrence of tooth-related inflammatory lesions increased the risk of MCBs in the mandibular body regions (p < 0.001; OR 11.640; 95% CI 4.327-31.311). High-contrast images had a weaker association with MCBs (p = 0.002; OR 1.002; 95% CI 1.002-1.003). The most frequent tooth-related inflammatory lesions in both groups were endodontic (34 lesions; 45.94% of the total lesions). Most of the tooth-related inflammatory lesions related to MCBs were endodontic (20 cases) and combined endodontic and periodontal inflammation (20 cases).
An association was observed between MCBs in the mandibular body regions and tooth-related inflammatory lesions. Inflammatory lesions of endodontic origin are most often associated with MCBs.

The mandibular canal (MC) originates in the mandibular foramen and runs bilaterally through the mandibular ramus and body, ending in the mental foramen. One of the most common anatomical variations is bifid MC, the configurations of which have been classified into four categories and sub-categories. The prevalence of these variations depends on the imaging method used. Studies carried out in panoramic X-rays and cone beam computed tomography (CBCT) show prevalences varying between 1% and 20%. In this case report we present the finding of a bilateral bifid MC by CBCT examination; we describe its location and morphological characteristics. The variation found was a type 1 bilateral bifid MC, which consists in an accessory canal originating from a single mandibular foramen and extending to the third molar or its immediate surroundings. In this report we discuss the importance of detecting these anatomical variations, as well as their implications in clinical practice.