Unusual Mandibular Incisive Canal Behind the Curtain of Periapical Radiolucency Using a CBCT-Assisted Diagnostic Approach: A Case Report and Literature Review

Abstract

Background: Additional neurovascular channels represent a significant anatomical feature in the mandibular anterior region. These neurovascular channels are seldom mentioned in existing literature. It is essential for clinicians to recognize the existence of these additional channels when analyzing radiographs and preparing for surgeries in the anterior mandible. Dental computed tomography (DCT) offers three-dimensional visualization of the lingual neurovascular canal. Aim: The purpose of this case report is to describe an infrequent course of mandibular incisive canal (MIC) by Cone-beam computerised tomography (CBCT) examination along with its location and morphological characteristics. Study Design: Case Report. Methodology: A 45-year-old patient presented with pain and discolouration in lower anterior teeth. Periapical radiograph revealed a large periapical lesion with an additional radiolucent line crossing between the mandibular incisors. Limited field of view (FOV) CBCT scan revealed it to be an accessory neurovascular channel traversing from premolar area to extending downward and upward, superimposed over the periapex-periapical area of tooth #32. Non-surgical root canal therapy (NSRCT) was performed and the patient was followed up after 6 months. Results: Post RCT, the patient was clinically asymptomatic with periapical healing evident at follow up visits after 1 month, 3 months and 6 months. CBCT aided the precise localisation of the MIC. Conclusion: It is important for the dentist to know the incidence and positions of accessory foramina in the mandible in implant placement and while performing periapical surgery in un healed apical periodontitis cases to prevent complications like nerve damage and incomplete nerve blocks.