Clinical significance of the structural integrity of the superior aspect of the mandibular canal.
BACKGROUND: Sparse data can be found regarding the structural integrity of the superior aspect of the mandibular canal. In many cases, the mandibular canal must be carefully evaluated prior to defining patient treatment. METHODS: In this case report, a 54-year-old patient presented with a periapical infection involving the mesial root of the mandibular right second molar (#31). Radiographic evaluation revealed that the periapical lesion extended from the apex of the tooth to the superior aspect of the mandibular canal. Upon surgical removal of the tooth, an apical communication between the extraction socket and mandibular nerve was located. A guided bone regeneration procedure was performed to protect the nerve from subsequent damage and to prepare the site for future implant placement. Implants were placed in the area approximately 5 months following the regenerative procedure. RESULTS: After implant placement, the patient experienced normal function and no mandibular symptomatology. Implants have been in function for the past 4 years. CONCLUSIONS: Many factors, both pathologic and developmental, can lead to a discontinuity of the superior aspect of the mandibular canal. Normally, a thin cortical plate of bone protects the nerve. When a lack of structural integrity of the canal roof is discovered, enucleation of a periapical infection or subsequent implant placement can lead to potential disruption of the nerve. Limited information is available regarding the integrity of this protective cover. This case report underscores the importance of proper clinical diagnosis before implant placement in the posterior mandible.