{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T17:39:43Z","timestamp":1794591583735,"version":"4.9.1"},"reference-count":34,"publisher":"American Academy of Implant Dentistry","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:p>Placement of dental implants in the anterior mandible is considered by many clinicians to be a relatively low-risk procedure. However, hemorrhagic episodes following implant placement in the mandibular symphysis are regularly reported and can have serious consequences. The use of high-resolution focused cone beam scanners has given us the ability to visualize the intricate neurovascular network of the intraforaminal region without distortion and in greater detail. Knowledge of the arterial supply and navigated implant placement in the mandibular symphysis can help to avoid these potentially life-threatening emergencies.<\/jats:p>","DOI":"10.1563\/aaid-joi-d-10-00136","type":"journal-article","created":{"date-parts":[[2010,10,8]],"date-time":"2010-10-08T14:22:49Z","timestamp":1286547769000},"page":"745-753","source":"Crossref","is-referenced-by-count":21,"title":["Maxillofacial Anatomy: The Mandibular Symphysis"],"prefix":"10.1563","volume":"37","author":[{"given":"Robert J.","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Oral Implantology, Atlantic Coast Dental Research Clinic, Palm Beach, Florida; The Center for Advanced Aesthetic and Implant Dentistry, Delray Beach, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren C.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Private practice, Melbourne, Florida; Atlantic Coast Dental Research Clinic, Palm Beach, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Boudet","sequence":"additional","affiliation":[{"name":"Private practice, West Palm Beach, Florida; Atlantic Coast Dental Research Clinic, Palm Beach, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon H.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Private practice, Coral Springs, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"434","reference":[{"key":"i1548-1336-37-6-745-b01","series-title":"Radiologie","first-page":"1051","article-title":"Dental CT in the planning of surgical procedures: its significance in the oro-maxillofacial region from the view point of the dentist","volume":"39","author":"Solar\n              P,","year":"1999","unstructured":"Solar\n              P, \n            \n              Gahleitner\n              A. \n          \n          Dental CT in the planning of surgical procedures: its significance in the oro-maxillofacial region from the view point of the dentist. Radiologie. 1999;39:1051\u20131063."},{"key":"i1548-1336-37-6-745-b02","series-title":"J Prosthet Dent","first-page":"42","article-title":"Comparison of 2D orthoradially-reformatted CT images for dental implant treatment planning","volume":"74","author":"Lam\n              E,","year":"1995","unstructured":"Lam\n              E, \n            \n              Ruprecht\n              A, \n            \n              Yang\n              J. \n          \n          Comparison of 2D orthoradially-reformatted CT images for dental implant treatment planning. J Prosthet Dent. 1995;74:42\u201346."},{"key":"i1548-1336-37-6-745-b03","series-title":"Dentomaxillofac Radiol","first-page":"329","article-title":"Validation of spiral computed tomography for dental implants","volume":"27","author":"Cavalcanti\n              MGP,","year":"1998","unstructured":"Cavalcanti\n              MGP, \n            \n              Yang\n              J, \n            \n              Ruprecht\n              A, \n            \n              Vannier\n              MW. \n          \n          Validation of spiral computed tomography for dental implants. Dentomaxillofac Radiol. 1998;27:329\u2013333."},{"key":"i1548-1336-37-6-745-b04","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"369","article-title":"2D and 3D reconstructions of spiral CT in localization of the inferior alveolar canal for dental implants","volume":"87","author":"Yang\n              J,","year":"1999","unstructured":"Yang\n              J, \n            \n              Cavalcanti\n              MGP, \n            \n              Ruprecht\n              A, \n            \n              Vannier\n              MW. \n          \n          2D and 3D reconstructions of spiral CT in localization of the inferior alveolar canal for dental implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:369\u2013374."},{"key":"i1548-1336-37-6-745-b05","series-title":"J Oral Implantol","first-page":"165","article-title":"Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident","volume":"29","author":"Flanagan\n              D.","year":"2003","unstructured":"Flanagan\n              D. \n          \n          Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident. J Oral Implantol. 2003;29:165\u2013173."},{"key":"i1548-1336-37-6-745-b06","series-title":"Implant Dent","first-page":"131","article-title":"Lingual vascular canals of the mandible: the risk of bleeding complications during implant procedures","volume":"16","author":"Longoni\n              S,","year":"2007","unstructured":"Longoni\n              S, \n            \n              Sartori\n              M, \n            \n              Braun\n              M, \n            et al. \n          Lingual vascular canals of the mandible: the risk of bleeding complications during implant procedures. Implant Dent. 2007;16:131\u2013138."},{"key":"i1548-1336-37-6-745-b07","series-title":"SADJ","first-page":"64","article-title":"Haematoma of the floor of the mouth following implant placement","volume":"57","author":"Boyes-Varley\n              JG,","year":"2003","unstructured":"Boyes-Varley\n              JG, \n            \n              Lownie\n              JF. \n          \n          Haematoma of the floor of the mouth following implant placement. SADJ. 2003;57:64\u201365."},{"key":"i1548-1336-37-6-745-b08","series-title":"Int J Oral Maxillofac Surg","first-page":"367","article-title":"Anatomical variation in arterial supply of the mandible with special regard to implant placement","volume":"37","author":"Loukas\n              M,","year":"2008","unstructured":"Loukas\n              M, \n            \n              Kinsella\n              CR\n              Jr, \n            \n              Kapos\n              T, \n            \n              Tubbs\n              RS, \n            \n              Ramachandra\n              S. \n          \n          Anatomical variation in arterial supply of the mandible with special regard to implant placement. Int J Oral Maxillofac Surg. 2008;37:367\u2013371."},{"key":"i1548-1336-37-6-745-b09","series-title":"Implant Dent","first-page":"117","article-title":"Critical hemorrhage in the floor of the mouth during implant placement in the first mandibular premolar position: a case report","volume":"14","author":"Kalpidis\n              CD,","year":"2005","unstructured":"Kalpidis\n              CD, \n            \n              Konstantinidis\n              AB. \n          \n          Critical hemorrhage in the floor of the mouth during implant placement in the first mandibular premolar position: a case report. Implant Dent. 2005;14:117\u2013124."},{"key":"i1548-1336-37-6-745-b10","series-title":"J Oral Maxillofac Surg","first-page":"201","article-title":"Life-threatening hemorrhage from placement of a dental implant","volume":"48","author":"Mason\n              ME,","year":"1990","unstructured":"Mason\n              ME, \n            \n              Triplett\n              RG, \n            \n              Alfonso\n              WF. \n          \n          Life-threatening hemorrhage from placement of a dental implant. J Oral Maxillofac Surg. 1990;48:201\u2013204."},{"key":"i1548-1336-37-6-745-b11","series-title":"Int J Oral Maxillofac Implants","first-page":"379","article-title":"Assessment of the blood supply to the mental region for reduction of bleeding complications during implant surgery in the interforaminal region","volume":"14","author":"Hofschnieder\n              U,","year":"1999","unstructured":"Hofschnieder\n              U, \n            \n              Tepper\n              G, \n            \n              Gahleitner\n              A, \n            \n              Ulm\n              C. \n          \n          Assessment of the blood supply to the mental region for reduction of bleeding complications during implant surgery in the interforaminal region. Int J Oral Maxillofac Implants. 1999;14:379\u2013383."},{"key":"i1548-1336-37-6-745-b12","series-title":"Dent Implantol Update","first-page":"41","article-title":"Dental implant imaging: TeraRecon's dental 3D cone beam computed tomography system","volume":"18","author":"Garg\n              AK.","year":"2007","unstructured":"Garg\n              AK. \n          \n          Dental implant imaging: TeraRecon's dental 3D cone beam computed tomography system. Dent Implantol Update. 2007;18:41\u201345."},{"key":"i1548-1336-37-6-745-b13","series-title":"Surg Radiol Anat","first-page":"466","article-title":"The three dimensional microstructure of trabecular bone in the mandible","volume":"26","author":"Moon\n              HS,","year":"2004","unstructured":"Moon\n              HS, \n            \n              Won\n              YY, \n            \n              Kim\n              KD, \n            et al. \n          The three dimensional microstructure of trabecular bone in the mandible. Surg Radiol Anat. 2004;26:466\u2013473."},{"key":"i1548-1336-37-6-745-b14","series-title":"Surg Radiol Anat","first-page":"416","article-title":"Presence and course of the incisive canal in the human mandibular interforaminal region: two-dimensional imaging versus anatomical observations","volume":"25","author":"Mraiwa\n              N,","year":"2003","unstructured":"Mraiwa\n              N, \n            \n              Jacobs\n              R, \n            \n              Moerman\n              P, \n            et al. \n          Presence and course of the incisive canal in the human mandibular interforaminal region: two-dimensional imaging versus anatomical observations. Surg Radiol Anat. 2003;25:416\u2013423."},{"key":"i1548-1336-37-6-745-b15","series-title":"Dentomaxillofac Radiol","first-page":"322","article-title":"Appearance, location, course and morphology of the mandibular incisive canal: an assessment on spiral CT scan","volume":"31","author":"Jacobs\n              R,","year":"2002","unstructured":"Jacobs\n              R, \n            \n              Mraiwa\n              N, \n            \n              vanSteenberghe\n              D, \n            et al. \n          Appearance, location, course and morphology of the mandibular incisive canal: an assessment on spiral CT scan. Dentomaxillofac Radiol. 2002;31:322\u2013327."},{"key":"i1548-1336-37-6-745-b16","series-title":"Implant Dent","first-page":"169","article-title":"Autogenous mandibular bone grafts in the treatment of the resorbed maxillary anterior alveolar ridge: rationale and approach","volume":"7","author":"Garg\n              AK,","year":"1998","unstructured":"Garg\n              AK, \n            \n              Morales\n              MJ, \n            \n              Navarro\n              I, \n            \n              Duarte\n              F. \n          \n          Autogenous mandibular bone grafts in the treatment of the resorbed maxillary anterior alveolar ridge: rationale and approach. Implant Dent. 1998;7:169\u2013176."},{"key":"i1548-1336-37-6-745-b17","series-title":"Implant Dent","first-page":"420","article-title":"Complications of intraoral donor sites for bone grafting prior to implant placement","volume":"15","author":"Silva\n              FM,","year":"2006","unstructured":"Silva\n              FM, \n            \n              Cortez\n              AL, \n            \n              Moreira\n              RW, \n            \n              Mazzonetto\n              R. \n          \n          Complications of intraoral donor sites for bone grafting prior to implant placement. Implant Dent. 2006;15:420\u2013426."},{"key":"i1548-1336-37-6-745-b18","series-title":"J Neurocytol","first-page":"480","article-title":"Observations on the progress of Wallerian degeneration in transected peripheral nerves of C57BL\/Wld mice in the presence of recruited macrophages","volume":"22","author":"Hall\n              SM.","year":"1993","unstructured":"Hall\n              SM. \n          \n          Observations on the progress of Wallerian degeneration in transected peripheral nerves of C57BL\/Wld mice in the presence of recruited macrophages. J Neurocytol. 1993;22:480\u2013490."},{"key":"i1548-1336-37-6-745-b19","series-title":"Clin Implant Dent Relat Res","first-page":"154","article-title":"Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications","volume":"5","author":"Clavero\n              J,","year":"2003","unstructured":"Clavero\n              J, \n            \n              Lungren\n              S. \n          \n          Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications. 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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:686\u2013688."},{"key":"i1548-1336-37-6-745-b21","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"232","article-title":"Arterial supply to the floor of the mouth and lingual gingiva","volume":"77","author":"Bavitz\n              JB,","year":"1994","unstructured":"Bavitz\n              JB, \n            \n              Harn\n              SD, \n            \n              Homze\n              EJ. \n          \n          Arterial supply to the floor of the mouth and lingual gingiva. 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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:625\u2013629."},{"key":"i1548-1336-37-6-745-b23","series-title":"J Periodontol","first-page":"631","article-title":"Hemorrhaging associated with endosseous implant placement in the anterior mandible: a review of the literature","volume":"75","author":"Kalpidis\n              CD,","year":"2004","unstructured":"Kalpidis\n              CD, \n            \n              Setayesh\n              RM. \n          \n          Hemorrhaging associated with endosseous implant placement in the anterior mandible: a review of the literature. J Periodontol. 2004;75:631\u2013645."},{"key":"i1548-1336-37-6-745-b24","series-title":"J Periodontol","first-page":"1893","article-title":"Emergency tracheostomy following life-threatening hemorrhage in the floor of the mouth during immediate implant placement in the mandibular canine region","volume":"71","author":"Givol\n              N,","year":"2000","unstructured":"Givol\n              N, \n            \n              Chaushu\n              G, \n            \n              Halamish-Shani\n              T, \n            \n              Taicher\n              S. \n          \n          Emergency tracheostomy following life-threatening hemorrhage in the floor of the mouth during immediate implant placement in the mandibular canine region. J Periodontol. 2000;71:1893\u20131895."},{"key":"i1548-1336-37-6-745-b25","series-title":"Int J Oral Maxillofac Implants","first-page":"127","article-title":"Lingual perimandibular vessels associated with life-threatening bleeding: an anatomic study","volume":"22","author":"Mardinger\n              D,","year":"2007","unstructured":"Mardinger\n              D, \n            \n              Manor\n              Y, \n            \n              Mijiritsky\n              E, \n            \n              Hirshberg\n              A. \n          \n          Lingual perimandibular vessels associated with life-threatening bleeding: an anatomic study. Int J Oral Maxillofac Implants. 2007;22:127\u2013131."},{"key":"i1548-1336-37-6-745-b26","series-title":"Surg Radiol Anat","first-page":"201","article-title":"The anatomical features and surgical use of the submental artery","volume":"27","author":"Atamaz Pinar\n              Y,","year":"2005","unstructured":"Atamaz Pinar\n              Y, \n            \n              Govsa\n              F, \n            \n              Bilge\n              O. \n          \n          The anatomical features and surgical use of the submental artery. Surg Radiol Anat. 2005;27:201\u2013205."},{"key":"i1548-1336-37-6-745-b27","series-title":"Okajimas Folia Anat Jpn","first-page":"83","article-title":"The appearance of foramen in the internal aspect of the mental region of mandible from Japanese cadavers and dry skulls under macroscopic observation and three-dimensional CT images","volume":"82","author":"Yoshida\n              S,","year":"2005","unstructured":"Yoshida\n              S, \n            \n              Kawai\n              T, \n            \n              Okutsu\n              K, \n            et al. \n          The appearance of foramen in the internal aspect of the mental region of mandible from Japanese cadavers and dry skulls under macroscopic observation and three-dimensional CT images. Okajimas Folia Anat Jpn. 2005;82:83\u201387."},{"key":"i1548-1336-37-6-745-b28","series-title":"Int J Oral Maxillofac Implants","first-page":"68","article-title":"Computed tomographic diagnosis and localization of bone canals in the mandibular interforaminal region for prevention of bleeding complications during implant surgery","volume":"16","author":"Tepper\n              G,","year":"2001","unstructured":"Tepper\n              G, \n            \n              Hofschneider\n              UB, \n            \n              Gahleitner\n              A, \n            \n              Ulm\n              C. \n          \n          Computed tomographic diagnosis and localization of bone canals in the mandibular interforaminal region for prevention of bleeding complications during implant surgery. 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Int J Oral Maxillofac Implants. 2007;22:359\u2013365."},{"key":"i1548-1336-37-6-745-b30","series-title":"Radiol Med","first-page":"854","article-title":"A rare case of double mental foramen: imaging with computed tomography","volume":"85","author":"Meoli\n              S,","year":"1993","unstructured":"Meoli\n              S, \n            \n              Fucci\n              G, \n            \n              Vaia\n              E. \n          \n          A rare case of double mental foramen: imaging with computed tomography. Radiol Med. 1993;85:854\u2013857."},{"key":"i1548-1336-37-6-745-b31","series-title":"Int J Oral Maxillofac Surg","first-page":"70","article-title":"Navigated implantation after microsurgical bone transfer using intraoperatively acquired cone-beam computed tomography data sets","volume":"37","author":"Heiland\n              M,","year":"2008","unstructured":"Heiland\n              M, \n            \n              Pohlenz\n              P, \n            \n              Blessmann\n              M, \n            et al. \n          Navigated implantation after microsurgical bone transfer using intraoperatively acquired cone-beam computed tomography data sets. Int J Oral Maxillofac Surg. 2008;37:70\u201375."},{"key":"i1548-1336-37-6-745-b32","series-title":"Implant Dent","first-page":"41","article-title":"Surgical navigation in oral implantology","volume":"15","author":"Miller\n              RJ,","year":"2006","unstructured":"Miller\n              RJ, \n            \n              Bier\n              J. \n          \n          Surgical navigation in oral implantology. Implant Dent. 2006;15:41\u201347."},{"key":"i1548-1336-37-6-745-b33","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"597","article-title":"Near fatal airway obstruction after routine implant placement","volume":"92","author":"Niamtu\n              J\n              III.","year":"2001","unstructured":"Niamtu\n              J\n              III. \n          \n          Near fatal airway obstruction after routine implant placement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:597\u2013600."},{"key":"i1548-1336-37-6-745-b34","series-title":"Clin Oral Implants Res","first-page":"79","article-title":"Bone classification: an objective scale of bone density using the computerized tomography scan","volume":"12","author":"Norton\n              MR,","year":"2001","unstructured":"Norton\n              MR, \n            \n              Gamble\n              C. \n          \n          Bone classification: an objective scale of bone density using the computerized tomography scan. 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