{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:21:50Z","timestamp":1785410510366,"version":"3.56.0"},"reference-count":14,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["VI25G035"],"award-info":[{"award-number":["VI25G035"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"award":["VI25G035"],"award-info":[{"award-number":["VI25G035"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: Inferior alveolar nerve injury is a common complication of Bilateral Sagittal Split Osteotomy. Preoperative three-dimensional tracing of the mandibular nerve canal using Cone-beam CT may help reduce this risk. We reconstructed the nerve course in 428 consecutively planned BSSO cases and developed a statistical model that quantifies population-level canal position to guide safe, evidence-based osteotomy planning. Methods: Traceable mandibular nerve canal CBCTs from 440 BSSO candidates (2023\u20132025) were retained. The mandibles and 2.5 mm diameter canals were segmented in Mimics and fused with intraoral scans. Next, the meshes were aligned non-rigidly to a template. A k-nearest-neighbour analysis mapped the outer mandibular surface to canal distances of all the patients on the template mandible model. Results: After excluding 12 scans because the nerve could not be traced, 428 mandibles were studied. The canal\u2019s position varied, with regions near the vertical ramus and premolar regions frequently showing fewer than 3 mm of buccal bone covering the mandibular nerve. In contrast, a preferred safe zone was identified in the second molar region, where more than 97.8% of patients had greater than 5 mm of buccal bone clearance. A population-based colour map was generated to visualise the risk areas and confidence intervals for outer cortex-to-canal distances. Conclusions: This study provides the first high-resolution, population-based 3D map of nerve clearance in BSSO patients. Routine use of CBCT with patient-specific nerve tracing is recommended to reduce the risk of nerve injury.<\/jats:p>","DOI":"10.3390\/jpm16050237","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:03:47Z","timestamp":1777536227000},"page":"237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Population-Based 3D Mapping of Inferior Alveolar Nerve Clearance in Bilateral Sagittal Split Osteotomy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-7568","authenticated-orcid":false,"given":"Haye H.","family":"Glas","sequence":"first","affiliation":[{"name":"Clinic for Virtual Surgical Planning, 3D VSP B.V., Hoogwatum 2, 9906 TD Bierum, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8225-8140","authenticated-orcid":false,"given":"Tom L.","family":"Zwijnenberg","sequence":"additional","affiliation":[{"name":"Clinic for Virtual Surgical Planning, 3D VSP B.V., Hoogwatum 2, 9906 TD Bierum, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2536-4786","authenticated-orcid":false,"given":"Johan","family":"Jansma","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Expertcenter for Orthofacial Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutger H.","family":"Schepers","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Expertcenter for Orthofacial Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.jcms.2016.04.023","article-title":"Risk Factors for Common Complications Associated with Bilateral Sagittal Split Osteotomy: A Literature Review and Meta-Analysis","volume":"44","author":"Verweij","year":"2016","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.bjoms.2018.10.279","article-title":"Is Injury to the Inferior Alveolar Nerve Still Common during Orthognathic Surgery? Manual Twist Technique for Sagittal Split Ramus Osteotomy","volume":"56","author":"Choi","year":"2018","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.ijom.2014.11.010","article-title":"Systematic Review of the Incidence of Inferior Alveolar Nerve Injury in Bilateral Sagittal Split Osteotomy and the Assessment of Neurosensory Disturbances","volume":"44","author":"Agbaje","year":"2015","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"116","DOI":"10.4103\/ijdr.ijdr_315_22","article-title":"Incidence of Inferior Alveolar Nerve Sensory Deficit and Intra-Operative Nerve Encounters after Advancement of Retrognathic Mandible\u2014A Cross-Sectional Survey Study","volume":"33","author":"Vyloppilli","year":"2022","journal-title":"Indian J. Dent. Res."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Valls-Onta\u00f1\u00f3n, A., Ortiz-Guti\u00e9rrez, A., Duran-Vall\u00e9s, F., Giralt-Hernando, M., and Hern\u00e1ndez-Alfaro, F. (Br. J. Oral Maxillofac. Surg., 2026). Bilateral Sagittal Split Osteotomy Buccal Cut Classification. Indications: Pros and Cons, Br. J. Oral Maxillofac. Surg., in press.","DOI":"10.1016\/j.bjoms.2026.01.004"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.ijom.2016.12.008","article-title":"Cortical Bone Thickness of the Mandibular Canal and Implications for Bilateral Sagittal Split Osteotomy: A Cadaveric Study","volume":"46","author":"Promma","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_7","first-page":"e36004","article-title":"Assessment of Mandibular Canal Using Cone-Beam Computed Tomography (CBCT) and Its Relevance in Post-Operative Neurosensory Disturbances Following Bilateral Sagittal Split Osteotomy Setback","volume":"15","author":"Kanneth","year":"2023","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4682105","DOI":"10.1155\/2022\/4682105","article-title":"CBCT Evaluation of Buccolingual Orientation of Inferior Alveolar Canal in Mandibular Posterior Region for Implant Planning","volume":"2022","author":"Chua","year":"2022","journal-title":"Int. J. Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"405","DOI":"10.4103\/ijdr.IJDR_418_17","article-title":"Assessing the Variation in Course and Position of Inferior Alveolar Nerve among South Indian Population: A Cone Beam Computed Tomographic Study","volume":"29","author":"Kavarthapu","year":"2018","journal-title":"Indian J. Dent. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1007\/s00784-019-03120-7","article-title":"MRI of the Inferior Alveolar Nerve and Lingual Nerve-Anatomical Variation and Morphometric Benchmark Values of Nerve Diameters in Healthy Subjects","volume":"24","author":"Burian","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2213","DOI":"10.1007\/s00784-016-2014-x","article-title":"Tracking of the Inferior Alveolar Nerve: Its Implication in Surgical Planning","volume":"21","author":"Agbaje","year":"2017","journal-title":"Clin. Oral Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1016\/j.joms.2015.02.030","article-title":"Angled Osteotomy Design Aimed to Influence the Lingual Fracture Line in Bilateral Sagittal Split Osteotomy: A Human Cadaveric Study","volume":"73","author":"Verweij","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_13","first-page":"81","article-title":"Esthetic Considerations in Minimally Invasive Orthognathic Surgery","volume":"44","author":"Claus","year":"2023","journal-title":"Compend. Contin. Educ. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1016\/j.joms.2015.03.023","article-title":"Influence of Osteotomy Design on Bilateral Mandibular Ramus Sagittal Split Osteotomy","volume":"73","author":"Wolford","year":"2015","journal-title":"J. Oral Maxillofac. Surg."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/5\/237\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T04:11:35Z","timestamp":1777695095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/5\/237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":14,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jpm16050237"],"URL":"https:\/\/doi.org\/10.3390\/jpm16050237","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}