Prevalence and extension of the anterior loop of the mental nerve in different populations and CBCT imaging settings: A systematic review and meta-analysis

PURPOSE: This study aimed to identify the prevalence and extension of the anterior loop (AL) of the mental nerve in different populations and according to different cone-beam computed tomography (CBCT) imaging settings. MATERIALS AND METHODS: Medline/PubMed, Embase, Scopus, Web of Science, and ProQuest were searched. The main inclusion criterion was ALs evaluated in CBCT images. The quality of studies was assessed with the Joanna Briggs Institute risk of bias checklist. Subgroup analyses were conducted for sex, side, continent, voxel size, field of view, and type of CBCT-reconstruction images with a random-effects model. RESULTS: Sixty-three studies with 13,743 participants (27,075 hemimandibles) were included. An AL was found in 40.6% (95% CI: 32.8%-48.9%, P<0.05) of participants and 36.0% (95% CI: 27.5%-45.5%, P<0.05) of hemimandibles, in 34.9% (95% CI: 25.1%-46.2%, P<0.05) of males and 34.5% (95% CI: 23.5%-47.4%, P<0.05) of females. The average length of ALs was 2.39 mm (95% CI: 2.07-2.70 mm, P<0.05). Their extension was 2.13 mm (95% CI: 1.54-2.73 mm, P<0.05) in males and 1.85 mm (95% CI: 1.35-2.36 mm, P<0.05) in females. Significant differences were observed regarding the prevalence and length of ALs among continents and for its measured length on different CBCT-reconstruction images, but not between other subgroups. CONCLUSION: AL was a relatively common finding. The voxel size and fields of view of CBCT devices were adequate for assessing AL; however, a 2-mm safety margin from anatomical structures (such as the AL) could be recommended to be considered when using CBCT imaging.