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The purpose of this article is to assess the incidence of lingual foramina and associated vasculature in the anterior mandible to improve the understanding of their locations for dental implant placement. Intra-operative bleeding can be a significant complication. Pre-surgical assessment of the surgical site should be performed to identify anatomical landmarks. This can prevent a potential life-threatening haemorrhage that may compromise the airway.  Nutrient canals can occur in the anterior mandible and have been reported to cause significant bleeding if violated. Using cone beam computerized tomography (CBCT) this study defines the anatomical locales in the mandible. CBCTs of 70 patients were obtained and examined for the presence of lingual foramina. The distance of lingual foramina to the inferior border of the mandible, bifurcations and propensity for the midline were assessed. Lingual foramina were found in all of the examined mandibles with variable configurations. CBCT may be important in planning for surgical procedures in the anterior mandible to prevent an unexpected hemorrhage. The present study is limited by its sample size, method of assessment and confinement to a geographical population. The results will need validation in further studies which may incorporate multiple assessment techniques and a larger sample size with to include greater geographical distribution. Future work may seek to describe emanations of the terminus of the sublingual artery.

The conventional practice of implant site preparation and implant placement is carried out freehand after treatment planning based on interpretation from a two-dimensional IOPA (Intraoral periapical radiograph) or OPG (Orthopantamograph) and by a wise clinical judgment. Much is left to guessing till the actual surgical appointment where we may be greeted by uncertainties related to soft tissue thickness, bone volume, bone density, proximity to anatomic structures, etc. Computer guided implant surgery is a CAD-CAM (Computer aided designing-Computer aided milling) solution to avoid such surprises. Here a virtual surgery based on a CT (computerized tomographic) scan and a surgical template made in accordance to it guides the depth, diameter and orientation of the implant. The surgery may be done flapless and requires minimum time. This article illustrates the use of an alternative for highly demanding surgical cases with the use of computer-guided implant placement on a 48 years old female patient, who was referred for placing implants in both maxilla and mandible. This technique optimizes implant placement and soft tissue esthetics while providing the patient with a fixed restoration. Computer-guided technology enhances accuracy and precision of the surgical procedure, minimizes complications and facilitates surgery in challenging anatomical locations.

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