Demographic-Based Variations in Mental Nerve Looping: Anatomical Analysis and Surgical Risk Implications

Anatomical variations in mental nerve looping critically influence surgical outcomes in oral and maxillofacial interventions. This study investigates demographic-based morphological differences and quantifies their clinical risks. Retrospective analysis of 103 patients assessed looping characteristics (visibility, morphology, position, diameter) via CBCT imaging. Subgroup analyses employed Generalized Estimating Equations (GEE), with Monte Carlo simulations modeling injury probabilities. Progressive age-related changes included nerve thickening (0.02 mm/year, *p* < 0.001) and inferior migration (*p* < 0.001). Sexual dimorphism was evident, with males demonstrating thicker nerves (4.6 ± 1.6 mm vs. 4.2 ± 1.3 mm, *p* = 0.03). Deep loop positions (34.3% prevalence) conferred a 4-fold injury risk increase. Risk stratification revealed significantly higher injury probabilities in patients >40 years (10.2%) versus younger individuals (4.1%). High-risk variants included Type 1b anterior loops (17.6%) and double-loop configurations (3.9%), the latter exclusively observed in patients >45 years (*p* = 0.03). Demographic factors substantially influence mental nerve looping anatomy, with older age and male sex correlating with higher-risk morphological features. These findings support routine CBCT evaluation for patients >40 years and males undergoing procedures near the mental foramen. We propose protocol modifications including: (1) 3.0 mm safety margins for deep loops, (2) piezoelectric instrumentation for high-risk variants, and (3) age-adjusted surgical planning. Such targeted approaches may reduce iatrogenic nerve injuries by 62% based on our models.