Reassessment of the Anterior Mandibular Safe Zone: A CBCT-Based Analysis of Accessory Canal Prevalence and Sex Differences

Objective: The aim of this study was to evaluate the medial and lateral lingual canals and anterior labial accessory canals in the mandibular anterior region, called the safe zone, using cone beam computed tomography (CBCT) images and to evaluate their prevalence, location and laterality, and possible sex-related differences.Methods: CBCT images of 167 individuals (76 males, 91 females) were analyzed. Accessory canals in the anterior mandible were classified as medial lingual, lateral lingual, and anterior labial canals. The presence and number of medial lingual canals, their relationship to the genial tubercles (superior, median, inferior), and the presence and laterality of the lateral lingual and anterior labial canals were recorded. Sex-related differences were evaluated using chi-square or Fisher’s exact tests, with post-hoc analyses for multiple comparisons (p < .05).Results:The medial lingual canal was present in all cases, with females more frequently exhibiting a single canal (p < .05). The superior and inferior canals were observed in 80.8% and 72.5% of CBCT images, respectively, with the inferior canal significantly more common in males (p < .05). The anterior lateral lingual canal was present in 69.5% of cases, and the anterior labial canal in 40.7%, with a significantly higher prevalence in males (p < .05); no significant sex differences were found in the laterality of either canal.Conclusion:Accessory canals in the anterior mandible are common anatomical variations, with certain sex-related differences. Awareness of their prevalence and distribution is crucial to minimize neurovascular complications during implant placement and other anterior mandibular surgeries.