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Volume 2 | Issue 1/2016 33 Journal of Oral Science & Rehabilitation Rev iew of th e a rte r i al anato my i n the ante r i o r mandi ble Introduction Knowledge of the topographic anatomy of the mandibular region is very important in implant dentistry. Severe, life-threatening complica- tions can occur after dental implant placement in the mandible, especially in the anterior re- gion. In the case of arterial vascular trauma in the floor of the mouth during implant place- ment in the mandibular anterior region, sur- geons should be prepared to manage a severely compromised oropharyngeal airway.1 The number of complications associated with implantology has risen owing to the in- creasing number of implants being placed. An electronic search performed in the MEDLINE (PubMed) and Embase databases with the searchterm“dentalimplants”indicatedthatthe numberofarticlesrelatedtodentalimplantsin- creases every year. Worthington wrote, “The number of practitioners performing implant surgeryhasincreaseddramaticallyoverthelast fifteenyears.As confidence is gained,theytend to accept increasingly challenging cases and it isto be expectedthatthe incidence ofproblems and complications will increase. Serious prob- lems and complications may result from inade- quate treatment planning, some from careless instrumentation, and some from lack of appro- priate precautions.”2 Some important early complications afterdentalimplantation maybe neurological,3, 4 infections5 and hemorrhages,6, 1, 7 Neurological complications are the most fre- quent (8.5%),4 followed by infections (1.8%),8 and severe, life-threatening hemorrhagic com- plications are the most rare, with only 15 cases reported in the literature.6 Although severe immediate hemorrhagic complications are infrequent, the mechanical pressure from sealed bleeding spaces adjacent to the upper airway may become life-threaten- ing extremelyquickly.1 Therefore,these arethe most serious complications, especially when they occur in the anterior region of the mandible. Laceration ofthe inferioralveolarar- tery can lead to severe bleeding, but the com- pressionbytheimplantitselfcanstopthehem- orrhage. The floor of the mouth is not a closed cavity like the canal of the inferior alveolar nerve; therefore, if bleeding occurs, the blood collects in the supramylohyoid space, pressing the tongue to the palate. Thus, perforation of the lingual cortical plate in the anterior region of the mandible can cause uncontrollable bleeding of the sublingual artery, which re- quires in-hospital treatment.6 The practitioner must have an extensive knowledge of the anatomy ofthe surgical field to avoid this com- plication. This paper highlights the essential anatom- ical details that must form part of the practi- tioner’s knowledge in order to perform dental implant surgery in the anterior mandible with maximum safety and minimal risk. Materials&methods A study of the anatomical body structures lo- catedintheanteriormandibleandfloorofmouth was performed. The cadavers used were do- nated by the University of Valencia (Valencia, Spain). An intravascular perfusion with colored latex was performed for better discrimination of the vessels. The tissue was dissected with the blunt technique principally—closed scissors wereinsertedintotheconnectivetissueandthen opened. The structures were recorded photo- graphically. A literature review was conducted to assess the anatomy ofthe anterior mandible, through a search in electronic databases, namely MED- LINE (PubMed), Embase and the Cochrane Li- brary. Boolean operators and truncation were used forthe search. The search terms used were “(anatomyORvessel*ORmuscleORartery)AND anterior AND mandible.” The inclusion criteria were case reports, anatomical studies on cadav- ers orradiographic studies ofthe anatomyofthe floor of the mouth and the anterior mandible, performed in humans. The exclusion criterion wasanticoagulatedpatients. Results B o ny anato my and mu scu latu re o f the su bli ngu al re gi o n Among the soft tissues surrounding the man- dible are the floor of the mouth (made of up the sublingual region and the tongue itself), and the mentaland genialareas.The sublingualregion is limited belowbythe mylohyoid muscle, laterally bythe hyoglossus, genioglossus and geniohyoid muscles, above bythe mucosa ofthe floor ofthe mouth, and anteriorly by the body of the man- dible(Fig. 1). Volume 2 | Issue 1/201633