Clinical Anatomy 14:445– 452 (2001)

The Mandibular Canal of the Edentulous Jaw

KAREN E. POLLAND,1 SHONA MUNRO,1 GORDON REFORD,1 ANDREW LOCKHART,1
GILLIAN LOGAN,2 LAETITIA BROCKLEBANK,2 AND STUART W. McDONALD1
1
Laboratory of Human Anatomy, University of Glasgow, Glasgow, Scotland, United Kingdom
2
Glasgow Dental School, University of Glasgow, Glasgow, Scotland, United Kingdom

The morphology of the mandibular canal after loss of teeth has received little detailed
attention. Improved documentation of this topic would allow better interpretation of dental
radiographs and would enable those engaged in tooth implantation to better understand the
nature of the tissue into which the prostheses are placed. In this study on mandibles from
seven dissecting room cadavers panoramic radiographs usually showed the mandibular canal
clearly, an incisive canal less so. The wall of the mandibular canal was similar in dentate and
edentulous mandibles, and was highly perforated, as suggested by Cryer (Anderson et al.,
1991). In edentulous specimens, it was composed mainly of cancellous bone with only
occasional single osteons. The inferior alveolar nerve near the mandibular foramen was a
large trunk, consisting of three to four nerve bundles with connective tissue sheaths. It became
more loosely arranged toward the mental foramen. Medial to the mental foramen, the nerves
were frequently in the form of small bundles in the marrow. Any incisive canal was
ill-defined and neurovascular bundles, when present, ran through a labyrinth of intertrabe-
cular spaces. Clin. Anat. 14:445– 452, 2001. © 2001 Wiley-Liss, Inc.

Key words: mandible; incisive canal; bone; inferior alveolar nerve; dental im-
plant

INTRODUCTION (Edwards, 1954; Gabriel, 1958; Gershenson et al.,

The mandibular canal transmits the inferior alveo-
lar nerve and vessels, whose course has been reviewed
by Anderson et al. (1991). Branches from the nerve
and vessels communicate with the teeth through small
canals (Soames, 1995). Between the apices of the first
and second premolars, the mandibular canal splits into
the mental and incisive canals (Soames, 1995). The
incisive canal continues forwards to the incisive teeth,
whereas the mental canal runs upwards and back-
wards to the mental foramen, which opens below the
second premolar or the space between the first and
second premolars (Romanes, 1981). These canals
carry respectively the incisive and mental branches of
the inferior alveolar nerve and vessels.
With age and the loss of teeth, the mandible is
reduced in size, the ramus becomes oblique, the angle
increases toward 140° and the neck inclines posteri-
orly (Gabriel, 1958). Neufeld (1958) found no change
in the angle, coronoid process, neck and condyle of
the aged dentate mandible. After the loss of teeth, the
alveolar border is resorbed and the mandibular canal
and mental foramen lie close to the alveolar border
1986; Xie et al., 1997). Occasionally the inferior alve-
olar nerve can be exposed to surrounding tissues (Ed-
wards, 1954; Gabriel, 1958) and can cause pain in
those wearing dentures (Nedelman and Bernick,
1978). Bone may also be lost from the base of the
mandible (Xie et al., 1997).
The greatest change in the edentulous mandible is
in the alveolar process that undergoes extensive and
progressive resorption (Edwards, 1954, Lavelle, 1985).
During the healing process after tooth extraction, the
alveoli are filled with cancellous bone and a cortical
layer partially covers the crest of the ridge (Neufield,
1958). The amount of bone resorption after tooth
extraction is most variable in the anterior region.
This study aims to determine two aspects of the
anatomy of the edentulous mandible that have re-
ceived little detailed attention: i) the bony architec-
*Correspondence to: Dr. Stuart W. McDonald, Laboratory of Hu-
man Anatomy, University of Glasgow, Glasgow, G12 8QQ, UK.
E-mail: S.McDonald@bio.gla.ac.uk
Received 16 January 2001; Revised 24 April 2001

© 2001 Wiley-Liss, Inc.

446 Polland et al.
Fig. 1. Diagram showing positions at which bone slices were cut
(see text).
ture and composition of the mandibular canal and ii)
the internal structure medial to the mental foramen, a
region not readily visualized in panoramic radiographs.
MATERIALS AND METHODS
Seven edentulous mandibles were obtained from
cadavers in the Laboratory of Human Anatomy. Five
were from male subjects aged 64 –91, and two from
females aged 74 and 90. Most of the attached soft
tissue was removed but care was taken not to scratch
the bones. Panoramic radiographs of the mandibles
were taken at the Glasgow Dental Hospital using a
Siemens Orthophos X-ray machine (Siemens, Erlan-
gen, Germany). The seven mandibles were placed on
a chin rest during the X-ray procedure.
After radiography, the mandibles were divided at
the mental symphysis. The right sides of four speci-
mens were retained for reference.
In the remaining three mandibles, one half was
used to prepare 2 mm thick dry bony slices and the
other half was used to obtain slices for histological
sectioning. The slices were cut using a small band
saw, as shown in Figure 1. Slice A was 1 mm below the
mandibular foramen and was parallel to the inferior
margin of the body of the mandible. Slice B was
perpendicular to the anterior end of Slice A. Slice C
was midway between Slice B and the mental foramen.
Slice D was 1 mm posterior to the mental foramen and
Slice E was 1 mm anterior to the mental foramen.
Finally Slice F was immediately lateral to the midline.
In the four mandibles whose right halves were used
for reference, bony slices and histological sections
were prepared from the same side of the mandible.
Slices A–F, as described above, were used for the
bony specimens and adjacent Slices A1–F1 were used
for histology (Fig. 1).
Preparation of Bony Slices
The slices of the mandible for study of the bone
architecture were placed into a 5% solution of sodium
hypochlorite (bleach) and gently agitated to remove
any remaining soft tissues. The slices in which the
trabeculae in the interior of the mandible were more
closely arranged required the longest time, up to 60 hr
in bleach. The slices were rinsed in running water to
dislodge any remaining intertrabecular tissue before
being dried and stored.
Histology
The slices of the mandible for microscopic exami-
nation were decalcified in Rapid Decalcifier (CellPath
plc, Hemel Hempstead) at 40°C for about 8 hr. The
slices were then processed for wax histology and em-
bedded in Paraplast. Histological sections were cut at
a thickness of 7 ␮m and stained using celestine blue,
Mayer’s hematoxylin and eosin. The combination of
hematoxylin and celestine blue was used as a nuclear
stain because the acid present in Rapid Decalcifier
inhibits the uptake of hematoxylin (Bancroft and Ste-
phens, 1982).
RESULTS
Gross Appearance
All seven mandibles exhibited marked atrophy of
the alveolar process and had many of the other fea-
tures of the aged edentulous mandible, as described
by Gabriel (1958).
Panoramic Radiographs
On the radiographs (Fig. 2), the coronoid process,
the condylar process, the ramus and the angle of the
mandible were all obvious. Between the right and left
mental foramina, all radiographs showed a highly ra-
diolucent region with little definition of structure. In
all of the plates, the mandibular foramen was repre-
sented by a radiolucency with ill-defined margins.
The mental foramen was also difficult to distinguish
but was seen on the right side in four mandibles and
on the left in only one of these. In three mandibles
neither mental foramen could be identified.
All seven radiographs showed the mandibular canal
in the ramus on both sides; in two, the canal in the
ramus was bounded by a distinct wall, which was
radio-opaque and clearly visible as far as the boundary
between the ramus and body. In each of the other five
 Mandibular Canal of the Edentulous Jaw 447

Fig. 2. Panoramic radiograph. The mandibular canals (C) are

prominent in the ramus but less distinct in the body of the mandible.
Anteriorly the radiograph is more radiolucent and shows little detail of
Fig. 3. Bony Slice A, just below the mandibular foramen, viewed
the internal structure.
from above. Lateral (L), medial (M), anterior (A) and posterior (P)
aspects are shown. Small foramina (arrows) can be seen in the wall of
radiographs, the position of the radiolucent canal was the mandibular canal (C). Magnification ⫻10.
clear but its wall was poorly defined.
In all of the radiographs, the canal was less distinct
in the body of the mandible than in the ramus, and it Slices A (Fig. 3) and B and circular in Slices C (Fig. 4)
became less distinct as it ran from the posterior part of and D. Although the diameter of the canal varied from
the body toward the mental foramen. In the two mandible to mandible, it was uniform throughout its
mandibles where the canal in the ramus was bounded length in any one canal.
by bone, the canal was also clearly visible in the body
as far as the mental foramen but it did not have a
distinct radio-opaque wall. In a further two mandibles,
the canal could be visualized on both sides to the
region of the mental foramen, but was less clear than
in the first two. Of the remaining three specimens, the
canal was indistinct in the body of the mandible on
the right side in two and on the left side in one.
Medial to the mental foramen, no incisive canal and
little of the internal bony structure could be visualized
in any of the radiographs.
Bony Slices
Although care was taken when slicing the bone,
some sections were damaged. The bony slices were
irregular in shape and size but their profiles corre-
sponded, in a general way, to those described by
Cawood and Howell (1988). Most showed moderate to
severe resorption, corresponding to Stages III, IV and
V of Cawood and Howell (1988).
On examination with a stereomicroscope, the cor-
tex of the mandible was visible in all specimens. In
some of the slices, trabeculae were broken but the
others showed an irregular lattice of narrow trabeculae
or plates. There was no obvious difference in their
pattern through Slices A–D. In two of the mandibles a
number of trabeculae were slender and tapered to a
blunt end.
The shape of the profile of the mandibular canal Fig. 4. Mandibular canal (C) in bony Slice C, a coronal section
depended upon the sectional plane, being oval in through the body of the mandible. Magnification ⫻10.
448 Polland et al.

No differences were noted between the male and

female specimens.

Histology
In the histological sections several features were
studied: i) the cortex of the mandible, ii) the cancel-
lous bone and marrow of the medulla, iii) the wall of
the mandibular canal, iv) the inferior alveolar nerve
and vessels and their connective tissue sheaths, v) the
incisive nerve and its surroundings.

Cortex of Mandible
Every section showed the cortex of the mandible
and, in all, it was composed of compact bone. Fre-
quently the external and internal surfaces of the cor-
tex showed circumferential lamellae but the remain-
der of the cortex was composed of osteons (Haversian
systems) and interstitial lamellae. Occasional Volk-
mann’s canals were seen and blood vessels were
sometimes observed passing between the outer sur-
face of the mandible and the cortex. Although blood
vessels were seen penetrating the cortex, no nerves
could be distinguished at this site.

Fig. 5. A large intertrabecular space (S) in bony Slice E, anterior

to the mental foramen. Magnification ⫻20.

In all slices showing a bony canal wall, it took the

form of a perforated cylinder of bone containing nu-
merous circular or oval foramina (Fig. 3). Figure 3
illustrates well the general finding that the wall was
plate-like and approximately 0.1 mm thick. The num-
ber of foramina was approximately constant along the
canal but they had no particular orientation. Presum-
ably the foramina allow branches of the inferior alve-
olar nerve and vessels to leave the canal to supply the
surrounding tissue and teeth, when present.
Slices E and F were examined to determine their
internal architecture and whether an incisive canal
was present. Of the seven mandibles, Slice E was
damaged in one and Slice F in three. In Slices E and
F, the trabeculae were generally more densely packed
than in Slices A to D. Two of the Slices E and two of
the Slices F clearly had no incisive canal, had a thick
cortex and only small intertrabecular spaces in the
medulla. The others had larger intertrabecular spaces
but it was impossible on the slices to assign the term
canal to any. As expected they were of smaller diam-
eter than the mandibular canal in Slices A–D. Their
walls had large deficiencies that made it impossible to Fig. 6. Bony Slice E, anterior to the mental foramen, with inter-
distinguish them from intertrabecular spaces (Figs. 5 trabecular spaces of variable size but no bony canal. Magnification
and 6). ⫻10.
 Mandibular Canal of the Edentulous Jaw 449

Fig. 7. Histological section of Slice D, posterior to the mental

foramen. The nerve (N) lies in a neurovascular bundle partially sur-
rounded by cancellous bone (T). It consists of a number of small nerve Fig. 8. Individual osteon in wall of mandibular canal. Magnifi-
bundles invested in connective tissue. Magnification ⫻20. cation ⫻300.

Cancellous Bone and Marrow

foramen (Fig. 11), enclosed with the vessels in a
All specimens showed cancellous bone and marrow sheath of connective tissue. The inferior alveolar ar-
in the medulla. The trabecular profiles were small and tery was always seen alongside the nerve trunk but
widely separated and showed the usual features. The the associated vein(s) was indistinct. At the mandib-
marrow was of the yellow variety in all specimens; in ular foramen, the nerve usually consisted of three or
one mandible, it consisted mostly of fat and, in the four closely related large bundles of nerve fibers, each
others, there were clusters of red marrow cells among surrounded by perineurium and the whole nerve sur-
the adipocytes. The histological appearance of the rounded by a distinct epineurium (Fig. 11). As it was
marrow was similar throughout all parts of each of the followed forward through the mandible, the main neu-
half mandibles studied. rovascular bundle usually retained a similar cross sec-
tional area; although the nerve bundles and vessels
Wall of the Mandibular Canal
were smaller anteriorly, the connective tissue sur-
In all sections the mandibular canal had a bony wall rounding them became looser and more abundant
(Fig. 7). It was composed of cancellous bone but (Fig. 7). The nerve trunk divided into smaller bun-
occasional single osteons were present in some spec-
imens (Fig. 8). Deficiencies in the bone represented
the foramina seen in the gross slices. Where the canal
wall was devoid of bone, the neurovascular bundle lay
adjacent to the marrow. In some sections of Slice A,
and occasionally elsewhere, the canal lay alongside the
inner aspect of the cortex that there formed part of its
wall.
Medulla Medial to Mental Foramen
Medial to the mental foramen, bony trabeculae
were readily observed, as in Sections A–D. Some sec-
tions showed an incisive neurovascular bundle par-
tially surrounded by cancellous bone (Fig. 9). In one
specimen, one side of the bundle lay adjacent to the
cortex (Fig. 10). Other specimens showed no distinct
neurovascular bundle (see below).
Inferior Alveolar Neurovascular Bundle
Fig. 9. The nerve (N) in this histological section of Slice F lies in
All specimens on microscopy showed the inferior a neurovascular bundle partially surrounded by cancellous bone (T).
alveolar nerve as a large trunk near the mandibular Magnification ⫻50.
450 Polland et al.
Fig. 10. Nerve (N) in Slice E adjacent to cortex (C) and partially
surrounded by cancellous bone (T). Magnification ⫻20.
dles, each surrounded by rather looser perineurium,
but was still surrounded by an epineurium. The ar-
tery, however, became notably smaller as it was fol-
lowed anteriorly, although not appreciably so between
Slices D and E, the site of the mental foramen. In
some Slices E and F, a distinct neurovascular bundle
Fig. 11. Inferior alveolar nerve (N) and artery (A) in Section A.
Magnification ⫻20.
Fig. 12. Small nerve bundle (N) in marrow. Part of a bony
trabecula (T) is also seen. Magnification ⫻300.
was present, at least partially surrounded by bone. In
other Slices E and F, no distinct neurovascular bundle
could be seen but small nerve bundles were present in
the marrow. In one half-mandible, no distinct nerve
bundle was seen in Slice E but a distinct bundle was
seen in Slice F adjacent to the mental symphysis; this
bundle had presumably crossed the midline from the
other side.
Many of the mandibular specimens, at all levels,
showed small neurovascular bundles or individual
nerves, presumably branches of the main bundle,
within the marrow (Fig. 12).
Correlation Between Radiographs, Bone Slices
and Histological Sections
The panoramic radiographs of the seven edentu-
lous mandibles all showed a mandibular canal. Medial
to the mental foramen, the radiographs were very
radiolucent and no incisive canal and little of the
internal features could be discerned. Although some
of the bony Slices A to D were damaged, all the intact
ones showed a mandibular canal, consistent with the
radiographic appearances. The bony Slices E and F,
medial to the mental foramen, however, showed in-
tertrabecular spaces of various sizes. Histological sec-
tions of corresponding sites showed that some speci-
mens contained distinct neurovascular bundles
bounded in places by the cortex and in others by
cancellous bone. Few of these features could be seen
on the panoramic radiographs.
DISCUSSION
The morphology of the mandibular canal of the
edentulous jaw has not previously been described in

detail. In the light of the increased use of implants in
dental restoration, this study aimed to gain a greater
understanding of the anatomy of the mandibular canal
in the edentulous jaw. We also found that the mandi-
ble medial to the mental foramina was radiolucent in
panoramic radiographs and wondered about the inter-
nal architecture of the bone in this region.
The edentulous mandibles in this study showed
the general features of aged mandibles described by
others (Edwards, 1954; Gabriel, 1958; Soames, 1995;
Xie et al., 1997). Most showed moderate to severe
resorption, following the classification of Cawood and
Howell (1988). None of the mandibles in this study
showed the inferior alveolar nerve exposed to the
surrounding tissues as described by Edwards (1954)
and Gabriel (1958).
In the seven mandibles we studied, the mandibular
canal was generally clearly visualized in panoramic
radiographs. Its presence was confirmed by examina-
tion of the bony slices. None of the radiographs, how-
ever, showed clearly the bony architecture medial to
the mental foramen, although in some of the bony
slices the cortex was thick and intertrabecular spaces
were small in this region. In others intertrabecular
spaces were variable in size. Whereas in some histo-
logical sections the incisive neurovascular bundle was
partially bounded by the deep aspect of the cortex or
by cancellous bone, the bony slices showed widely
communicating intertrabecular spaces so that ascrip-
tion of the term canal was inappropriate. The cross-
sectional nature of our material did not allow study of
how these spaces connected disto-mesially.
Dharmer (1997) stated that by tilting the patient’s
head at an approximate 5° angle downwards the
course of the mandibular canal in radiographs can be
seen more clearly, in some instances because of re-
duced superimposition of other parts of the mandible.
He did not mention the incisive canal, but stated that
about 60% of mental foramina were visible on stan-
dard panoramic radiographs and that about 90% were
seen using his technique. Of the 14 mental foramina
in this study, only five were clearly seen. The smaller
number visualized may reflect the altered position of
the foramen in the edentulous mandible.
The bony slices revealed that the wall of the man-
dibular canal in edentulous subjects has many foram-
ina. Neufeld (1958) described this in dentate subjects
and recalled the term “cribriform tube” (Anderson et
al., 1991). The observations in the present study show
appearances similar to those described by Neufeld
(1958) and help explain why he stated that the canal is
enclosed by a layer of bone similar to that of the
lamina dura of the sockets of the teeth. They also
explain why Starkie and Stewart (1931), without his-
Mandibular Canal of the Edentulous Jaw 451
tology, reported that the canal wall in the posterior
two thirds of the mandible was composed of compact
bone.
Neither Neufeld (1958) nor Starkie and Stewart
(1931) examined the wall of the mandibular canal
microscopically. In the present study, microscopy
showed that the canal wall was composed of cancel-
lous bone with only occasional single osteons present.
Sometimes part of the canal wall was formed by the
cortex of the mandible. There were many deficiencies
in the canal wall; although no nerves were seen pass-
ing through these deficiencies, small neurovascular
bundles were occasionally seen in the surrounding
marrow. It was clear that the deficiencies were much
larger than any neurovascular bundles that might have
been passing through them.
Away from the canal, the trabeculae were thin and
widely separated. This supports Neufeld’s (1958)
statement that the trabeculae surrounding the man-
dibular canal are thinner and fewer than in the dentate
mandible; he speculated that the trabeculae near the
alveolar process become adapted to the forces trans-
mitted by lower dentures.
Starkie and Stewart (1931) reported that the infe-
rior alveolar nerve divides posteriorly, one branch sup-
plying the molars, premolars and canines and the
other supplying the incisor teeth. Olivier (1928) and
Carter and Keen (1971) reported that in about 60% of
mandibles the inferior alveolar nerve ran forwards as a
large single bundle in a bony canal. In the other 40%,
the inferior alveolar nerve and associated blood ves-
sels were spread out so that there was no distinct
neurovascular bundle. In the present study, all the
histological sections through the mandibles showed a
large bundle in a distinct mandibular canal.
Previous workers have described the incisive
branch of the inferior alveolar nerve. Carter and Keen
(1971) reported that it continues toward the canine
and incisor teeth. Wadu et al. (1997) stated that the
inferior alveolar nerve divides into the mental and
incisive branches in the molar region. They also re-
ported communications between the mental and inci-
sive nerves proximal to and at the mental foramen. In
the present study, microscopy frequently showed
small nerve bundles, rather than a distinct neurovas-
cular bundle, anterior to the mental foramen. Neuro-
nal loss after tooth extraction was described by Heas-
man (1984). We confirmed the findings of Wadu et al.
(1997) that, in the edentulous mandible, veins were
indistinct.
Failure of an inferior alveolar nerve block to anes-
thetize incisor teeth because of contralateral innerva-
tion is well documented (Rood, 1977). Olivier (1928)
and Starkie and Stewart (1931) both reported cross
452 Polland et al.
innervation of the terminal branches of the mental
nerves to form an incisal plexus near the labial surface
of the incisor roots. Although Wadu et al. (1997)
agreed with this, they also reported that small terminal
branches of the incisive nerves crossed the midline to
contribute to the innervation of the contralateral inci-
sors in dentate mandibles. In four of their six mandi-
bles the contribution was predominantly from the
right side to the left. They found no cross innervation
in the edentulous specimens. In one of our specimens
no distinct neurovascular bundle was seen microscop-
ically in Slice E of the right hand side, yet a distinct
neurovascular bundle was present in Slice F. Presum-
ably this had crossed the midline from the left hand
side.
Some authors (e.g., Starkie and Stewart, 1931) have
commented on a connective tissue sheath around the
inferior alveolar nerve but Olivier (1928) stated that
the incisive nerves lay free in the spongy bone lacking
a fibrous or bony sheath. We found that the nerves are
always surrounded by a fibrous sheath.
Occasionally, there may be two or more mandibular
canals (Gershenson et al., 1986; Wyatt, 1996), reflect-
ing their development (Chavez-Lomeli et al., 1996).
When present, multiple canals are usually bilateral
(Carter and Keen 1971; Nortje et al., 1977). In the
present study, only one canal was seen in each side of
each mandible.
The morphology of the mandibular canal of the
edentulous jaw has not previously been described in
detail. In panoramic radiographs of edentulous man-
dibles, little of the internal bony structure can be
discerned medial to the mental foramina. This study
shows that the mandible is not hollow in this region
but contains a labyrinth of cancellous bone, but prob-
ably no canal, any persisting nerve bundles running
through the intertrabecular spaces. With regard to
implantation of prosthetic teeth, the study shows that
the body of the mandible contains a canal, similar in
architecture to that described by others in the dentate
subject. It also shows that, medial to the mental fora-
men, implants would be placed into cancellous bone
containing small nerve bundles in the intertrabecular
spaces.
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