Bifid mandibular nerve as a possible cause of inadequate anesthesia in the mandible

Failure to achieve complete mandibular anesthesia is a problem that often occurs. The explanations include faulty anesthetic solutions, faulty technique, and anatomic or physiologic variations. Bifurcation of the mandibular nerve, rarely mentioned in the literature, may be a cause of inadequate anesthesia in a small percentage of cases.     

Systemic bone disease in patients with mandibular atrophy

Although the etiology of alveolar ridge resorption is unclear, the labile alveolar bone may be highly sensitive to changes in systemic bone mineral content. Ten patients presenting with severe mandibular atrophy were studied by photon absorption densitometry. Four patients exhibited a significant reduction in radial midshaft mineral content. All four had systemic bone disease revealed on undecalcified histological sections although serum biochemical studies were normal. Common factors were severe mandibular atrophy, decreased bone density, and systemic bone disease. Photon absorption densitometry is suggested as a screening mechanism for systemic bone disease in patients with severe mandibular atrophy.