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The anterior mandible is generally regarded as a safe anatomical region for implant placement. However, anatomical variations may lead to severe intraoperative complications with potential fatal outcome. The objective of this study was to evaluate the anterior mandibular lingual defect (AMLD) in patients undergoing implant surgery.The CT data of 338 consecutive dental implant patients were reformatted with appropriate software. The AMLDs were first identified using 3-D reconstruction and further evaluated in the relevant 2-D slices.The AMLD was present in 10.95% of patients; of these, 83.8% were present bilaterally. No significant differences were found between sex, age, or race within the investigated population with regards to the presence of the AMLD.The presence of an AMLD might be a possible cause of near-fatal bleeding during routine dental implant surgery. This study found the presence of the AMLD in a small (10.95%), but not negligible number of patients. To avoid possible complications, meticulous planning and the use of 3-D imaging are advisable before performing implant surgery in this anatomical region.