Assessment of the Nasopalatine Canal in Patients Requiring Dental Implants in the Maxillary Anterior Region Using Cone Beam Computed Tomography

Abstract

Aim: To assess the nasopalatine canal in patients requiring dental implants in the maxillary anterior region using cone beam computed tomography (CBCT).

Methodology: About 56 patients requiring dental implants in the maxillary anterior region of either gender reporting to the daily Outpatient Department, Department of Oral Medicine and Radiology aged between 18 and 60 years were selected. They were subjected to a CBCT scan using Newtom Giano CBCT machine (NewTom, Imola, Italy). Newtom New Technology software and a slice thickness of 0.3 mm were used. For assessment of the implant site at the maxillary anterior region, alveolar bone width in the anterior region of the canal at the upper, middle, and lower third, incisive foramen diameter (IFD), nasopalatine canal length (NPCL), canal diameter in the floor of the nasal fossa and nasopalatine canal morphology was determined.

Results: Out of 56 patients, males comprised 30 and females 26. The mean bone height in 11 regions was 15.6±3.9, in 12, 16.2±2.7 mm, in 13 was 15.5±2.4 mm, in 21 was 13.7±4.2 mm, in 22 was 14.7±3.6 mm, in 23 was 16.7±1.5 mm. A non-significant difference was observed when comparing the bone height at different implant sites (p>0.05). The mean bone width at 3 mm and 6 mm from an alveolar crest in 11 regions was 4.3 mm and 5.3 mm, in 12 was 5.7 mm and 6.2 mm, in 13 was 3.7 mm and 4.6 mm, in 21 regions was 4.1 mm and 5.5 mm, in 22 regions was 4.6 mm and 5.7 mm and in 23 regions was 4.0 mm and 4.9 mm, respectively. A significant difference was observed when comparing the bone width at 3 mm and 6 mm at different implant sites (p<0.05). Nasopalatine canal type was A in 42 (75%), B in 13 (23.2%), and C in 1 (1.8%) patient. The mean alveolar bone width in the anterior region of the canal at the upper third was 10.1 mm, in the middle third was 7.4 mm, and in the lower third was 5.2 mm. The mean IFD was 4.6 mm, the NPCL was 13.5 mm, and the canal diameter on the floor of the nasal fossa was 3.8 mm. A significant difference was observed in comparing nasopalatine canal type (p<0.05).

Conclusion: For the clinician to assess implant placement in the maxillary esthetic zone, CBCT imaging of the nasopalatine canal is crucial. It is possible to prevent intraoperative and postoperative complications such as hemorrhage, sensory impairment, osseointegration failure, and nasopalatine duct cyst formation.

Keywords: anatomical assessment; cone beam computed tomography; dental implant; maxillary anterior region; nasopalatine canal.

Figure 1. CBCT-images showing the three shapes of the nasopalatine canal

A: Cylindrical shape (type A); B: A canal with a branch in the upper part (type B); C: A canal with a branch in the middle part (type C) CBCT: Cone beam computed tomography

Figure 2. Measurement of bone height and bone width

Figure 3. Assessment of bone height