Clinical Evaluation of the Nasopalatine Canal in Implant-Prosthetic Treatment: A Pilot Study

Abstract

Implant-prosthetic rehabilitation of missing teeth in the anterior maxilla is often challenging due to ongoing bone resorption and remodeling events and may require regeneration procedures involving the nasopalatine canal (NPC). We describe a surgical approach with a block graft in relation to the NPC and evaluate clinical performance, sensory perception, and aesthetic result of the implant-prosthetic treatment over a two- to nine-year (mean: 3.5 years) follow-up. Ten implants (six in the right central incisor and four in the left central incisor) were, respectively, placed in 10 consecutive patients with bone defects affecting the NPC and unfavorable widening of the incisive foramen. Treatment stages included: (1) Diagnosis: evaluation of clinical-aesthetic parameters using Cone Beam Computed Tomography; (2) Surgery: block graft placement by palatine and incisal with simultaneous guided bone regeneration, and late (6–10 months) implant placement; (3) Prosthetics: placement of a screw-retained crown (torque of 32 N/cm). At treatment initiation, all the NPCs evaluated in our study were free of pathologies. Treatment evaluation included bone crest thickness, neurosensory status, patients’ treatment perception, and pink and white aesthetic scores (PES/WES). Pre-surgery, anterior ridge thickness at the level of the incisive foramen was (mean ± SD) 3.5 ± 2 mm, 5.4 ± 1.5 mm, and 6.1 ± 1.9 mm at heights of 4, 8, and 14 mm apical to the marginal bone crest, respectively. Post-treatment values were, respectively, 10.1 ± 2.0 mm, 10.5 ± 1.0 mm, and 13.4 ± 3.0 mm. The perception of treatment with the aesthetic pink and white indices (PES/WES) was an average of 7.5 and 7 points, respectively, out of a total of 10 each index, with a recovery of 100% of the neurosensory perception of the area. We propose that bone augmentation using block and particulate graft material can compensate for anatomical variations in the NPC, optimize implant’s three-dimensional positioning and improve facial contour, providing tissue and implant stability and good aesthetic outcomes.

Clinical performance of single implant prostheses restored using titanium base abutments: A systematic review and meta‐analysis

“…Eight studies assessed aesthetic outcomes (Table 12). Three of the 29 studies assessed the PES and WES scores together with the mean ± standard deviation been reported respectively (8.5 ± 1.4 and 8.4 ± 2.0) (Bodereau et al, 2020; Krawiec et al, 2021). Two studies provided aesthetic outcomes utilizing PES only (Erhan Çömlekoğlu et al, 2018; Vazouras et al, 2022).…”

Análisis de las Variaciones Anatómicas y Dimensionales del Canal Nasopalatino Mediante Tomografía Computarizada de Haz Cónico

“…En cuanto a la longitud del CNP se observaron las mediciones similares a las reportadas en otros estudios (Jain et al, 2017;Nasseh et al, 2017;Singhal et al, 2018;Gil-Marques et al, 2020;Bodereau et al, 2020;Obando Castillo & Ruiz García de Chacón, 2020). Sin embargo, hay autores que obtuvieron valores mayores (Safi et al, 2017;Hakbilen & Magat, 2018).…”

“…La evaluación del tamaño y morfología del CNP es de especial importancia al momento de planificar procedimientos quirúrgicos que involucren la zona de la premaxila (Gönül et al, 2016). Sin embargo, las variaciones anatómicas no están bien documentadas en la literatura y hay pocos estudios sobre el análisis tridimensional del CNP y la reabsorción que conlleva la tabla ósea vestibular (TV) y palatina (TP) con el paso del tiempo luego de la pérdida dentaria en esta zona (Jain et al, 2017;Gil-Marques et al, 2020;Bodereau et al, 2020). Cawood & Howel (1988) observaron que en la región anterior del maxilar el tipo de reabsorción que predomina es la horizontal, que se produce desde la cresta ósea vestibular a la cresta ósea palatina, de este modo se aproximan las estructuras anatómicas al CNP, lo que da como resultado la emergencia de este mismo en la cima de la cresta ósea por la migración del alveolo hacia la zona palatina.…”

Morphological evaluation of the nasopalatine canal using cone beam computed tomography and its clinical implications for orthodontic miniscrew insertion

“…2 The morphology of the nasopalatine canal is crucial in the planning of prosthetic restorations in the anterior region of the maxilla, primarily because the limited bone volume in this area affects the stability and osteointegration of dental implants. [3][4][5][6] In particular, it is of great importance to diagnose the pathology of the nasopalatine canal, as the most common nonodontogenic cysts in the oral cavity are nasolabial cysts. 7 In addition to these considerations for prosthetic and surgical treatment, the anatomy and position of the nasopalatine canal also determine orthodontic treatment planning.…”