Displacement of the incisive foramen in conjunction with implant placement in the anterior maxilla without jeopardizing vitality of nasopalatine nerve and vessels: a novel surgical approach

Abstract

Accurate implant placement in the anterior maxilla is essential in achieving optimal prosthetic rehabilitation with proper function and acceptable esthetic and phonetic demands. One of the preferable prosthetic solutions to restore a missing maxillary incisor in young adults is by an implant-supported crown. Bone resorption together with an enlarged incisive foramen, challenge proper implant placement. A simultaneous procedure where the implant osteotomy site penetrated the incisive canal is presented. A configurated cortico-cancellous block graft core was adjusted to fit the foramen while its soft tissue content was pushed back posteriorly but not removed. This procedure was followed by an immediate implant placement. Re-entry at 9 months revealed solid bone support embracing the implant body. Although the size of the incisive foramen diminished significantly, the nasopalatine branches were still evident. No complications and/or loss of sensation were observed.

Nasopalatine Canal Revisited: An Insight to Anterior Maxillary Implants

“…successfully treated a patient with an implant in the nasopalatine canal by adapting a corticocancellous bone block graft to the canal causing displacement of the neurovascular bundle posteriorly [26].…”

Morphologic evaluation of the incisive canal and its proximity to the maxillary central incisors using computed tomography images

“…However, more than 60% of our subject pool had an incisive canal width larger than the interroot distance, and individual variations of canal dimension, especially enlargement and asymmetry of the canal morphology, are frequently reported with 3D evaluation. 20,21,30,31 Anatomical features of the incisive canal have been studied in connection with rehabilitation of the maxillary anterior region [18][19][20][21][22][23][24] and the placement of orthodontic mini-implants. 30,[32][33][34] However, the consequences or the possibilities of incisor roots being in contact with the incisive canal following tooth movement are poorly documented in the orthodontic literature.…”

“…[17][18][19][20][21][22] Because of its proximity to the maxillary incisors, the possibility of surgical invasion of the incisive canal during dental procedures has been reported, and this can result in nonosseointegration of dental implants or sensory dysfunction. 23,24 Although the overall anatomy of the incisive canal is well defined, its precise location in relation to the maxillary incisors is not well documented in the orthodontic literature. This may be because of the difficulties in detecting incisive canal morphology using conventional orthodontic radiographs.…”

Radiographic Assessment of Anatomy of Nasopalatine Canal for Dental Implant Placement: A Cone Beam Computed Tomographic Study

“…Although it has become the treatment of choice for most of the dentists, still the complications arising from dental implant placement are the biggest challenge. 3 Maxillary anterior teeth are more prone to fracture in children and are considered to be esthetically important teeth. The success rate of dental implant in maxillary anterior region depends on location and angle of implant.…”