Cone beam computed tomography assessment of the maxillary incisive canal and foramen: considerations of anatomical variations when placing immediate implants

Assessment of the Nasopalatine Canal Length and Shape Using Cone-Beam Computed Tomography: A Retrospective Morphometric Study

The anatomical position of the nasopalatine canal in the anterior maxilla makes it one of the most important vital structures in the region. Surgical and implant procedures in this area require local anesthesia to be administered. It is, therefore, important to morphologically assess the length and shape of the nasopalatine canal for performing surgical procedures with more accuracy in this area. Cone-Beam Computed tomography scans were scrutinized using inclusion criteria of age 18 years and above, absence of any pathological lesions/fracture/surgery in the nasopalatine area, absence of orthodontic treatment or maxillary jaw correction surgeries, and exclusion criteria including CBCT scans with artifacts or error s in the area of interest, anterior implants, absence of bone diseases, trauma, surgeries, and impactions in the area of interest. A total of 360 scans were analyzed for the length and shape of the nasopalatine canals. The results of the study showed that the mean nasopalatine canal length was 12.51 mm. The hourglass shape of the canal was most common and had the highest representation in both genders, with male 80.62% and female 87.01%. A statistically significant difference (p < 0.001) was noted in nasopalatine canal length between males and females. The study provides insight into the significant association of gender with the canal's shape and length of the canal. The length of the canal does not influence with age. These parameters are helpful for surgical planning and interventions in the anterior maxillary region.

Evaluation of the Nasopalatine Canal of Patients With and Without Cleft Lip and Palate in CBCT Exams

OBJECTIVE

To identify and compare the morphology and dimensions of the nasopalatine canal (NPC) of individuals with and without cleft lip and palate using Conical Beam Computed Tomography (CBCT) images and to relate the results to the type of cleft and tooth absences in the region.

SETTING

This is a cross-sectional, analytical study with a retrospective sample.

PATIENTS, PARTICIPANTS

100 CBCT exams from patients with cleft lip and palate and 100 CBCT exams from patients without cleft lip and palate were used.

INTERVENTIONS

The NPC was evaluated for its morphology and measurements in the coronal, sagittal, and axial reformatting of CBCT exams.

RESULTS

It was obtained as a result that in the group of patients with a cleft, the shapes of funnel, banana, and needle of the NPC were more frequent than in the control group. Patients with cleft lip and palate had significantly a larger nasopalatine foramen and a larger NPC diameter, besides a significantly shorter NPC, compared to controls. In both groups, edentulous patients had less anterior maxillary bone thickness, when compared to patients with maxillary anterior teeth. Patients with clefts had a bone thickness buccal to the NPC less than in the control group.

CONCLUSIONS

This study confirms the anatomical variability of NPC in patients with cleft lip and palate. This finding reinforces the need for thorough surgical planning of the anterior region of the maxilla, in CBCT exams, by the dentist.

Morphometric study of incisive canal and its anatomic variations in brazilian individuals

OBJECTIVE

To conduct a morphometric evaluation of the incisive canal, adjacent structures, and their anatomic variations in Brazilian individuals.

METHODS

A retrospective study was conducted using a sample of 157 multislice computed tomography images of adult Brazilian individuals of both sexes (20-96 years). The exam was performed with the RadiAnt DICOM Viewer 4.0.1 (64-bit) software that uses the DICOM PACS standard for visualization of medical and dental images.

RESULTS

The values for length and height of the canal, thickness of the palatine bone plate, and latero-lateral diameter of the incisive foramen were higher in men than in women (p < 0.05).

CONCLUSION

The findings of this study demonstrated morphometric differences for the following parameters: latero-lateral diameter; width of canals at all levels measured; palatine bone plate height; canal length and palatine bone plate thickness in relation to the male and female sexes in the Brazilian population.

Morphometric Evaluation of Morphological Variations of the Nasopalatine Canal: A Retrospective Study Using Cone-beam Computed Tomography

AIM

The study aimed to analyze the morphological and anatomical variations of the nasopalatine canal (NPC) using cone-beam computed tomography (CBCT) images and their association with age and gender among the subpopulation of the Qassim region of Saudi Arabia.

MATERIALS AND METHODS

The CBCT records of 401 patients referred to the Department of Radiology between January 2020 and July 2023 were randomly selected in the retrospective cross-sectional study. The anatomical characteristics such as the length of the NPC, and the superior and inferior width of the canal, were analyzed. In the sagittal and axial planes, the morphological variants of the shape of the NPC were also investigated. The Statistical Package for the Social Sciences (SPSS) software was used for statistical analyses at a 5% significance level.

RESULTS

The study examined the CBCT images of 219 females (54.6%) and 182 males (45.4%) with an overall mean age of 40.17 ± 2.31 years. The overall length of the NPC and superior and inferior canal width were 13.86 ± 2.68 mm, 3.4 ± 1.42 mm, and 4.07 ± 2.06 mm, respectively. Independent t-test revealed that the males had a statistically significant larger superior (3.62 ± 1.78 mm) and inferior canal width (4.33 ± 1.79 mm). In terms of gender, the Chi-square test revealed a statistically significant association (p < 0.01) between the morphological shape of the NPC in the axial and sagittal planes. The heart-shaped (51.4%) and cone-shaped canals (34.2%) were the most frequently recorded NPC in the axial and sagittal planes, respectively. Pearson's correlation found a statistically significant positive relationship (p < 0.05) between the superior and inferior canal width and the canal length. Spearman's correlation revealed a statistically highly significant correlation between the NPC shape in the sagittal plane and gender (p < 0.001).

CONCLUSION

The study findings revealed a statistically significant difference in the anatomical and morphological traits of the NPC in the axial and sagittal planes based on gender. The effect of age and gender was found to exhibit significant differences with the NPC parameters. The heart-shaped canal in the axial plane and the cone-shaped canal in the sagittal plane were more prevalent in the study sample. A three-dimensional (3D) examination of the NPC will be crucial to avert challenging circumstances prior to surgical treatments in the anterior maxilla.

CLINICAL SIGNIFICANCE

The NPC is a long, narrow canal that can take up to 58% of the buccal bone plate width, and an accurate 3D anatomic illustration of the NPC allows for reliable surgical planning and dental implant placement.

Anatomical Patterns of the Nasopalatine Canal and Incisive Foramen in an African Setting: A Cross-Sectional Study

Study Design: Descriptive cross-sectional. Objective: To determine the morphology and morphometry of the nasopalatine canal (NPC) and incisive foramen (IF) in an African population. Methods: Measurements of the NPC and the IF were carried out on 150 Cone-Beam computed tomography (CBCT) scans. The maxillary bone thickness anterior to the NPC was measured at 3 levels. Independent t-test and Chi-square test were performed to determine the presence of sexual dimorphism. Results: The presence of one Stenson's foramen was most prevalent. The mean length of NPC was 13.21 ± 3.25 mm with significantly longer canals in males. The most prevalent shape of NPC was cylindrical in sagittal view and a single canal in coronal view. The mean angulation of NPC was 118.42° to the horizontal plane. The average dimensions of the IF were 3.53 mm and 3.07 mm in the anteroposterior and mediolateral diameter, respectively, while the most common shape was round. The anterior maxillary bone was thicker in males and generally reduced in thickness from the anterior nasal spine superiorly towards the alveolar crest inferiorly. Conclusion: This study highlights the anatomical characteristics of the NPC and IF, with significant sexual dimorphism observed regarding the number of Stenson's foramina, length of NPC, shapes of the NPC and IF, as well as alveolar bone thickness anterior to NPC.

Morphological Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography: A Retrospective Study of 124 Consecutive Patients

This study aimed to assess and analyze the morphology and dimensions of the nasopalatine canal (NPC), as well as the adjacent buccal osseous plate (BOP), and to investigate the effect of gender, edentulism, NPC types, absence of maxillary central incisors (ACI) and age on the NPC and BOP, using cone beam computed tomography (CBCT). A total of 124 CBCT examinations (67 female and 57 male patients) were retrospectively included and evaluated. The assessment of the dimensions of the NPC, as well as the dimensions of the adjacent BOP, was performed by three Oral and Maxillofacial Radiologists on reconstructed sagittal and coronal CBCT sections under standardized conditions. Regarding the dimensions of the NPC and the adjacent BOP, the mean values were significantly higher among males than females. Furthermore, edentulous patients showed a significant reduction in BOP dimensions. Additionally, NPC types showed a significant effect on the length of the NPC, and the ACI had a significant effect on reducing BOP dimensions. Age had a significant effect on the diameter of the incisive foramen, with the mean values generally increasing with an increasing age. CBCT imaging of this anatomical structure contributes significantly to its full assessment.

Are morphological and morphometric characteristics of maxillary anterior region and nasopalatine canal related to each other?

OBJECTIVES

The main purpose of this article was to clarify the relationship of anterior bone and tooth morphology with NPC. The anatomical features of the NPC region in three dimensions from coronal, axial, and sagittal directions were analyzed using CBCT and the effects of age, gender, sagittal root positions (SRPs) of central teeth, anterior overbite depth (AOD), central incisor (CI)/palatal plane (PP) angle, NPC/PP angle, and collum angles (CA) on NPC were evaluated in a group of the Turkish population.

MATERIALS AND METHODS

In this retrospective study, CBCTs of a total of 330 individuals between the ages of 17 and 82 were evaluated. The effects of SRP, AOD, CI/PP angle, NPC/PP angle and CA on the anatomical features of NPC were examined on the basis of age and gender. Descriptive statistics, Kolmogorov-Smirnov, Chi-square, Wilcoxon, Mann-Whitney-U, Kruskal-Wallis, and Spearman correlation tests were used. p values of < 0.05 were accepted as statistically significant.

RESULTS

While the SRPs, CI/PP angle, NPC/PP angle, CA, and age did not differ statistically according to NPC shape (p > 0.05), NPC shape varied according to gender and AOD (p < 0.05). It was found that cylindrical NPC (32.8%) was more common in females, while conical-shaped NPC (30.7%) was more common in males (p < 0.01). While most conical NPC was detected in individuals with Class I overbite depth, cylindrical NPCs were found in Class II and III individuals (p < 0.01).

CONCLUSIONS

The results showed that gender and AOD are influential factors on NPC shape. While conical-shaped NPC is more common in individuals with bite depth incisal, cylindrical-shaped NPC is more likely to be seen in individuals with middle and cervical thirds.

Morphometric and volumetric analysis of the proximity between the incisive canal and maxillary central incisors during anterior retraction: a retrospective cone-beam computed tomography study

OBJECTIVES

To elucidate the relationships and factors affecting the proximity between the incisive canal (IC) and maxillary central incisors and to predict the probable outcomes after anterior tooth retraction using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

Retrospective CBCT data taken before and after maxillary anterior retraction in 36 patients were used in this study. The incisive canal length (ICL), maxillary central incisor length (TL), angles between the palatal plane and axes of the maxillary alveolar border (θ1), IC (θ2), and maxillary central incisor (θ3), retraction distance (TDE), distance from the maxillary central incisors to the IC (D), cross-sectional area of the IC (CSA), and volume of the IC were evaluated. Comparison of the parameters between contact and noncontact groups were examined. Logistic regression was performed to analyze the probable outcome prediction.

RESULTS

All parameters significantly decreased after anterior retraction, except for the ICL. Eighteen roots in 12 patients contacted the IC. The θ1, θ2, θ3, and D values at all levels were significantly lower, whereas the TDE, midlevel and oral opening CSA, and volume were significantly higher in the contact group compared with the noncontact group. The larger the pretreatment θ1 and θ3 were, the higher was the chance of incisors not contacting the IC.

CONCLUSIONS

Maxillary central incisors not contacting the IC after anterior retraction was positively associated with larger degrees of pretreatment maxillary alveolar bone angle and maxillary central incisor angle.

Tridimensional Analysis of Incisive Canal and Upper Central Incisor Approximation

OBJECTIVE

The present study aimed to estimate the location of the incisive canal (IC) concerning the upper central incisor roots (U1) in order to explore the amount of incisor retraction as per the envelope of discrepancy amongst Chinese patients with different vertical facial growth patterns.

METHODS

This is a cross-sectional study that used a total of 207 pretreatment cone-beam computed tomography (CBCT) scans of adults with a skeletal class I relationship. Sixty-nine cases were included in each of the normodivergent, hypodivergent, and hyperdivergent facial groups. The IC volume was measured using Mimics 21 software. The IC width and IC-U1 proximity were measured using in vivo 6 software. Linear measurements were conducted at 3 vertical levels.

RESULTS

The IC has shown a larger volume in the hyperdivergent group and male patients. Overall, the IC has recorded linear width greater than the inter-root distance of U1 in 59.1%, 66%, and 68.8% amongst the normodivergent, hypodivergent, and hyperdivergent facial groups, respectively, and in 58.3% of males and 70.8% of females. The overall sagittal distances between the U1 and IC were 4.00 ± 0.82 mm, 4.60 ± 0.83 mm, and 3.60 ± 0.80 mm amongst the normodivergent, hypodivergent, and hyperdivergent facial groups, respectively.

CONCLUSIONS

The maximum sagittal distances between U1 and IC were 4.8 mm, 5.4 mm, and 4.4 mm amongst the normodivergent, hypodivergent, and hyperdivergent facial groups, respectively. Thereby, our findings have revised the retraction aspect of the envelope of discrepancy as per the different vertical facial growth patterns, which could serve a reference for the clinical practice involved considerable incisors movement, especially among Chinese patients.

Proximity of upper central incisors to incisive canal among subjects with maxillary dentoalveolar protrusion in various facial growth patterns

OBJECTIVE

To investigate the position of the upper central incisor roots (U1) relative to the incisive canal (IC) among subjects with maxillary dentoalveolar protrusion in various facial growth patterns.

MATERIALS AND METHODS

240 cone beam computed tomography images of skeletal Class I and II maxillary or bimaxillary protrusive subjects with a mean age of 23.74 ± 3.73 years were enrolled according to their facial growth pattern. The IC volume was measured using Mimics 21 software (Materialise, Leuven, Belgium). The U1 inter-root distance, width of IC, and their proximity were estimated using Invivo6 software (Anatomage, San Jose, CA).

RESULTS

The IC volume was slightly greater among the high angle facial group and female patients than the other groups. Overall, the IC width was greater than the U1 inter-root distance in 55.65%, 57.6%, and 65% among the average, low, and high angle facial groups, respectively, and in 56.5% and 62.9% of males and females, respectively. The overall anteroposterior (sagittal) distances between the U1 roots and IC were 4.36 ± 1.18, 4.78 ± 1.17, and 3.83 ± 0.90 mm among the average, low, and high angle facial groups, respectively.

CONCLUSIONS

The high angle facial group and female patients showed slightly greater IC dimensions than the other groups. The overall maximum sagittal distances between the U1 and IC were around 5.5, 6, and 4.7 mm among the average, low, and high angle facial groups, respectively. The low angle facial group and male patients tended to have greater sagittal distances. Therefore, the present findings could serve as a guideline when a considerable amount of upper incisor retraction is planned for Class I or II maxillary or bimaxillary dentoalveolar protrusion patients.

The Role of Morphometric Characteristics of Anterior Maxilla in Planning the Interventions Accompanied by Orthodontic Teeth Movement – An Overview

The anterior maxilla or premaxilla is part of the upper jaw and the most significant content of this region, from the aspect of orthodontic therapy, are the incisor teeth. The frequency of complications during orthodontic movement of the upper incisors refers to a more detailed evaluation of the anatomical structures of the premaxilla. The aim of this study was to investigate morphological and morphometric characteristics of the anterior maxilla by cone beam computed tomography, which could be of interest for planning orthodontic teeth movement. By reviewing the available literature, we compared the values of the alveolar bone height, the distance between the alveolar crest and enamel – cement boundary, total alveolar bone width, the thickness of the buccal, and palatal plate, nasopalatine canal, and accessory canals of the anterior maxilla. The results of our study show changes in the labial and palatal aspects of the alveolar bone height during orthodontic interventions. Different results of the alveolar bone width are in correlation with gender, age, and type of orthodontic tooth movement. Distance between the nasopalatine canal and maxillary central incisors was estimated at the value from 4 to 6 mm, which is below the recommended value for maximum incisal retraction by Proffit. Research results show variations in shape, length, and diameter of the nasopalatine canal, which indicates individual varieties detected on cone beam computed tomography. Other anatomical structures and measures show an insignificant correlation with orthodontic teeth movement. According to the contradictory results of the available articles, it is required to achieve an individual approach to orthodontic interventions in the area of the anterior maxilla.

The Shape of Nasopalatine Canal as a Determining Factor in Therapeutic Approach for Orthodontic Teeth Movement-A CBCT Study

The aim of this study was to evaluate the impact of the nasopalatine canal (NPC) shape and its morphometric characteristics on expected teeth movement by assessing the distance to maxillary central incisors (MCIs) according to NPC type. The retrospective study was performed on 133 CBCT images. The following parameters were obtained: the antero-posterior diameter (A-P) of the nasal foramen (NF), canal length, A-P and mediolateral diameter (M-L) of the incisive foramen (IF), and the distance between NPC and MCIs. With the exception of being hourglass-shaped, each NPC shape showed specific impacts of NPC shape on the relationship between NPC diameters at different sections and distances to MCIs. In banana-shaped NPC, a significant correlation was observed for A-P NF diameter, while in cylindrical-shaped NPC, a significant correlation was observed for NPC length. The increase in M-L IF, A-P IF, A-P NF, and NPC length in funnel-shaped NPC may be a risk factor for interventions that could result in teeth movement. According to the results, it seems that the proposed methodological approach for analysis of CBCT slices in the anterior maxilla may offer detailed information that could be an additional tool in planning the procedures that result in expected teeth movement.

The Shape of Nasopalatine Canal as a Determining Factor in Therapeutic Approach for Orthodontic Teeth Movement—A CBCT Study

The aim of this study was to evaluate the impact of the nasopalatine canal (NPC) shape and its morphometric characteristics on expected teeth movement by assessing the distance to maxillary central incisors (MCIs) according to NPC type. The retrospective study was performed on 133 CBCT images. The following parameters were obtained: the antero-posterior diameter (A-P) of the nasal foramen (NF), canal length, A-P and mediolateral diameter (M-L) of the incisive foramen (IF), and the distance between NPC and MCIs. With the exception of being hourglass-shaped, each NPC shape showed specific impacts of NPC shape on the relationship between NPC diameters at different sections and distances to MCIs. In banana-shaped NPC, a significant correlation was observed for A-P NF diameter, while in cylindrical-shaped NPC, a significant correlation was observed for NPC length. The increase in M-L IF, A-P IF, A-P NF, and NPC length in funnel-shaped NPC may be a risk factor for interventions that could result in teeth movement. According to the results, it seems that the proposed methodological approach for analysis of CBCT slices in the anterior maxilla may offer detailed information that could be an additional tool in planning the procedures that result in expected teeth movement.

Morphological evaluation of the incisive canal with reference to gender and age: A cone-beam computed tomography study

Background

The incisive canal (IC) is an important anatomical structure in the premaxilla that should be considered during many dental procedures.

Aims

The objective of this study is to associate the IC morphology and dimensions with reference to gender and age by means of cone-beam computed tomography (CBCT).

Patients and Methods

A retrospective study was conducted using archived CBCT records of patients who sought treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. OnDemand 3D Imaging software was utilized in image reconstruction and measurement determination. The parameters evaluated were the IC shape and dimensions in a sagittal and coronal view at two levels: palatal opening and nasal opening. The variables were compared according to age and gender using one-way Analysis of Variance (ANOVA) and Kruskal Wallis tests. Confidence level was obtained at P < 0.05.

Results

Out of the 370 CBCT images assessed, only 100 images fulfilled the inclusion criteria; 50 males and 50 females. No substantial variance in IC shapes was found in both the sagittal and coronal perspectives with reference to age and gender. Likewise, there was no statistical variation in IC dimensions with reference to age. On the other hand, there was a statistical difference in IC length when correlated with gender as the male subjects had longer IC as compared to females (P < 0.01).

Conclusion

There is no association between IC morphology, age and gender. However, substantial variation in IC length was observed between genders.

Comparison of distance of upper central incisor root and incisive canal in different sagittal and vertical skeletal patterns and sex: A retrospective CBCT study

INTRODUCTION

To evaluate the influence of sagittal and vertical skeletal patterns (skeletal classes and facial profiles), and sex on the distance between upper central incisors roots and incisive canal.

MATERIAL AND METHODS

Cone-beam computed tomography exams of 172 patients were classified into skeletal classes I, II, and III and according to the facial profile into mesofacial, brachyfacial, and dolichofacial. In sagittal reconstructions, linear measurements were done between central incisors roots and incisive canal at three levels: incisive foramen opening, intermediate region, and the region close to the apex of upper central incisors. In axial reconstructions, measurements of incisive canal width and distance between the roots were obtained. Analysis of Variance (three-way ANOVA) was used to evaluate measurement differences in relation to skeletal classes, facial profiles, and sex.

RESULTS

The distance between upper central incisors roots and incisive canal anterior region was little influenced by sagittal and vertical skeletal patterns and sex. Men had significantly greater incisive canal (mean=2.85mm; SD=1.18) width compared to women (mean=2.40mm; SD=1.04), regardless of skeletal class and facial profile (P<0.05). In general, inter-root distance between medial points of central incisors roots and incisive canal opening was greater in the region close to upper central incisors apex (mean=3.84mm; SD=1.44) than in incisive foramen opening (2.44mm; SD=1.04), (P<0.05).

CONCLUSIONS

The distance between upper central incisors roots and incisive canal is little influenced by sagittal and vertical skeletal patterns and sex.

Gender Differences in the Morphological Characteristics of the Nasopalatine Canal and the Anterior Maxillary Bone - CBCT Study

The aim of this study was to investigate the gender differences in anatomical and morphometric characteristics of the nasopalatine canal–NPC and horizontal dimensions of the anterior maxilla by CBCT, which could be of interest for clinicians who perform implant surgery in this region. A retrospective quantitative study was conducted using CBCT images from the radiological database of the Department of Dentistry (Kragujevac) on a total of 113 participants (63 male and 50 female). The results of our study confirmed no gender difference in the distribution of NPC type, while the most frequent NPC type confirmed gender variations (cylindrical in females, funnel in males), but the lowest incidence of NPC type in both males and females was banana-type. The NPC length was significantly increased in males with no significant gender impact on medio-lateral (M-L) and antero-posterior (A-P) dimensions of the incisive foramen, as well as the A-P dimension of the nasal foramen. Linear regression analysis revealed the significant correlation between the M-L dimension of incisive foramen and the anterior maxilla diameter at all bone levels for males, and between the NPC length and the anterior maxilla diameter only in females at the level D. Also, both NPC type and gender significantly affected the correlations between the estimated parameters (females showed significant correlation only in funnel NPC type at the level D, while males showed significant correlation in both funnel NPC type at the level A, but also in hourglass-type at the level D). Those results imply significant gender impact in planning of various surgical interventions in the anterior maxilla region.

Morphological Characteristics of the Nasopalatine Canal and the Relationship with the Anterior Maxillary Bone—A Cone Beam Computed Tomography Study

The aim of this study was to evaluate the interconnection between the type of nasopalatine canal (NPC) and morphometric characteristics of the anterior maxilla. The investigation involved 113 subjects, and the morphometric parameters were obtained using cone beam computed tomography (CBCT). NPC shapes were classified into four types: banana-, hourglass-, cylindrical-, and funnel-shaped (distribution of approximately 9, 25, 31, and 35%, respectively). The analysis revealed that the NPC shape was significantly connected with the morphometric properties of anterior maxilla horizontal dimensions. In general, a banana-shaped NPC was accompanied with an overall reduction in anterior maxilla diameters when compared to other NPC shapes, with no significant difference between the other three NPC shapes. Furthermore, the morphometric characteristics that depend on NPC shape at the sagittal cross-section were significantly correlated with diameters of the incisive foramen, nasal foramen, and NPC length. According to the results of our study, it seems that the presented analyses of morphometric data may allow useful insight into the algorithms of various interconnections between the measures obtained in the region of the anterior maxilla, which could be of interest for a time rationale approach when planning some surgical procedures, such as immediate dental implant placement planning.

Morphological Characteristics of the Nasopalatine Canal and the Relationship with the Anterior Maxillary Bone-A Cone Beam Computed Tomography Study

The aim of this study was to evaluate the interconnection between the type of nasopalatine canal (NPC) and morphometric characteristics of the anterior maxilla. The investigation involved 113 subjects, and the morphometric parameters were obtained using cone beam computed tomography (CBCT). NPC shapes were classified into four types: banana-, hourglass-, cylindrical-, and funnel-shaped (distribution of approximately 9, 25, 31, and 35%, respectively). The analysis revealed that the NPC shape was significantly connected with the morphometric properties of anterior maxilla horizontal dimensions. In general, a banana-shaped NPC was accompanied with an overall reduction in anterior maxilla diameters when compared to other NPC shapes, with no significant difference between the other three NPC shapes. Furthermore, the morphometric characteristics that depend on NPC shape at the sagittal cross-section were significantly correlated with diameters of the incisive foramen, nasal foramen, and NPC length. According to the results of our study, it seems that the presented analyses of morphometric data may allow useful insight into the algorithms of various interconnections between the measures obtained in the region of the anterior maxilla, which could be of interest for a time rationale approach when planning some surgical procedures, such as immediate dental implant placement planning.

Anatomical and Morphological Assessment of Nasopalatine Canal in Pediatric and Adolescent Population via Cone Beam Computed Tomography

INTRODUCTION

Anatomical and morphological structure of nasopalatine canal (NPC) is important for surgical techniques carried out on the maxilla. The aim of the present study was to analyze the anatomical and morphological characteristics of the NPC among pediatric and adolescent population using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 437 cases were analyzed using CBCT images in this retrospective, cross-sectional study. Shape was analyzed as hourglass, cone, funnel, banana, cylindrical, and tree branch like. Number of foramina Stenson (FS) was evaluated through coronal, axial, and sagittal views. Landmark evaluation involved; diameter of FS, diameter of incisive foramen, diameter at the mid-canal length, NPC length, and narrowest buccal bone thickness. Pathology presence near NPC was evaluated to determine alterations on the landmark metrics.

RESULTS

Nasopalatine canal shape distribution revealed 32% hourglass, 9.6% conic, 10.8% funnel, 11.9% banana, 29.5% cylindrical and 6.2% tree branch. Number of FS (P = 0.021; P < 0.05), diameter of FS (P = 0.041; p < 0.05), NPC length (P: 0.020; P < 0.05), and narrowest buccal bone thickness from the mid-canal length was significantly higher in males (P: 0.000; P < 0.05). Diameter of incisive foramen and diameter at the mid-canal length revealed no significance among genders (P1 = 0.318, P2 = 0.105; P > 0.05). Incidence of pathology near NPC is 20.8% and was not affected by gender (P = 0,192; P > 0.05).

CONCLUSIONS

The current study demonstrates significant variations of NPC morphology among patients. Therefore, CBCT analysis is highly recommended for clinicians to reduce the complications in oral and maxillofacial surgery practices and to provide better surgical outcomes.

Palatal temporary skeletal anchorage devices (TSADs): What to know and how to do?

OBJECTIVES

Since palatal temporary skeletal anchorage devices (TSADs) have become important tools for orthodontic treatment, this narrative review was aimed to provide an updated and integrated guidelines for the clinical application of palatal TSADs.

SETTING AND SAMPLE POPULATION

A narrative review article including researches on palatal TSADs in orthodontics related to anatomy, success rate and clinical application.

MATERIALS AND METHODS

The anatomical characteristics, success rate and its consideration factors and clinical application of palatal TSADs based on the direction of tooth movement were evaluated.

RESULTS

To improve the stability of TSADs, hard tissue factors such as bone depth, cortical bone thickness, bone density and soft tissue thickness were evaluated. Anatomically risky structures, including the nasopalatine foramen, canal and the greater palatine foramen, nerve, vessel need to be identified before placement. The success rate of palatal TSADs was greater than that of the buccal inter-radicular space. Palatal TSADs have been used for various purposes because they can control tooth movement in all directions and, three-dimensionally; their applications include the retraction of anterior teeth, protraction of posterior teeth, distalization, intrusion, expansion and constriction. They can be applied directly or indirectly to the lingual arch or transpalatal arch. Design modifications using splinted 2 miniscrews have been suggested.

CONCLUSION

Palatal TSADs allow clinicians to perform minimally invasive and easy placement with good stability by understanding the anatomical characteristics of the palatal region, and they show good control over 3-dimensional tooth movements in various clinical cases.

Unilateral maxillary central incisor root resorption after orthodontic treatment for Angle Class II, division 1 malocclusion with significant maxillary midline deviation: A possible correlation with root proximity to the incisive canal

Root resorption can be caused by several factors, including contact with the cortical bone. Here we report a case involving a 21-year-old female with Angle Class II, division 1 malocclusion who exhibited significant root resorption in the maxillary right central incisor after orthodontic treatment. The patient presented with significant left-sided deviation of the maxillary incisors due to lingual dislocation of the left lateral incisor and a Class II molar relationship. Cephalometric analysis demonstrated a Class I skeletal relationship (A point-nasion-B point, 2.5°) and proclined maxillary anterior teeth (upper incisor to sella-nasion plane angle, 113.4°). The primary treatment objectives were the achievement of stable occlusion with midline agreement between the maxillary and mandibular dentitions and appropriate maxillary anterior tooth axes and molar relationship. A panoramic radiograph obtained after active treatment showed significant root resorption in the maxillary right central incisor; therefore, we performed cone-beam computed tomography, which confirmed root resorption along the cortical bone around the incisive canal. The findings from this case, where different degrees of root resorption were observed despite comparable degrees of orthodontic movement in the bilateral maxillary central incisors, suggest that the incisive canal could be an inducing factor for root resorption. However, further investigation is necessary to confirm this assumption.

Radiographic Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography

PURPOSE

To assess the morphology of nasopalatine canal and to determine the variation of this canal in correlations to age and gender in Iraqi sample using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 200 requested CBCT images for nasopalatine canal evaluation before dental implantology at the anterior maxillary region. The morphology of canals was classified into 3 groups in coronal cross-sections. The effects of age and gender were also measured.

RESULTS

The study comprised 100 males and 100 females with mean age of 30.64 ± 9.46 years. Most of the cases showed Y-shape configuration type III 43.5% followed by type I single canal 35.5%, and type II with 2 parallel canals 21%, CONCLUSION:: Due to the wide variation in the morphology of nasopalatine canals, it is highly recommended to perform CBCT evaluation to the anterior maxilla before dental implantology in order to prevent any damage to the neurovascular bundle.

Morphometric analysis of nasopalatine foramen in Sri Lankan population using CBCT

Nasopalatine canal (NPC) is an important anatomical structure present in the anterior mid maxilla. It has the synonyms of incisive canal or anterior palatine canal. The objective of this study was to identify the morphometric characteristics of the NPC in group of Sri Lankan people using Cone beam computer tomography (CBCT) and to determine normal morphological course and anatomical variations. Fifty Maxillary CBCT images of anterior maxilla, obtained from the archives of the University Dental Hospital, Peradeniya were retrospectively analyzed to determine the position of the NPC. Morphology, canal dimension of NPC and its relation to the maxilla. Majority had a single opening (48%) or 2 openings (46%). Average diameter of the canal was 3.692 mm with a range of 2-6 mm. Majority of the canals had funnel shape and were vertically curved. Average length of canal was 12.142 mm and angulations of the curvature was 115.694⁰. Average antero-posterior diameter at nasal fossa was 2.852 mm, at mid-palate 2.366 mm and at hard palate 3.034 mm. Our findings were different from the findings reported in the literature. This may be due to the differences in ethnicity or limited size of sample. Within the limits of this study, we conclude that the form of the NPC is variable; predominantly funnel shaped with a single or two openings and with an average diameter of 3.7 mm in Sri Lankan population. Identification of variations in the position and shape will help in clinical practice specially in introducing local anesthetic block injections during dental treatment.

Advocacy of diagnostic criteria for maxillary incisive canal cysts based on alteration of normal maxillary incisive canals according to aging in Japanese populations

Background

The purpose of the present study was to describe the CT imaging findings of normal incisive canals and incisive canal cysts and propose cut-off values to differentiate between them.

Methods

A total of 220 normal subjects and 40 patients with incisive canal cysts on multi-detector row computed tomography (MDCT) were retrospectively analyzed. The shapes, sizes, anatomic variations, Hounsfield scale values, and so on of maxillary incisive canals and the sizes and Hounsfield scale values of maxillary incisive canal cysts were analyzed.

Results

A significant difference in sizes of maxillary incisive canals in normal subjects was found between males and females. The sizes of maxillary incisive canals were significantly wider during aging, but shapes, anatomic variations, and Hounsfield scale values in the maxillary incisive canals were not significantly different with aging. A significant difference in sizes but not Hounsfield scale values was found between normal maxillary incisive canals and maxillary incisive canal cysts. Based on a cut-off of over 6 mm in the width of incisive canals, maxillary incisive canal cysts could not be appropriately diagnosed for subjects over 60 years of age. Over 60 years of age, maxillary incisive canal cysts could be appropriately diagnosed based on a cut-off of over 7.1 mm in width of incisive canals. When maxillary incisive canals of the hourglass types were seen on sagittal sections, significantly more patients had maxillary incisive canal cysts than other types.

Conclusion

In coincidentally diagnosing asymptomatic incisive canal cysts on imaging, we should apply different cut-offs for the size of the maxillary incisive canal for patients over and under 60 years of age. Specifically, the cut-offs for the long axis of maxillary incisive canal cysts were 7.1 mm for patients over 60 years of age and 6.0 mm for those under 60 years of age. In addition, we should pay attention to wider canals with hourglass shapes as indicative of cystic change of maxillary incisive canals.

Differences in the shape and direction-course of the nasopalatine canal among dentate, partially edentulous and completely edentulous subjects

We aimed to analyze the nasopalatine canal shape and anatomical variations of the buccal bone wall and compare the effect of the presence or absence of the central maxillary incisors on the nasopalatine canal. The shape of the nasopalatine canal and the dimensions of the buccal bone wall were measured in 150 patients who underwent a cone-beam computed tomography study. We found that the most prevalent shape of the nasopalatine canal was funnel (31%) and the most common direction-course was slanted-straight (33%). The buccal bone wall in relation to the nasopalatine canal was thickest at the anterior nasal spine level and narrowest at the level of the most anterior-inferior point of the buccal cortex of the maxilla. A statistically significant difference was detected between morphology and direction-course of the nasopalatine canal and dental status. In sum, the study of the nasopalatine canal showed multiple variations. Precise knowledge of these variations may help to decrease the incidence of complications during implantology treatment and during facial and dental surgery.

Two-year observation of the occlusal vertical dimension after bite raising via cone-beam computerized tomography: A preliminary study

Variation of the occlusal vertical dimension (OVD) has been discussed empirically for decades, but it has not been thoroughly explored with experimental data. In the present study, cone-beam computerized tomography (CBCT) of six selected patients was conducted to evaluate the bones of the lower facial structures. The anterior lower facial heights (ALFHs), alveolar process heights (APHs), vertical facial pattern (VFP), occluding dentition height (ODH) and condyle space (CS), which were evaluated by three-dimensional (3D) and two-dimensional (2D) lateral cephalometry derived from CBCT, were compared before and two years after the OVD increased full mouth rehabilitation. Consistent significant increases in ALFHs and the VFP indicated the OVD increase, while a significant decrease in the ΔODH indicated compressed dentition. In addition, 55 of the 56 sites (98.21%) of APH measurement illustrated no significant difference before and after treatment. The findings indicated that the increased OVD did not relapse to baseline and was sufficiently tolerated, with mostly constant APHs and an altered ODH after two years of observation in the six patients.

The nasopalatine canal, a limiting factor for temporary anchorage devices: a cone beam computed tomography data study

Objectives

There is only little knowledge on topographical predispositions of the nasopalatine canal as a limiting factor for insertion of mid-palatal temporary anchorage devices (TAD). The purpose of the study was to assess the course of the nasopalatine canal, the adjacent vertical bone quantity, and whether it might differ among vertical facial types, using pre-existing cone beam computed tomography (CBCT) scans.

Material and Methods

Out of a consecutive sample collected from April 2008 to August 2012, only patient data depicting both upper and lower jaw completely were evaluated retrospectively. The linear measurements were taken on the respective midsagittal view perpendicular to the palate at the level of 1st molar/2nd premolar (5/6), 2nd premolar/1st premolar (4/5), and 1st premolar/canine (3/4). Screen-prints were used to measure the inclination of the nasopalatine canal in relation to the maxillary jaw base. Maxillary and mandibular divergence was assessed on rendered lateral cephalograms.

Results

Out of 3869 pre-existing consecutive CBCT scans, data from 398 patients met the inclusion criteria and could be extracted. The mean vertical bone was 4.09 mm at the 5/6 level, 5.22 mm at the 4/5 level, and 3.14 mm at the 3/4 level, respectively. A statistically significant negative correlation exists between jaw divergence and the canal angulation with regard to the maxillary base. A statistically significant negative correlation exists between the canal angulation and vertical bone measurements at the 4/5 and 3/4 levels.

Conclusions

Vertical bone volume is sufficient at 4/5 level for TAD placement, and bares only a small risk for neuro-sensory impairment. Therefore, only in rare cases a CBCT is justified for palatal implant placement. The course of the nasopalatine canal is negatively correlated with the vertical skeletal facial pattern pointing to the fact that in hypodivergent patients a TAD might be placed in a more distal or paramedian region.

The incisal foramen as a means of insertion for one of three ultra-short implants to support a prosthesis for a severely atrophic maxilla - A short-term report

As a continuation of our prospective cohort study for a total of 18 patients with 72 implants in severely atrophic maxillae corresponding to Cawood and Howell class V and VI (1988) [1] with four 4.0 × 5.0 mm ultrashort locking taper implants Ewers et al., 2018 [2], we now present a prospective cohort study with a total of 9 patients. The special feature of this newly modified study is the reduction of the number of implants to only three 4.0 × 5.0 mm or 4.5 × 6.0 mm or 5.0 × 6.0 mm calcium phosphate-coated Bicon Integra CP implants. Reducing the number of implants is possible by inserting the middle implant into the incisal foramen and the nasopalatine canal. All patients were restored with metal-free prostheses made of a glass fiber-reinforced hybrid resin material. Neither were any implants lost during the observation period, nor did any patient experience any sensory alteration due to the placement of an implant into the nasopalatine canal. Three implants were sufficient in all patients to stabilize their 12-unit prosthesis.

Contact of the incisive canal and upper central incisors causing root resorption after retraction with orthodontic mini-implants: A CBCT study

OBJECTIVES

To explore risk factors for contact between the incisive canal (IC) and upper central incisors (U1) and to evaluate the relationship between contact and root resorption using cone-beam computer tomography (CBCT).

MATERIALS AND METHODS

This retrospective study used CBCT data of 33 patients treated by a senior orthodontist. Anterior teeth were retracted with mini-implants, and CBCT scans were taken before and after retraction. IC height and width, U1 lingual movement, and U1-IC distance and root length decrease were compared between contact and noncontact groups.

RESULTS

Sixteen U1 roots in 11 patients touched the IC. The contact group had lower positioned ICs (2.86 ± 1.10 mm) than the noncontact group (4.07 ± 1.72 mm). The middle of the U1 roots showed more lingual movement to ICs in the contact group (2.30 ± 1.20 mm) than in the noncontact group (1.07 ± 1.16 mm). Right central incisors were closer to the IC than were the left. Root length decreased significantly more in the contact group (2.63 ± 0.93 mm) than in the noncontact group (1.14 ± 0.83 mm).

CONCLUSIONS

There is a risk for the U1 root to contact the IC during anterior retraction when the IC is lower positioned. This contact might cause external apical root resorption.

The Incisive Canal: A Comprehensive Review

The incisive canal, also known as the nasopalatine canal, is an interosseous conduit through the anterior maxilla connecting the oral and nasal cavities. Within this canal lies the nasopalatine nerve and the vascular anastomosis between the greater palatine and sphenopalatine arteries. The embryology of the canal has led to interesting theories explaining its function. Efforts have been made to describe the morphometrics of the incisive canal by radiologic evaluation across sex and ethnicities. This paper aims to review the current literature on the embryology, anatomy, and clinical relevance of the incisive canal.

Digital technology for performing a nasopalatine and greater palatine nerve block with a modified implant surgical guide: A technique article

This article describes a computer-aided design and computer-aided manufacturing (CAD-CAM) technique to perform a precise nerve block of the nasopalatine and greater palatine nerves by using an implant surgical guide. The technique uses additional guide anchor pins planned and positioned for specific anatomic landmarks during guided implant surgical guide planning. A relief modification virtually designed on the intaglio surface of the surgical guide allows for palatal soft tissue distension following administration of local anesthetic. This information is then transferred to the guide manufacturer to order the modified guided implant surgical guide. The purpose of this procedure is to provide precise delivery of local anesthetic and to prevent any discrepancy in surgical guide seating following injection.

Cone beam computerized tomography evaluation of incisive canal and anterior maxillary bone thickness for placement of immediate implants

Purpose:

Variation of dimensions of the nasopalatine canal and anterior maxillary bone thickness vary in relation to age, gender, edentulism, and ethnicity; thorough knowledge with regard to these landmarks is of vital importance prior to surgical procedures such as implant placement and local anesthesia in the anterior maxilla. Cone beam computerized tomography (CBCT) aids in accurate treatment planning in such situations.

Subjects and Methods:

A total of 300 participants were selected by the inclusion and exclusion criteria. CBCT was performed with Hyperion X9 CBCT Scanner. Images were reconstructed from the CBCT data using NNT image reconstruction software and visualized using multi-planar resolution screen. The dimensions of the nasopalatine foramen (NPF), the incisive canal (IC) and foramen, and anterior maxillary bone thickness were measured.

Results:

The mean diameter of NPF was found to be 3.27 mm, incisive foramen (IF) was 3.62 mm, IC was 2.12 mm. The average length of the IC was 10.66 mm. The IF was located at a mean distance of 13.81 mm away from the most anteroinferior point of the cortical plate of the labial bone of the maxilla. The anterior maxillary bone was the thickest at the nasal spine level (10.94 mm), and was the narrowest at lower labial alveolus (7.16 mm). The average anterior maxillary bone thickness was found to be 8.36 mm.

Conclusion:

Within the limitations of the study, it was found that found that gender and age are important factors that affected the characteristics of the IC and the amount of bone anterior to it.

Morphology and Dimensions of Nasopalatine Canal: a Radiographic Analysis Using Cone Beam Computed Tomography

STATEMENT OF THE PROBLEM

The surgical procedure of dental implantation in anterior maxillary area may be limited by the shape and size of nasopalatine canal (NPC). CBCT imaging provides three-dimensional information for surgical planning.

PURPOSE

This study is designed to evaluate the anatomy of NPC in a selected Iranian population.

MATERIALS AND METHOD

In this cross sectional study, CBCT images of 301 patients were evaluated for NPC characteristics. Five linear measurements including width and length of NPC were performed on reformatted sagittal cross sections. The shapes of NPC were also classified in three groups according to Bronstein et al. classification in CBCT coronal cross sections. The effects of age and gender on measured dimension were assessed. Student's t-test, one-way ANOVA/Tukey HSD tests, chi-square and Pearson's correlation coefficient were used for statistical analysis.

RESULTS

The study comprised 140 males (48.5%) and 161 females (53.5%) with mean age of 34.56±11.87. The mean length of NPC for men and women were 11.46 and 9.37 mm respectively, showing a significant statistical difference. Other dimensions of NPC and alveolar bone thickness were also greater in men with exception of buccal bone plate width in front of Stensen foramen (8.45±2.24 vs. 8.52±2.03 mm).Most of the cases showed Y-shape configuration. The diameter of oral opening of NPC (3.17±1.01 mm) was positively correlated with the patients age (r= 0.138, p= 0.01), while buccal bone over the oral opening of NPC (7.05±1.38) mm showed negative correlation with age (r= -0.199, p= 0.001).

CONCLUSION

All NPC dimensions are meaningfully greater in men except for buccal bone plate thickness in front of Stensen foramen. The type of canal has no effect on dimensions of the canal.

Assessment of the Nasopalatine Canal: an Anatomical Study

Objective:

The aim of this study was to evaluate the anatomy of the nasopalatine canal in a Lebanese population using cone-beam computed tomography (CBCT) technology.

Materials and Methods:

CBCT images of 63 Lebanese adult patients were included in this study. The length, shape, diameter of the oral opening corresponding to the incisive foramen and inclination in relation to the hard palate of the nasopalatine canal were analyzed.

Results:

Of all canals assessed, 13 were hourglass-shaped, 23 were cylindrical-shaped, 23 were funnel-shaped and 4 were spindle-shaped. The mean canal length and the incisive foramen anteroposterior diameter were respectively 11.52 mm and 4.91 mm. The average canal inclination related to the hard palate was 17.09 degrees.

Conclusion:

Within the limits of this study, we conclude that in Lebanese patients, the shape of the nasopalatine canal is variable. No statistical significance was noticed between genders except for the canal length which was found shorter in our female sample.