Article

Three-dimentional observation of the incisive canal and the surrounding bone using cone-beam computed tomography

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Abstract

Objectives The shape of the anterior region of the maxilla is critical when planning implant treatment. The purpose of the present study was to assess the typical morphology of the incisive canal and surrounding bone. Methods In total, 70 maxillae of Japanese dry skulls were used after being divided into dentate and edentulous groups. Cone-beam computed tomography (CBCT) images of the maxilla were acquired by using standardized methods. Using the anterior nasal spine as a reference point, the change in position was measured and analyzed statistically. Also, three-dimensional (3-D) images of the incisive canal were classified into five subsets: cylinder, groove, penetration, bifurcation at the superior portion, and bifurcation at the inferior portion. Results The quantity of alveolar bone in the incisor region was greatly reduced from the alveolar ridge and labial surface. Moreover, the vertical position of the incisive foramen was significantly (P < 0.05) superior in the edentulous groups. Regarding the classification of maxillae by the 3-D shape of the incisive canal, many canals were cylindrical. Conclusions Horizontal bone reduction from the labial side and vertical bone reduction from the alveolar crest were conspicuous; thus, the angle of the anterior alveolar bone changed after the loss of teeth. The incisive canal diameter in the edentulous group was larger than in the dentate group. The nondestructive assessment of the incisive canals and surrounding bone with CBCT showed two typical shapes for the presence or absence of the incisors. These findings indicate the importance of image diagnosis before esthetic restoration.

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... So, before the placement of dental implant nasopalatine canal morphology and dimensions should be evaluated carefully [3] . To prevent complications due to placement of implants in the incisor area, three-dimensional configuration of nasopalatine canal, its position in relation to the surrounding structures, alveolar bone morphology, and incisors' morphological changes in the alveolar bone should be estimated carefully [4] . Also important anatomical structures like nasopalatine canal, incisive and mental foramina, inferior alveolar canal, nasal fossa and maxillary sinus should be properly evaluated while selecting the implant site. ...
... For 3D visualization of various structures, which are difficult to detect on panoramic and intra-oral views, Cone beam computed tomography (CBCT) is recommended. [4] . In addition, there are no obvious differences between linear measurements on CBCT and direct measurements of maxillofacial structures, which is the gold standard [7] . ...
... In our study, the cylindrical shape was found in 55% of the scans, the funnel-shaped canal was found in 30%, spindle shape 8.3%, and an hourglass in 6.7% [ Table 3] [11] . our results are also consistent with the ones of Yasser et al., Liang et al., Asaumi et al. [15,12,4] Other shapes like (1) cone shape, (2) banana like, (3) tree branch like shapes of the canal have also been reported by Etoz and Sisman. [16] . ...
... The mean IC width of 3.61 mm was comparable to that described by Liang et al., [14] who disclosed a discrepancy of 3.3 mm in cadavers to 3.6 mm in CT scans. This measurement is also similar to that reported in dentate Japanese, [15] whereby the labio-palatal and mesiodistal width was 2.8 mm and 3.3 mm, respectively • Canal diameter -In the present study, diameter at the mid-point does not exhibit any statistical significance in relation to gender or age groups. However, studies by Guncu et al., [4] Esmaeili et al. [16] exhibit statistical significance with regard to the mean canal diameter in males and females • Incisive canal length -The present study validates the wide diversification in length of IC that is unaffected by age, but influenced by gender, greater in males compared to females; with a mean length of 16.33 mm which is close to that described by Kim et al. [11] The result of present study correlates with that published by various researchers. ...
... mm in Koreans [19] The diameter of NPF is greater compared to IF. The values obtained for the diameters of the IC at three different points implied presence of funnel contoured pathway amidst superior (broader NF orifice), midway (intermediary IC diameter) and inferior (narrower IF orifice) points, akin to that illustrated by Mraiwa et al. [2] and Kim et al.; [11] which is in opposition to that noted by Asaumi et al. [15] who interpreted the orifice to be wider at the oral cavity side. Mardinger et al. [18] and Tözüm et al. [10] found the middle part of the canal to be the narrowest. ...
... With increase in age, the NP canal diameter increases and the IC length decreases due to the bone resorption. [12,14,15,18,20] However, the present study did not detect any significant difference in canal dimensions in subjects of various age groups probably because edentulous patients were excluded; Mardinger et al. [18] suggested presence of teeth assure stability in dimensions of IC in dentate subjects. • Incisive foramen location -In the present study, average distance equals to 13.81 ± 2.05 mm, with males and females exhibiting 14.09 ± 2.01 mm and 13.54 ± 2.07 mm showing statistical difference in gender as well as in relation to age groups. ...
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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.
... [1][2][3][4][5][6] The most common surgical procedures in this region (also known as the premaxillary zone) include the extraction of impacted or supernumerary teeth, implant placement, endodontic treatment, periodontal surgery, the elimination of cysts, and orthognathic surgery. [7][8][9][10][11][12][13][14][15][16][17][18] Anatomically, the nasopalatine canal is a relatively long and narrow structure located on the maxillary midline. It contains both the nasopalatine nerve (terminal branch) and the descending palatine artery. ...
... Cone beam CT (CBCT) offers several advantages with respect to convention CT, allowing us to identify and evaluate not only the structures of the anterior maxillary region but also their possible anatomical variants and the characteristics of the alveolar bone from a threedimensional perspective. 2,12,[20][21][22][23][24] The present study analyzes the anatomical characteristics and dimensions of the nasopalatine canal and alveolar bone based on CBCT images from patients seen in the Dental Clinic of the University of Murcia (Spain). ...
... The use of CBCT can help avoid the complications resulting from invasion of the canal, including damage to the nerve or vessels. 8,12 In this context, nerve damage can result in areas of paresthesia, dysesthesia, anesthesia, or even worse, neuropathic pain. Vascular complications in turn tend to manifest as profuse bleeding, which, although not life-threatening, usually causes considerable concern. ...
Article
Background Surgery of the anterior maxillary zone has a strong impact upon dental and facial aesthetics and function.PurposeTo determine the anatomical characteristics and dimensions of the nasopalatine canal and alveolar bone using cone beam computed tomography (CBCT).Materials and MethodsA retrospective, cross-sectional study was made of the nasopalatine canal in 122 randomly selected CBCT scans corresponding to 66 males (44.3%) and 56 females (55.6%). The following measurements were made: maximum length and diameters of the nasal and oral openings of the nasopalatine canal; distance from the crestal margin to the buccal wall (at apical, middle, and coronal level); and angulation of the nasopalatine canal. The anatomical variants were morphologically classified as follows: A (single canal), B (double canal), or C (Y-shaped canal).ResultsThe anatomy of the nasopalatine canal showed important variability in terms of morphology and dimensions. Type A was observed in 48 patients (39.34%), type B in 10 (8.19%), and type C in 64 (52.45%). The mean diameter of the nasal opening or orifice was 3.02 ± 1.0 mm versus 3.29 ± 1.0 mm in the case of the oral opening. The mean length of the canal was 11.02 ± 2.4 mm. Significant differences were found between males and females, with greater canal dimensions and alveolar bone thickness values anterior to the nasal canal zone among males (p < .05).Conclusions Our study shows gender to exert a significant influence upon the anatomical dimensions of the anterior maxilla and incisor canal. Given the anatomical variability characterizing the nasopalatine canal, we recommend CBCT evaluation prior to any type of surgery of the anterior maxillary zone.
... In general, no serious clinical complication has been reported to result from surgical intrusion to the content of the IC [12], although a case hematoma formation 1 week after surgical removal of an impacted supernumerary tooth in the maxilla has been reported [13]. Neurosensory changes that usually happen following surgical transection of the nasapalatine nerve is felt the most during the first week, but return to normal within a month [12]. ...
... Implant restoration of the upper incisors is a challenging task due to its aesthetic and functional requirement, amid the limitation that results from the resorption of alveolar bone following tooth extraction, and a variation in the dimension and location of the IC and the IF [19,20]. The former has been addressed by many researchers through various bone graft technique and materials used [13]. However, anatomic limitation arising from the close proximity of the IF and large IC limits one's ability to immediately place implants in the ideal position. ...
... Although the IC is discussed in the literature, there are only a handful of studies describing the morphology and morphometric variations of this canal [7,15,18,[21][22][23][24][25][26] of which only three involved Asian subjects [6,13,27]. Most other studies focused on IC pathology and their management [28][29][30]. ...
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The maxillary incisive canal connects the roof of the oral cavity with the floor of nasal cavity and has the incisive and nasal foramina respectively at its two opposite ends. Its close proximity with the anterior incisors affects one's ability to place immediate implants in ideal position. To avoid causing complication, variations in their dimensions were studied. Images of ninety Mongoloids patients examined with i-CAT Cone Beam Computed Tomography were included. The sizes of the nasopalatine foramen, the incisive canal and foramen, and anterior maxillary bone thickness were measured. The direction and course of the canals were assessed. The mean labiopalatal and mesiodistal measurements of the incisive foramen were 2.80mm and 3.49 mm respectively, while the labiopalatal width of the nasal foramen was 6.06mm. The incisive canal was 16.33mm long and 3.85 mm wide. The anterior maxillary bone has an average thickness of 7.63 mm. The dimensions of the incisive foramen and incisive canal, and anterior maxillary bone thickness demonstrated gender differences with males showing greater values. The anterior maxillary bone thickness was affected by age but this difference was not observed in canal dimensions. The majority of subjects have a funnel shape-like incisive canal with the broader opening located at its superior. They seem to have a longer slanted-curve canal with one channel at its middle portion and a narrower incisive foramen opening than those reported elsewhere. This study found that gender is an important factor that affected the characteristics of the IC and the amount of bone anterior to it. Male generally had bigger IC and thicker anterior bone. In addition, the anterior maxillary bone thickness was affected by aging, where it becomes thinner with increased age even though the subjects were fully dentate.
... [1][2][3] The diameter and angulation to the palatal plane of the maxillary incisive canal in adults were reported in previous studies using spiral and cone-beam computed tomography (CT). [4][5][6] However, development of the maxillary incisive canal in childhood was not evaluated. ...
... Cone-beam CT was used for the observation of various fine anatomical structures, [7][8][9] and the angulation, and diameter of the maxillary incisive canal in adults were measured using it in previous studies. 4,5) The mean antero-posterior angulation at the inferior level was 75.3 degrees in IIIC, and the value was close to that of adults (mean: 74.3 degrees) in a previous study. 4) The mean difference of angulation between the inferior and middle levels was lower in IIA and IIC, and it was understood that the maxillary incisive canal was straight from the inferior level to nasal floor. ...
... 4,5) The mean antero-posterior angulation at the inferior level was 75.3 degrees in IIIC, and the value was close to that of adults (mean: 74.3 degrees) in a previous study. 4) The mean difference of angulation between the inferior and middle levels was lower in IIA and IIC, and it was understood that the maxillary incisive canal was straight from the inferior level to nasal floor. Significant differences with different of angulations were noted between IIC and after IIIA. ...
Article
The maxillary incisive canals were observed in childhood from infancy to school-aged children to clarify their development. Cone-beam computed tomography was performed to investigate 44 dry child skulls. Two-dimensional images of various planes in the maxillary incisive canal were reconstructed on a computer using 3-dimensional visualization and measurement software. Then, antero-posterior angulation, and antero-posterior and lateral axes of the maxillary incisive canal were measured at the inferior and middle levels. The mean difference of angulation between the inferior and middle levels was 2.3 degrees in IIC, and 11.1 degrees in IIIC. The mean ratio of the lateral axis to antero-posterior axis at the middle level was 2.54 in IIC, and 1.93 in IIIC. In conclusion, it was antero-posteriorly straight from IA to IIC, and, after IIIA, it curved at the middle level. The cross-sectional shape in IIC was depressed with a larger lateral axis.
... 1 During implant placement in the anterior region of the maxilla, attention should be paid to the atrophy of the alveolar bone following the loss of incisors and also to the morphology and position of the nasopalatine canal. 2 Any contact between the implant and the nasopalatine nerve may result in the failure of implant osseointegration or in neurological dysfunction. [3][4][5] The incisive canal (or nasopalatine duct) is located palatal to the maxillary central incisors and connects the palate to the floor of the nasal cavity. ...
... 16 Previous studies investigated the morphology of the canal using CT or magnetic resonance imaging (MRI) [16][17][18] and CBCT assessments are rare with small sample sizes. 2,19 Therefore, we designed this study to accurately evaluate the morphology of the nasopalatine canal and its surrounding structures using CBCT. ...
... 18 Then, the coronal and sagittal sections were reconstructed and the nasopalatine canal shape (single, double, triple-canal and Y-shaped) was assessed in the coronal section. 2 In order to measure the upper diameter of the nasopalatine canal and incisive foramen, both coronal and sagittal sections were used (Figures 1 and 2). 20 With double-branched canals, the mean diameter of the foramina was considered. ...
Article
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Background and aims. Because of increasing concerns about surgeries in the anterior maxilla, including implant placement, it is necessary to examine the morphology of the nasopalatine canal and its surrounding bones. This study aimed to analyze the shape and position of the nasopalatine canal and incisive foramen using cone-beam computed tomography (CBCT). Materials and methods. CBCT images of 110 patients referred to Hamadan School of Dentistry were examined. The size and shape of the nasopalatine canal and incisive foramen, the distance between the incisive foramen and the anterior nasal spine, and the distance between the anterior border of the nasopalatine canal and the labial surface of the buccal plate were recorded. Results. The nasopalatine canal length decreased and its diameter increased with aging. The canal was found to be longer and wider in men. Patients without incisors had longer and thicker nasopalatine canals. The distance from the nasopalatine canal to the labial surface of the buccal plate was not gender-related but decreased with age. The distance to the labial cortical surface decreased significantly with loss of incisors. Conclusion. Given the diversities in the size and shape of nasopalatine canals, it is highly important to perform CBCT to prevent neurovascular damage.
... Considering these complications, nasopalatine canal morphology and dimensions should be evaluated carefully before dental implant placement [3]. In order to minimize complications following implant placement in the incisor area, threedimensional (3D) configuration of nasopalatine canal, its position in relation to the surrounding structures, alveolar bone morphology, and incisors' morphological changes in the alveolar bone should be evaluated carefully [4]. In www.jdt.tums.ac.ir ...
... In order to avoid these complications, an accurate evaluation of the nasopalatine canal and its surrounding bone is necessary, and the distance between the implant site and the adjacent anatomical landmarks should be measured precisely [7]. Cone beam computed tomography (CBCT) is recommended for 3D visualization of various structures, which are difficult to detect on panoramic and intra-oral views [4]. On the other hand, there are no obvious differences between linear measurements on CBCT and direct measurements of maxillofacial structures, which is the gold standard [8]. ...
... On the other hand, incisive canal shows minimal changes in horizontal direction after anterior tooth loss. This can be the result of significantly lower alveolar bone width in the anterior region of edentulous maxilla compared to dentulous maxilla [4,19]. In the current study, no significant relation was detected between age and nasopalatine canal dimensions except that with aging, alveolar bone width anterior to the canal in the lower third decreased significantly. ...
Article
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Objectives Precise radiographic assessment of the nasopalatine canal is required to prevent implant failure. The purpose of the current study was to determine the three dimensional (3D) morphology, as well as the dimensions of the nasopalatine canal using cone beam computed tomography (CBCT). Materials and Methods In this descriptive cross-sectional study, maxillary CBCT images from 300 patients (150 men, 150 women) were retrospectively evaluated. Sagittal and coronal views were reviewed to determine the nasopalatine canal morphology and dimensions. The difference in canal dimensions between men and women was evaluated using the Student’s t-test while the difference in canal morphology between the two sexes was assessed using Chi-square test. Results A total of 199 (66.3%) patients had type A canal (cylindrical without a branch), 69 (23%) had type B canal (a canal with a branch in the upper part), and 32 (10.7 %) had type C canal (a canal with a branch in the middle part). Incisive foramen diameter was 4.7±1.11mm on the sagittal section. Alveolar bone width in the anterior part of the canal was 12.3±1.7mm in the upper one third, 10.7±1.7mm in the middle one third, and 9.8±1.4mm in the lower one third. The angle of canal with palate was 109.5±5.7°. On the coronal sections, canal length was 14.1±3.0mm, incisive foramen diameter was 4.6±1.0mm, and canal diameter in the nasal floor was 5.1±1.0mm. Conclusions Significant differences in canal morphology were observed among the patients and CBCT was useful in determining nasopalatine canal morphology and its dimensions before implant placement.
... Nasopalatine canal morphology is very important in the planning of oral surgery techniques carried out on the maxillae, in the treatment of nasopalatine cyst, palatal pathologies that require a surgical intervention [5,11,29,31]. Successful dental implants in the anterior maxilla are detected by the available bone and neighbouring neurovascular structures [24]. It is also possible to place an implant into the NPC at the time of surgery [10]. ...
... The morphology of NPC was classified in sagittal, coronal and axial planes (Figs. [1][2][3][4][5]. The length of NPC was found by measuring the distance between the midpoints of nasopalatine foramen and incisive foramen. ...
... The shape and numbers of nasopalatine foramen, incisive foramen and NPC at the mid-level were evaluated (Figs. 4,5). The nasopalatine angle located anteriorly between the axis of NPC and the palate was measured (Fig. 6). ...
Article
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Background: Nasopalatine canal (NPC) (incisive canal) morphology is important for oral surgery techniques carried out on the maxilla, in the treatment of nasopalatine cyst, palatal pathologies that require a surgical intervention. Materials and methods: The morphology of NPC was classified in sagittal, coronal and axial planes on the CBCT. The length of NPC was found by measuring the distance between the mid-points of nasopalatine foramen and incisive foramen. The numbers, shapes and diameters of incisive foramen and nasopalatine foramen were examined. Nasopalatine angle present between the NPC and the palate and anterior to the NPC was measured. Results: In the sagittal plane, the shape of NPC was classified in six groups: 26.7% hourglass, 14.7% cone, 13.3% funnel, 16.0% banana, 28.7% cylindrical and 0.7% reverse-cone shaped. In the coronal plane, shape of NPC was classified in three groups: 63.3% Y shaped, 36.0% single canal, 0.7% double canal and external border of NPC was classified in four groups: 26.7% U, 28.7% Y, 44.0% V and 0.7% reverse-V shaped. In the axial plane, the shape of nasopalatine foramen, incisive foramen and NPC at the mid-level was evaluated. The shape of the canal was detected as four types at three evaluated levels: round, oval, heart and triangle shaped. It was seen in every three axial planes that the round group is more than the others. Conclusions: The morphological properties and variations of NPC should be considered with a correct radiological evaluation so as to prevent the complications and improper practices in local anesthesia, maxillary surgery and implant surgery practices. Especially dentists, otolaryngologist and plastic surgeons need to know the anatomy and variations of NPC.
... A total of 9 groups were created:(1) hourglass, (2) spindle, (3) cone, (4) funnel, (5) banana, (6) cylindrical, (7) tree branch like, (8) kink, (9) other (Fig. 2). The NPC was also assessed concerning the classification of Song et al. [23] for its sagittal direction-course: (1) vertical-straight, (2) vertical-curved, (3) slanted-straight, (4) slanted-curved (Fig. 3). ...
... It may result from the interindividual variations and non-homogenous distribution of dental groups. Also, the rate of resorption can change inter-individual and even in the same individual at different times [2]. The time span since tooth loss and factors (anatomic, metabolic, functional, and prosthetic factors) which affect the rate of resorption should be taken into consideration in future studies. ...
Article
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Background: Description of the nasopalatine canal (NPC) is important for planning surgical treatment, comprehension of the morphology and pathogenesis of lesions that occur in the anterior maxilla. The goal of this study was to analyze the dimensions and anatomic characteristics of the NPC on cone-beam computed tomography (CBCT) scans; to determine the incidence of anatomical variation; and to assess the correlations of these variables with age, gender, and dental status. Materials and methods: A total of 320 individual CBCT images were included. Reformatted sagittal, coronal and axial slices were evaluated. Sagittal images were used for measurements of the NPC and to classified shape and direction-course of the NPC. Coronal images were used to analyzed the NPC division levels and axial images were used to detect the number of palatal and nasal opening. Results: The mean NPC length was 11.45 ± 2.50 mm, statistically significant differences were detected between males and females (p < 0.05). Mean nasopalatine angle was 76.26° ± 8.12°, significant differences were detected in sagittal and coronal classifications. The most common canal was: funnel shapes (29%); slanted-curved direction-course (53.1%); middle third division level (43.1%); and one incisive foramen with two Stenson's foramina (1-2) (77.2%). Conclusions: The current study ensures new findings on the literature concerning the description of the anatomical structure of the canal. Also, the study highlights a significant variability in the anatomy and morphology of the NPC. Therefore, three-dimensional analysis of this structure is important for facilitating surgical management and preventing possible complications in this area.
... 5 To minimize bleeding and neurovascular bundle complications due to supernumerary/impacted tooth extractions, implant placements, surgical cyst, and tumor treatments, three-dimensional view of the NPC, its position with respect to the surrounding structures, and alveolar bone morphology should be carefully evaluated with CBCT. 6 With the assistance of CBCT evaluation of the premaxilla and nasopalatine canal morphology; both consistency of surgical borders will be protected safe and inclination of implants will be adequately determined, as well as protecting from trauma of the neurovascular bundle. 5 Based on the information gained from our study we estimate that CBCT can provide valuable information in preparation for surgery in the premaxillary area. ...
... 9,10 In the present study, incidence of pathology near NPC was found 20.8% with no difference between genders. Although many studies indicate the pathologies related to NPC in the literature, 6,[11][12][13][14][15] there are limited studies, concerning the anatomy and morphology of NPC using CBCT. [16][17][18][19] There are several classifications for NPC evaluation via CT, according to its shape; Mardinger et al 3 In the present study, 6 groups including hourglass, cone, funnel, banana, cylindrical, and tree branch, were used to classify the NPC shape. ...
Article
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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.
... [14] Analogous findings were also described in many studies on IC morphology. [3,13,[15][16][17][18][19][20] In contrast, the common IC profile for both dentulous (50%) and edentulous maxilla (45%) in Tokyo population was found to be of funnel-like shape according to the research conducted by Fukuda and others. [21] Mraiwa and colleagues, [11] on the other hand, discovered that the Y-shaped profile was common in the coronal view in the UK population. ...
... Similar to the findings of many studies, the funnel-and cylinder-like IC shapes were the most common shapes. [1,[14][15][16][17][18][19][20] Also, similar to the findings of Thakur and colleagues, [14] Nasseh and others [17] and Safi and colleagues, [19] banana-shaped IC was found to be the least frequent in the current study. ...
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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.
... 5,6 In addition, the IC morphology and position may greatly influence the angulation and position for dental implant placement. 7,8 Approximation of the IC and U1 should also affect orthodontic retraction of the anterior teeth. Nakada et al. 9 found that mesial movement of the root apex during orthodontic retraction might lead to its contact with the IC cortical plate and cause apical root resorption. ...
... For now, it is still uncertain how intrusion of a tooth root into the IC would influence the function of internal nerves or vessels, 4 but it was reported that, in a surgery extracting a supernumerary tooth, that intrusion into the IC caused a hematoma one week after the operation. 7 It was emphasized in prosthodontics and oral implantology that image diagnoses should be conducted before restoration 7 but, in orthodontics, few studies have paid attention to the approximation of U1 and the IC. 11 In past studies, the opening of the IC (the incisive foramen) was defined as the lowest point of the palatal wall. ...
Article
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.
... 1,2 This region plays a fundamental role in esthetics, phonetics and biomechanics. 3,4 The nasopalatine canal is the most important anatomical landmark in this region. 5 The nasopalatine canal and the incisive foramen, which include the nasopalatine artery and nerve are important bony structures in the anterior maxilla. ...
... Regarding the anatomical variations of the nasopalatine canal in the coronal plane, it was single in 55.66%, Yshaped in 30.66%, double in 12% and triple in 1.66%. This finding was different from the results of Safi et al, 1 Asaumi et al, 4 and Kajan et al. 22 In their study, Y-shape had the highest frequency followed by the single and double types. Triple form was not seen in any patient. ...
Article
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Aim: This study aimed to assess the anatomical variations of the nasopalatine canal and their association with age and sex using cone-beam computed tomography (CBCT). Materials & Method: A total of 300 CBCT scans of the maxilla were collected and axial, sagittal and coronal sections were reconstructed using NNT Viewer software. The length and shape of the nasopalatine canal in the sagittal and coronal planes, the angle and number of canals and the diameter of nasal and oral opening of the canal were all determined in the sagittal plane. The shape and number of incisive foramina in the axial plane and association with age and sex were also studied. Data were analyzed using SPSS version 18.0. Results: In the sagittal plane, cylindrical form had the highest frequency. The mean canal length was 10.19 ± 2.28 mm; this value was greater in males and had no association with age. The mean angle of nasopalatine canal was 110.75 ± 10.14° with no significant difference between males and females; 96% of the participants had one nasopalatine canal in the sagittal plane. The mean diameter of the incisive and Stenson foramina was 2.98 ± 1.01 and 2.70 ± 1 mm, respectively. These values were greater in males. In the coronal plane, single canal form had the highest frequency. No significant association was noted between canal shape and gender. The mean canal length was 9.36 ± 2.05 mm in this plane. This value was not significantly different in males and females. In the axial plane, heart-shaped incisive foramen had the highest frequency and 92% of the individuals had one incisive foramen. Conclusion: Considering the significance of nasopalatine canal and high prevalence of anatomical and morphological variations, it is recommended to evaluate the premaxilla on CBCT scans prior to surgical procedures in this region.
... The least common shape was found to be hourglass shape. [3] The findings are similar to the results of the study done by Thakur et al. in 2013 [6,7] [ Table 1]. ...
... [10] In our study, the cylindrical shape was found in 54% of the scans, the funnel-shaped canal was found in 32%, spindle shape 8%, and an hourglass in 6% [ Table 2]. [11] our results are also consistent with the ones of Yasser et al., Liang et al., Asaumi et al. [3,7,8] Other shapes like (1) coneshape, (2)bananalike, (3) treebranch like shapes of the canal have also been reported by Etoz and Sisman. [12] The average length of the NPC in our study was found to be 11.12 mm ranging from 8.73 to 18.58 mm; result close to the ones of Richa Mishra et al., Thakur et al., Tozum et al., and Fukuda et al., whose mean canal length measurement in a sagittal plane was 10.08, 10.86 and 11.75 mm ranging from 6.15 mm to 16.04 mm. ...
Article
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Aim: 1) To assess the morphological variation of the nasopalatine canal (NPC) concerning age and gender. 2). To assess the correlation between the gender and morphology of the canal. 3). To assess the correlation between age and length of the canal. Material and Method: This is a retrospective, randomized observational study. The study comprised of 50 CBCT scans of maxilla showing NPC completely. The scans were obtained in the department during the period ranging from December 2018 to June 2019. The patients were in the age range of 15–75 years. Scan of 22 females and 28 males were included in the study. Patient below 15 years of age and NPC pathology or impacted teeth in same region were excluded in the study. The scans were obtained using ICAT17-19 machine and analyzed Vision software. Cone-Beam 3D Imaging machine operating at 120 kvp, 37.07 mAs with 0.25 mm voxel size, and a field of view of 16 × 6 cm maxilla. Results: Nasopalatine canal has 4 different morphological shapes. The most common shape was the cylindrical shape amongst both males and females. The least common shape was found to be hourglass shape with increasing age the length of NPC was found to decrease. The length of the canal was found to be longer in males when compared to females. Conclusion: This study highlights the importance of NPC morphology before or during surgical procedures involving the maxilla.
... [13] In accordance with this, in our study, the cylindrical shape (62%) was found in most of the participants, funnel-shaped canal was found in 27% subjects, hourglass 9%, and spindle shape 2%. Our results are also consistent with the ones of Mardinger et al., [14] Tözüm et al., [15] Yaser et al., [16] Liang et al., [2] Asaumi et al., [17] Panjnoush et al., [18] Fernández-Alonso et al., [19] and Nasseh et al. [20] who found that the NPC cylindrical shape was the most frequent. ...
... NPC courses on midline of the maxilla at the level of roots of anterior incisors and exits into the nose through nasal foramen, foramina of stenson (FS) as well as into the mouth as incisive foramina (IF). Evaluation of size and morphology of NPC is especially important for planning oral surgical procedures, which are performed on the maxilla such as apical resection of central incisors, enucleation of the nasopalatine canal cyst, surgically-assisted rapid palatal expansion, LeFort I osteotomy procedures and to avoid possible complications [1,2,[5][6][7][8][9][10][11][12][13][14]. Furthermore, anterior maxilla is affected by traumas of the head and neck [4]. ...
Conference Paper
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Objectives: Nasopalatine canal (NPC) connects the nasal and oral cavities. It includes nasopalatine nerve, descending branch of nasoplataine artery, fibrous connective tissue and minor seromucous salivary glands. These structures may be exposed to damage during surgical interventions and thus, one must bear in mind the morphometric variations of NPC. NPC also has crucial importance in anterior maxillary rehabilitation. In this study, we aimed to investigate the possible alterations in morphology of NPC due to age, gender and absence of anterior incisors via using multiple detector computed tomography (MDCT) imaging method. Methods: A total of 100 (50 males and 50 females) between 18 and 90 years who have undergone MDTC imaging for head trauma, sinusoidal volume and headache and who do not have serious pathological condition that can affect the NPC were included. MDCT device with 80 detectors (160 slices) was used for imaging. Nasal foramen (P1) diameter, IF diameter (P2), NPC length (P3), distance between buccal wall of IF and facial side of the buccal bone (P4), distances: [between buccal bone wall of NPC and facial side of buccal bone (P5), distance between mid-NPC buccal wall and facial side of buccal bone (P6), distance between buccal wall of NPC and the apex of anterior central incisors (P7) and NPC angle (P8) were measured. Established data were statistically analyzed. Results: Detected shape variations of NPC were as follows (total, male and female): Cylindirical, hourglass, banana, funnel; canal shapes in coronal plane: unilateral, Y-type and parallelized. Mean canal diameters were bigger in males except P1 and P3 (p<0.05). The morphology of NPC has exhibited difference with respect to age and gender. Conclusion: NPC variations are important in aesthetical and functional aspects and must be entertained to decrease the incidence of complications related to facial or dental surgical interventions
... These findings corroborated the data obtained in a Turkish population [8]. Moreover, studies have demonstrated the difference in length of the incisive canal between the sexes, with higher mean values for men in different populations, such as Mongolians [10], Japanese [11], and North Americans [12]. The higher value of incisive canal length in men may be attributed to the craniocaudal dimension of the relatively larger face observed in the male in comparison with the female sex; and the differences in the size of the incisive canal may be relative to the facial instead of to the absolute dimensions [1]. ...
Article
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.
... This technology facilitates the evaluation of IAC due to its cross-sectional images which overcome the weak points of conventional images. [5] Various parameters influence the characteristics of CBCT image, such as field of view, slice interval, and tube current. One of the parameters which may affect the visibility of anatomic structures like IAC is the slice thickness. ...
Article
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Objective: The aim of this study is to evaluate the effect of slice thickness on the visibility of inferior alveolar canal (IAC) in cone-beam computed tomography (CBCT) images. Materials and Methods: CBCT images of thirty patients (15 male and 15 female) with an age range between 40–50 years old were used. Cross-sectional images were obtained with 0.5, 1, and 2 mm slice thickness and 2 mm interval. Two oral radiologists with at least 5 years' of experience observed all of the 90 images and rated the images based on the visibility of IAC in a 4-score classification (highly visible, visible, nearly visible, nearly invisible). Friedman test was used for the comparison of visibility of IAC in different slice thicknesses. To do the above test, the average of the scores of two examiners was calculated. A P. value below 0.05 was considered significant. Results: Visibility of IAC in different slice thicknesses of both raters showed no significant difference (P = 0.20). Conclusion: Within the limitations of this study the slice thickness has no effect on visibility of IAC in cross-sectional images. Future studies on other multiplanar images are recommended.
... The nasopalatine canal has been investigated by many researchers in different ways and populations (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14); some of them on dry skulls (12,14), the others using the imaging technology, either by two-dimensional (4) or three-dimensional radiography (e.g., CBCT) (1-11, 13, 14). ...
Article
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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.
... Canalis incisivus (CI) morfolojisi maxilla üzerinde gerçekleĢtirilen oral cerrahi tekniklerin planlanmasında, nasopalatin kist tedavisinde, cerrahi müdahale gerektiren damak patolojilerinde oldukça önemlidir (1)(2)(3)(4)(5)(6). Ayrıca, son zamanlarda anterior maksillar bölge ile ilgili estetik talebin fazla olması nedeniyle bu bölgedeki anatomik yapıların radyolojik tanımlanmasına olan ihtiyaç da artmıĢtır (7). ...
Thesis
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Nervus maxillaris ve dallarının anestezisi klinikte birçok amaçla kullanılabilmektedir. Bu çalışmada nervus maxillaris ve dallarından olan nervus nasopalatinus, nervus infraorbitalis, nervus palatinus minor ve nervus palatinus major’un kemik yapılar üzerindeki seyri ve bu kemik yapıların morfometrik özelliklerinin incelenmesi amaçlanmıştır. Bu amaçla 150 sağlıklı bireyin Konik-Işınlı Bilgisayarlı Tomografi görüntüleri retrospektif olarak değerlendirildi. Bu görüntüler üzerinde foramen nasopalatinum, canalis incisivus, foramen incisivum, sulcus infraorbitalis, canalis infraorbitalis, foramen infraorbitale, fossa pterygopalatina, canalis palatinus major, canalis palatinus minor, foramen palatinum majus, foramen palatinum minus incelendi. Veriler cinsiyet ve yaşa göre değerlendirildi. Sagital düzlemde foramen nasopalatinum’un çapı 4.13±1.08 mm, foramen incisivum’un çapı 6.47±1.41 mm, canalis incisivus’un uzunluğu 12.56±2.53 mm ve canalis incisivus açısı 74.28±7.72º olarak saptandı. Canalis incisivus’un sagital düzlemde en sık silindir şeklinde (%28.7), koronal düzlemde Y şeklinde (%63.3) olduğu saptandı. Transvers düzlemde foramen nasopalatinum ve foramen incisivum şekli en sık yuvarlak olarak saptandı (sırasıyla %75.3, %62.7). Foramen nasopalatinum’daki açıklık sayısı en sık iki adet (%63.3), foramen incisivum’daki açıklık sayısı en sık bir adet (%53.3) saptandı. Sulcus infraorbitalis ve canalis infraorbitalis’in uzunluğu sırasıyla 21.91±3.93 mm ve 8.37±1.78 mm saptandı. Foramen infraorbitale margo infraorbitalisin 7.43±1.41 mm altında, orta hattın 23.48±2.33 mm lateralinde ve cildin 9.73±2.16 mm altında olduğu saptandı. Foramen palatinum majus’un en sık 3. maksillar molar diş hizasında (%66), okluzal düzlemden 19.46±2.19 mm yukarıda, orta hattan 14.98±1.45 mm lateralde olduğu saptandı. Foramen palatinus majus ile canalis pterygoideus arası mesafe 28.20±3.36 mm, canalis pterygoideus ile fissura infraorbitalis arası mesafe 9.00±2.62 mm olarak saptandı. Elde edilen bulguların özellikle maksillofasial cerrahide yol gösterici ve literatüre katkı sağlayacağı düşünülmektedir.
... The present findings suggest that FOV-limited CBCT is a useful modality for orthodontic diagnosis of maxillary protrusion. Loss of a maxillary incisor affects the morphology of the maxillary alveolar border and, consequently, alters the morphology of the anterior wall of the incisive canal [32]. Moreover, changes in location and inclination of the maxillary incisors lead to morphological changes in the maxillary alveolar border [12,[33][34][35][36]. Therefore, pre and post-orthodontic treatment FOV-limited CBCT analyses for assessment of morphological changes in the maxillary anterior region and the incisive canal are required to ensure precise evaluation of tooth movement-induced anatomical changes in the surrounding tissues [27,36]. ...
Article
Background In setting goals for orthodontic treatment, determining the morphologies of the alveolar bone and maxillary incisor root is important for avoiding root resorption, dehiscence, and fenestration. This study aimed to analyze the configurational relationships among maxillary incisors, the alveolar border, and the incisive canal by cone-beam computed tomography (CBCT). Methods Cone-beam CT images of 93 orthodontic patients were evaluated for length of the incisive canal (L); angles between the palatal plane and the maxillary alveolar border (θ1), the incisive canal (θ2), and maxillary incisor (θ3); distance from the left maxillary incisor to the incisive canal (D); and cross-sectional areas of the incisive canal (CSAs) at three vertical levels. Comparison of variables between male and female patients was performed with the two-sample t test. Correlations between parameters were examined by Pearson’s correlation analysis and Bonferroni correction for multiple comparisons. Results Male patients exhibited significantly greater values of L than female patients. There were significant positive correlations between θ1 and θ2, θ2 and θ3, and θ3 and θ1. While the value of D was the lowest at the oral opening, that of the cross-sectional area of the incisive canal (CSA) was the greatest at the incisal root apex. Conclusions This study demonstrated that the incisive canal had large inter-individual variability, and the proximity between the incisive canal and the incisal root could not be precisely predicted by the conventional cephalograms. Therefore, pre-treatment CBCT examination should be recommended when a large amount of maxillary anterior retraction and/or intrusion is planned in orthodontic diagnosis.
... The age and gender had no significant effect on canal shape with which was in accordance with the findings of previous studies (31)(32)(33)(34). However, the dental status had strong effect on NPC shapes in contrary to previous studies (11,35,36). These differences may result from small sample sizes, non-homogenous distribution of tooth groups and the use of different imaging modalities such as micro-CT. ...
Article
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Background: The aim of this study was to analyze as three dimensions the anatomical and morphometric dimensions of nasopalatine canal (NPC) in the coronal, axial and sagittal directions using cone beam volumetric tomography (CBCT) and to evaluate the effect of age, gender and maxillary dental status on NPC and buccal bone thickness (BBT). Methods: In this study, CBCT data of the 619 individuals aged between 17-86 years were examined retrospectively with respect to dimensions and anatomic variations of the NPC and BBTs. The correlation of age, gender, and status of edentulism of anterior maxilla with all the variables were evaluated. Results: The NPC and BBT showed important variability in terms of morphology and dimensions. Morphological assessment of NPC revealed that 26.17% of NPCs were conical shape, 24.71% of canals were hourglass-shaped, 16.80% of canals were cylindrical shaped, 15.83 % of canals were funnel-like shaped, 11.14 % of canals were banane-like shaped, and 5.33 % of canals were tree branch-like shaped. Males and females showed significant differences in the length of the NPC and BBTs in the sagittal sections. There were significant differences between age and BBTs. In addition, the length of NPC and BBTs were statistically different according to dental status. Conclusions: These anatomical changes in terms of dimensional and morphological parameters revealed the importance of 3D imaging. Dentists should know and consider the variations in this canal in order to avoid possible complications during anesthesia and surgical procedures which were applied to the maxillary anterior region. More precautions should be taken during surgical procedures in females, elderly and edentulous patients.
... Intraoral periapical and occlusal radiographs were the older techniques for assessment. [6] Optic pathway gliomas have not played much role in assessment as the view did not permit the visibility of the canal. [5] Cone-beam computed tomography (CBCT) is the recent advancement in radiology field that helps to access all the skeletal details of the oral cavity. ...
Article
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Background: Locating the nasopalatine duct while placing the implants helps in preserving the contents of the duct, reducing the risk of paresthesia of the anterior maxilla. Not many clinicians consider the importance of nasopalatine duct and cause discomfort for the patient. Aim: The aim of this study was to do a retrospective study and assess the position and size of the nasopalatine duct using cone-beam computed tomography (CBCT) in dentulous and edentulous cases in Indian population. Materials and Methods: For the study, 50 CBCT of both dentulous and edentulous patients are taken from the Department of Implantology. The nasopalatine canal is identified and measured with a specific landmark in the CBCTs. Results: As per the gathered data, the evaluated population has an age ranging from 23 years to 80 years and of which 15 are male and 9 are female. The mean value of the canal from the anterior wall of the foramen to the anterior nasal spine in males is 14.69 mm and in females is 12.74 mm. Conclusion: This study would show the average location and size of the nasopalatine duct in the Indian population helping in assessing it while implant placement.
... Al-Amery et al. [16] observed that the mean width of the labiopalatal of the nasal foramen was 6.06 mm, even in this study the male showed greater values than female. Rieko et al. stated that the incisive foramen was placed more buccally in [17] edentulous cases and care should be taken during surgical procedures. ...
Article
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Background: The position of the incisive foramen in relation to the central incisors varies in different standard textbooks. This study was aimed at bringing in a standard value for the distance between the incisive foramen and central incisors in male and female skulls. Aim: This study aims to measure the variation in position of the incisive foramen in relation to the interproximal region of the central incisors in dry human skull. Materials and Methodology: A total of 61 adult dry human skulls were selected, with full complement of teeth with fully erupted third molars. Measurements were made from the interproximal region of the central incisors to the incisive foramen using a digital Vernier caliber. Results: The study inferred the location of incisive foramen to be about 0.99 cm from the interproximal region of the central incisors. Conclusion: There was no significant difference between the average values of the male and female skulls. The study was not significant statistically due to limited study samples.
... Therefore, the IC level through the root of the maxillary incisor was not available for these samples. Therefore, in this case, we used another method using ANS and IC nasal bifurcation to measure the IC dimension ( Figure 3B, bottom) [29]. The anteroposterior distances between the IC and the maxillary central incisor were not measured. ...
Article
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The objective of this study was to identify the change in incisive canal (IC) morphology and tooth–canal relationship after mini-implant-assisted rapid palatal expansion (MARPE). Pretreatment and posttreatment cone-beam computed tomography images of 30 subjects were retrospectively evaluated. The dimensional and volume changes of the IC after MARPE treatment were evaluated, and the tooth–canal relationship and positional relationship between the maxillary central incisors were additionally compared in the group where the root apex of the maxillary central incisors was higher than the IC oral opening. The mediolateral and labiopalatal widths of the IC were significantly increased in all three levels after MARPE treatment (p < 0.01). The amount of increase was greater in the mediolateral direction than in the labiopalatal direction. The anteroposterior distance from the mesial point of the maxillary central incisors to the anterior margin of the IC was significantly decreased only in the oral opening level in the samples where the apices of the maxillary central incisors were located more superior to the oral opening of the IC (p < 0.05). The mediolateral distance between the mesial points of the maxillary central incisors and the distance between the root apex of the maxillary central incisors significantly increased after MARPE (p < 0.001). However, the distance between the crown tips of the maxillary central incisors did not significantly increase, even after MARPE treatment (p > 0.05). The volume of the IC significantly increased after MARPE treatment (p < 0.001), and the average increase in the total volume of the IC was about 65%. MARPE increased the width and volume of the IC and did not result in a clinically significant change in the root–canal relationship.
... 26,27 The maxillary incisive canal together with the incisive foramen connects the palate to the floor of the nasal cavity. 28 Although no serious clinical complications have been reported as a result of surgical disturbance to the contents of the incisive canal, 29 temporary sensory discomfort has been reported following surgical transection of the nasopalatine nerve during the first week after surgery. 30 Conversely, complications arising from pressure on neurovascular structures due to prolonged use of dental implants have been reported leading to neurological dysfunction. ...
Article
Full-text available
Tooth development is a complex process whereby various genetic and environmental variables interact to achieve the final morphology and destination. Disruptions in the process lead to impaction and or ectopic eruption. Bilateral ectopic eruption of maxillary canine teeth into the incisive fossa is a rare phenomenon. This report describes bilateral permanent maxillary canine teeth erupting into the incisive fossa of the skull of an adult male African. The skull specimen was first examined physically, followed by Micro Focus X-ray Computed Tomography (µCT) to determine the morphology and trajectory of the impacted and ectopically erupting teeth. Physical examination of the skull revealed a portion of the right maxillary canine tooth in the incisive fossa. µCT revealed the presence of right and left permanent maxillary canines within the palatine bone with cusps projecting into the incisive fossa. Both teeth were mature with well-developed root, root canal and crowns with distinct cusps. The root of the right impacted canine tooth was deflected at its apex. Tooth impaction is caused by mechanical disturbance in the path of the developing tooth. This information is vital to practicing maxillofacial surgeons during interpretation of the radiographs and surgical correction of disorders of the oral cavity.
... 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. ...
Article
Objective: To evaluate the morphologic features and the relative position of the incisive canal with regard to the maxillary incisor roots using computed tomography (CT). Materials and methods: Morphologic evaluation of the incisive canal and its proximity to the maxillary central incisors were measured using CT images of 38 adults with skeletal and dental class I normal occlusion. Linear measurements were performed on the axial cross-sectional images corresponding to three vertical levels, the palatal opening of the incisive canal (L1), midlevel between the opening level and the root apex of the maxillary central incisors (L2), and the root apex of the maxillary central incisors (L3). Results: The percentage of subjects with an incisive canal width greater than the interroot distance of the central incisors was 86.8% and 63.2% at levels L1 and L2, respectively. The anteroposterior distance between the maxillary incisor roots and the boarder of the incisive canal was approximately 5-6 mm at levels L1 and L2. Conclusion: The anteroposterior distance between the maxillary central incisor roots and the incisive canal was approximately 5-6 mm. More than 60% of the subjects had an incisive canal width greater than the interroot distance. Evaluation of the proximity of the incisive canal to the maxillary incisors, along with its dimensional characteristics, may be helpful when a considerable amount of maxillary retraction is planned.
... Being aware of the structure and its possible variations helps surgeons operating in the area to avoid injuring the neurovascular bundle and to direct local anesthesia appropriately. There have been several studies of the variations and their implications (Asaumi et al. 2010;Bornstein et al. 2011;Tözüm et al. 2012). ...
Chapter
The incisive foramen is the distal opening of the incisive canal and an important structure to consider during dental implant, cystectomy of radicular and nasopalatine cysts, and extraction of supernumerary mesiodens. It serves as the exit point for the nasopalatine nerve and sphenopalatine artery. Being aware of the structure and its possible variations helps surgeons operating in the area to avoid injuring the neurovascular bundle and to direct local anesthesia appropriately. There have been several studies of the variations and their implications.
... 26,27 The maxillary incisive canal together with the incisive foramen connects the palate to the floor of the nasal cavity. 28 Although no serious clinical complications have been reported as a result of surgical disturbance to the contents of the incisive canal, 29 temporary sensory discomfort has been reported following surgical transection of the nasopalatine nerve during the first week after surgery. 30 Conversely, complications arising from pressure on neurovascular structures due to prolonged use of dental implants have been reported leading to neurological dysfunction. ...
Article
Full-text available
Tooth development is a complex process whereby various genetic and environmental variables interact to achieve the final morphology and destination. Disruptions in the process lead to impaction and or ectopic eruption. Bilateral ectopic eruption of maxillary canine teeth into the incisive fossa is a rare phenomenon. This report describes bilateral permanent maxillary canine teeth erupting into the incisive fossa of the skull of an adult male African. The skull specimen was first examined physically, followed by Micro Focus X-ray Computed Tomography (µCT) to determine the morphology and trajectory of the impacted and ectopically erupting teeth. Physical examination of the skull revealed a portion of the right maxillary canine tooth in the incisive fossa. µCT revealed the presence of right and left permanent maxillary canines within the palatine bone with cusps projecting into the incisive fossa. Both teeth were mature with well-developed root, root canal and crowns with distinct cusps. The root of the right impacted canine tooth was deflected at its apex. Tooth impaction is caused by mechanical disturbance in the path of the developing tooth. This information is vital to practicing maxillofacial surgeons during interpretation of the radiographs and surgical correction of disorders of the oral cavity.
... En la última década, la tomografía computarizada de haz cónico (CBCT por sus siglas en inglés) se ha convertido en una herramienta útil para el diagnóstico y estudio de las estructuras del macizo facial (Bou Serhal et al., 2000). La CBCT se considera una de las mejores opciones para la visualización tridimensional de estructuras que suelen ser difíciles de evaluar mediante radiografías convencionales (Asaumi et al., 2010). El CBCT presenta gran potencial diagnóstico con la ventaja de requerir bajas dosis de radiación (Dula et al., 2014), por lo tanto la evaluación mediante CBCT debe considerarse como un método imagenológico de diagnóstico básico. ...
Article
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Certain human structures present different dimensions and morphologies in each population and individual, the nasopalatine canal being one of these. It is located in the midline of the palate, and it contains the nasopalatine nerve and the terminal branch of the nasopalatine artery. The purpose of this study was to analyze and record measurements of the nasopalatine duct in Mexican population by Cone Beam Computed Tomography (CBCT). A total of 120 CBCT coronal, transversal and sagittal views were analyzed. The data were classified according to Bornstein´s parameters. The normality of the variables was determined with the Shapiro Wilk test and the statistical significance was determinate by U-Mann Whitney test. A statistically significant difference was found in the evaluated variables of the nasopalatal canal between men and women. The data obtained determined that the morphology of the nasopalatine canal is variable and a morphological and dimensional analysis before any surgical intervention related with the area is recommended.
Article
We report a case of cyst of the papilla palatina. A 70-year-old woman was referred to our department to receive consultation for a swelling of the anterior hard palate. On intraoral examination, we confirmed a defined swelling, measuring approximately 13 × 10 mm, in the soft tissue of the palatine papilla. A computed tomographic scan showed pressure-induced enlargement of the incisive fossa. We removed a cyst with the patient under general anesthesia. Histopathological examinations revealed inflammatory cell infiltration of the cyst wall, which was lined by stratified squamous epithelium, ciliated columnar epithelium, and simple cuboidal epithelium. We diagnosed a cyst of the papilla palatina based on clinical, radiological, and histopathological findings. After operation, there has been no sign of recurrence.
Article
The incisive canal is located on the median plane of the maxilla, posterior to the roots of the central incisor. Although the incisive canal is not considered an anatomic structure that may limit tooth movement, it has recently gained attention regarding the possibilities of surgical invasion and associated complications because of its proximity to the maxillary central incisors. In the 2 illustrated cases, lip protrusion was improved by en-masse bodily retraction of the anterior teeth (>8 mm) using temporary anchorage devices. Three-dimensional cone-beam computed tomography showed that the maxillary incisor roots were approximated to the incisive canal after maximum retraction. One central incisor root was in direct contact with the incisive canal with severe root resorption, but tooth vitality and the overall occlusion were stable in the long term without any sensory dysfunction. The apparent root resorption may be mainly related to the large amounts of anterior retraction and root movement in the 2 patients. However, the anatomic location of the incisive canal and the possibilities of its invasion after tooth movement should be closely monitored when maximum retraction is planned, to prevent potential complications. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
Article
Implant placement plays a vital role in oral rehabilitation following loss of the incisors. Thus, having knowledge of anatomical variations of adjacent neurovascular structures especially the nasopalatine canal (NPC) is essential. Due to the lack of basic information in Iran about the morphology of this canal and the probability of its variety in different populations, this study was designed on an Iranian population. In this descriptive study, we selected cone-beam computed tomography images of 198 patients comprising of 98 males and 100 females in two dental groups (edentulous or dentate). The shape of the nasopalatine foramen and the form of the canal in axial views were assessed. Then, the canal height and its diameter at the palatal, middle and nasal levels in cross-sectional images were measured. The available bone in the buccal and palatal sides of the canal was assessed. Data analysis was carried out using a Chi-square test and an independent t-test (P ≤ 0.05). The majority of the samples (81.8%) presented a single foramen. Cylindrical shape (57.6%) was the most frequently detected canal form. The mean of the estimated canal height was 12.84 ± 2.88 mm. The canal diameter at the palatal level between the sexes and dental groups showed statistically significant differences. In our investigated population, the NPC form was mainly cylindrical with a single opening foramen. The mean of the canal height was higher than that found in other populations. Furthermore, the canal diameter in the edentulous group was greater than that observed in the other group.
Article
An essential prerequisite to perform any dental procedure is a clear understanding and knowledge of dental anatomy and its possible variations. The root canal system is characterized for a complex morphology, which varies among populations, individuals in the same population and even in the same person. The aim of this study was to evaluate by CBCT the morphology, number, curvature, and length of roots of first and second maxillary premolars in a Mexican population. In this stud 1700 maxillary premolars were evaluated by CBCT scans of patients; the axial, sagittal and coronal sections were analyzed following the longitudinal axis of each tooth. As a result 51.60 % of the maxillary first premolars had a single root, 31.03 % had two roots, 16.29 % had root fusion, and 1.07 % had three roots. 22.3 % of the maxillary first premolars showed mesial curvature, 41.9 % had a distal curvature, and 35.7 % did not show any curvature; and the most prevalent configuration in maxillary first premolars was Type V. 88.9 % of the maxillary second premolars had a single root, 3.9 % had two roots, 6.9 % had root fusion, and 0.11 % had three roots; 37.59 % of the maxillary second premolars showed a mesial curvature and 62.40 % showed a distal curvature; and the most prevalent configuration in maxillary second premolars was Type I. The anatomy of the root canal system is extremely complex and has many anatomical configurations, these clinical situations must be considered previous to performing any endodontic treatment.
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Objectives The aim of this study was to provide a bibliometric overview of the oral radiology journal output, contents, and leading trends, and also include a detailed authorship analysis by evaluating the top contributors, and their geographic distributions between 1985 and 2020 years.Methods The databases available on the Scopus and journal’s Web Page were searched to identify the all published articles and reports with no restriction regarding publication year or study design. Seven hundred and seventy-seven articles were included and analyzed for the following bibliometric criteria: publication title, authorship, publication year, coauthors, institution of origin, country of origin, collaborating institution and countries, article category, study field, and number of citations based on the Scopus and Google Scholar.ResultsOriginal article is by far the largest group of study outcome that more than half of the articles were in this category and followed by the case reports (19.8%). The leading countries according to number of the articles were Japan by far (59.8%) followed by Turkey (10.8%) and South Korea (5.2%). The article by Arnheiter, Scarfe, and Farman has received the highest number of citations overall. As first and/or coauthor, Ariji E emerged as a most productive author with 35 publications and Osaka University was determined as the most prominent institutions by publishing the greatest number of articles. More than half of the articles were in the “Diagnosis of Orofacial Diseases” study field.Conclusion This bibliometric analysis provides a comprehensive overall picture of the 35 years of research progress and publication trends in oral radiology.
Article
Dental cone-beam computed tomography (CBCT) received regulatory approval in Japan in 2000 and has been widely used since being approved for coverage by the National Health Insurance system in 2012. This imaging technique allows dental practitioners to observe and diagnose lesions in the dental hard tissue in three dimensions (3D). When performing routine radiography, the examination must be justified, and optimal protection should be provided according to the ALARA (as low as reasonably achievable) principles laid down by the International Commission on Radiological Protection. Dental CBCT should be performed in such a way that the radiation exposure is minimized and the benefits to the patient are maximized. There is a growing demand for widespread access to cutting-edge health care through Japan’s universal health insurance system. However, at the same time, people want our limited human, material, and financial resources to be used efficiently while providing safe health care at the least possible cost to society. Japan’s aging population is expected to reach a peak in 2025, when most of the baby boomer generation will be aged 75 years or older. Comprehensive health care networks are needed to overcome these challenges. Against this background, we hope that this text will contribute to the nation’s oral health by encouraging efficient use of dental CBCT.
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Objective: The goal of this study was to investigate the possible variations in morphology of nasopalatine canal (NPC) morphometry depending on age, gender and absence of anterior incisors using multidetector row computed tomography (MDCT). Materials and methods: A total of 100 patients (50 men, 50 women) with a mean age of 43.29±18.81 (SD) years (range: 18-90 years) who have undergone head MDTC were included into the study. Foramen nasalis diameter (P1), foramen incisivum diameter (P2), NPC length (P3), distance between buccal wall of incisive foramen and facial side of the buccal bone (P4), distances between buccal bone wall of NPC and facial side of buccal bone (P5), distance between mid-NPC buccal wall and facial side of buccal bone (P6), distance between buccal wall of NPC and the apex of anterior central incisors (P7) and NPC angle (P8) were measured. Formal variations in NPC were searched for. Differences in morphometric data were searched using Student t-test or Mann-Whitney test. Gender-based analysis of the variations was done with the χ(2) test. Pearson's test was used to search for correlation between morphometric data and age. Results: P1 was larger in men (3.72±1.41mm) than in women (3.07±1.34mm) (P<0.001). Similarly, P3 was larger in men (13.68±2.73mm) than in women (11.43±2.78mm) (P<0.001). No differences in the other NPC measurements (P2, P4, P5, P6, P7, P8) were found between men and women. Morphological variations in NPC (cylindrical, hourglass, banana shape, funnel shape, single canal, Y-type canal, parallel canal and others) were detected with frequencies ranging from 8 to 65.3%. A significant negative correlation was found between NCP measurements and patient age for P3 (r=-0.311; P=0.002), P4 (r=-0.267; P=0.007) and P8 (r=-0.318; P<0.001). New NPC variations, which were not reported before were found in 19% of our patients. Conclusion: NPC shows myriad potential variations that have various prevalences. It is assumed that familiarity with these variations may help decrease the incidence of complications during facial or dental surgery.
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We present a rare anatomical variation in which an additional incisive canal was observed during the routine dissection of the palatal region in a cadaver. The diameter of the incisive and additional incisive canals measured 4.59 mm and 0.91 mm, respectively. Even though this variation is rare, oral surgeons should be aware of such anatomical variations for a better understanding.
Article
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.
Article
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.
Article
Purpose: Cone-beam computed tomography (CBCT) is commonly requested before dental implant treatment for the anatomic assessment of the inferior alveolar canal (IAC) to prevent its neurovascular content from being traumatized. CBCT images can be saved in different types of resolutions and bit depths; these parameters may significantly affect the diagnostic accuracy of images. This study aimed to assess the effect of resolution and bit depth on IAC visualization on exported mandibular CBCT images. Materials and methods: Forty-one mandibular CBCT images of differing image resolutions and voxel sizes (0.16, 0.32, and 0.48 mm) and differing bit depths (12 and 15) were exported from a software program as a single file. Two observers evaluated the cross-sectional images in terms of IAC visibility using a 3-point scale (good, moderate, and poor). Disagreements were resolved by including a third observer, and the highest agreement was recorded. Results: Study interobserver agreement was acceptable (84.2%) for IAC observation. The percentage of IAC observation was from 84.1 to 100% with the 12- and 15-bit depths, with a constant image resolution of 0.16 and 0.32 mm, respectively. A significant difference (from 19.5 to 48.8%) was noted between the 2 bit depths in the percentage of good IAC visualization with a constant resolution of 0.48 mm. Reduction in the image resolution to 0.48 mm showed a significant difference (19.5 to 100%) between the 12- and 15-bit depths in good IAC visualization. Conclusions: Exporting the mandibular CBCT images with 0.32 mm of resolution and a 12-bit depth will produce good and moderate radiographic IAC observation with the benefit of a smaller file size.
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Implant rehabilitation of the edentulous anterior maxilla remains a complex restorative challenge. Intricate preexisting anatomy dictates meticulous and accurate osteotomy planning. With progressive bone loss, the alveolar crest may approach anatomic structures. The nasopalatine nerve and vessels may ultimately emerge from the ridge crest. The radiologic changes of the nasopalatine canal were evaluated in different resorption phases of the premaxilla alveolus with regard to dental implantation. The study consisted of 207 subjects who had maxillary computed tomography scans before dental implantation. The Lekholm and Zarb classification was used to divide images according to the residual bony ridge: Class A (control group) and classes B to E (study group). Anatomic mapping of the nasopalatine canal structure was carried out in both groups. The canal diameter was wider along the degree of ridge resorption from classes A to E in all dimensions, mainly in the palatal opening (P <0.01), middle area (P <0.001), and nasal area. The mean diameter of the enlargement was 1.8 mm, which reached 5.5 +/- 1.08 mm (P <0.01) in type E bone. In the severely resorbed ridges (classes C through E), when the palatal opening was situated on the ridge, it occupied a mean of 35.6% (13% to 58%) of the area devoted to implant placement. Tooth loss was the main reason for ridge resorption (P <0.01). Canal diameter enlargement was greater anteriorly to the ridge and posteriorly to the palatal bone, mainly because of tooth extraction. The atrophy of disuse may influence surrounding structures, similar to the maxillary sinus tendency to expand into surrounding bone mainly after tooth loss.
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To validate measurement accuracy in proximity to the incisive canal from two-dimensional (2D) reformatted spiral computed tomography (CT). Eight cadaver heads were examined with spiral CT with 1 mm thick axial slices and 1 mm.s-1 table feed. The data was transferred to a networked computer workstation to generate 2D orthoradially reformatted images. The length of the incisive canal and width of the alveolar crest were measured independently by two oral and maxillofacial radiologists. The soft tissues in the region of the incisive foramen were removed and physical measurements made using an electromagnetic digitizer. There was no statistically significant difference between measurements on orthoradial 2DCT images and physical measurements (P > 0.05). Accurate measurements for dental implant placement in proximity to the incisive canal can be made from reformatted spiral CT images.
Article
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The aim of this study was to evaluate the accuracy of linear measurements obtained with dental cone beam CT (CBCT) and multislice CT (MSCT) by altering radiation doses using pre-operative planning of the placement of oral implants as a model. A human cadaver mandible was examined in two edentulous areas and one dentate area using CBCT and MSCT. The mandible was examined both dry and immersed in sucrose solution isointense with soft tissue. Two readers measured four linear distances twice from each section. The mandible was cut into 4 mm thick slices at three marked places. These slices were microradiographed and used as the gold standard for measurements from each section. The intraclass correlations between the intra- and interobserver readings obtained with the different methods showed almost perfect matches. The measurement error (ME) showed significant differences between the methods studied (P = 0.022): the mean ME was 4.7% for CBCT and 8.8% for MSCT of the dry mandible, 2.3% and 6.6%, respectively, for the mandible immersed in sucrose solution and 5.4% for low-dose MSCT. Lowering the MSCT radiation dose to less than a quarter of its conventional original value did not significantly affect the ME. CBCT is a reliable tool for implant-planning measurements when compared with MSCT. In this study, a considerable radiation dose reduction could be achieved with low-dose MSCT examinations without a major loss of measurement accuracy.
Article
Bone resorption of residual ridges is common. The rate of resorption varies among different individuals and within the same individual at different times. Factors related to the rate of resorption are divided into anatomic, metabolic, functional, and prosthetic factors.Anatomic factors include the size, shape, and density of ridges, the thickness and character of the mucosal covering, the ridge relationships, and the number and depth of sockets.Metabolic factors include all of the multiple nutritional, hormonal, and other metabolic factors which influence the relative cellular activity of the bone-forming cells (osteoblasts) and the bone-resorbing cells (osteoclasts). Age, sex, and general health are inadequate to describe the bone factor but do give some clinical clues.Functional factors include the frequency, intensity, duration, and direction of forces applied to bone which are translated into cellular activity, resulting in either bone formation or bone resorption, depending on the patient's individual resistance to these forces.Prosthetic factors include the myriad of techniques, materials, concepts, principles, and practices which are incorporated into the prostheses.Although the various factors can be divided into these four groups for academic purposes, they are all interrelated, and any one factor may be evaluated only if we place it in its proper perspective to all factors.Since bone resorption depends on the response of living cells to force, the more basic sciences concerned with the physiology and pathology of cells are understood, the more educated will be our clinical judgment.
Article
The aim of this study was to present an alternative treatment concept for the rehabilitation of the atrophic maxilla that used the nasopalatine canal as an anatomic buttress for dental implant insertion and to assess patient satisfaction with this treatment. The inclusion criterion for the study consisted of the presence of severe resorption of the edentulous maxilla (Class V according to the Cawood and Howell classification). In each patient, one implant was positioned in the nasopalatine canal. Additional implants were also placed in the remaining maxillary bone. The patients were followed for a minimum of 2 years after prosthesis connection. Satisfaction with the prosthesis was evaluated after 12 months using a visual analog scale. Seven patients with severely resorbed edentulous maxillae received a total of seven implants in the nasopalatine buttress and 29 implants posterior to this structure. One of the seven implants in the nasopalatine canal was lost during the osseointegration phase. All patients had stable prostheses at the end of the observation period. Patients were satisfied with comfort and stability, ability to speak, ease of cleaning, and esthetics and function of the prosthesis. Five patients experienced minor sensory alterations during the first weeks after surgery. At the final examination, which took place after a mean of 5 years (range, 3 to 7 years), all patients expressed the presence of normal sensation. It appears that implants in the nasopalatine canal may be a viable treatment approach for the rehabilitation of the severely atrophied maxilla. Patients were satisfied with a prosthesis supported by implants in the nasopalatine canal.
Article
The purpose of this study was to investigate the general structure of the incisive canal (IC) using 3-dimensional reconstruction and to classify into various types according to several criteria. The materials used in the study were 56 anterior maxillae harvested from human cadavers. The specimens were scanned with microscopic computerized tomography (microCT), and the resulting microCT images were reconstructed in 3 dimensions. Many ICs had 1 foramen inferiorly and 2 foramina superiorly, and the separating level was just beneath the nasal floor. The middle part of the IC was not always a single hollow canal. Single-channel, 2-channel, 3-channel, and even 4-channel ICs were observed. The ICs were classified into 4 types according to the lateral shape of the canal: vertical-straight, vertical-curved, slanted-straight, and slanted-curved. This study disclosed the detailed morphologic features of the IC, which will be helpful in the placement of local anesthesia or implants.
Article
A classification of the edentulous jaws has been developed based on a randomised cross-sectional study from a sample of 300 dried skulls. It was noted that whilst the shape of the basalar process of the mandible and maxilla remains relatively stable, changes in shape of the alveolar process is highly significant in both the vertical and horizontal axes. In general, the changes of shape of the alveolar process follows a predictable pattern. Such a classification serves to simplify description of the residual ridge and thereby assist communication between clinicians; aid selection of the appropriate surgical prosthodontic technique; offer an objective baseline from which to evaluate and compare different treatment methods; and help in deciding on interceptive techniques to preserve the alveolar process. An awareness of the pattern of resorption that takes place in various parts of the edentulous jaws, enables clinicians to anticipate and avert future problems.
Article
Tomography is often needed prior to implant surgery to evaluate jaw bone dimensions. Computed tomography (CT) is advocated as an alternative. The purpose of this study was to measure the absorbed doses to radiosensitive organ in the head and neck region when CT is used. Measurements were made with extruded LiF thermoluminescent dosemeters within and on an anthropomorphic phantom examined with a Philips Tomoscan LX CT scanner. Axial scanning was performed for the maxilla and both frontal, perpendicular to the alveolus, and axial for the mandible. The highest absorbed doses were at the skin surface, 38 mGy with maxillary scans, and from axial and frontal scans of the mandible 35 mGy and 37 Gy, respectively. The parotid dose was 31 mGy from maxillary scans and in the mandible the submandibular gland dose was 27 mGy with axial scanning and 16 mGy with frontal. The eye lens received its highest dose (5.5 mGy) from frontal scans of the mandible. Although outside the scanning plane the pituitary and the thyroid glands received comparatively high absorbed doses of 0.6-4.0 mGy. All organ doses measured were considerably higher than those reported for conventional tomography.
Article
Computerized tomography (CT) scanning, now widely used for the diagnosis and treatment planning of dental implant sites, can be more specifically useful with integrated computer software. In this instance, the potentially critical incisive foramen area at the premaxilla is analyzed to better under stand its configuration and volume relative to the placement of root-form implants.
Article
During a prospective study after separation of the nasopalatine nerve at the foramen incisivum during exposure or removal of impacted and palatal displaced maxillary canines, 59 patients were examined neurologically for 4 weeks postoperatively over an investigation period of 18 months. During the first week after the operation, subjective as well as objective sensory disorders were found in all of the patients, but after 4 weeks at the most no neurological deficit could be detected in any patient.
Article
To describe a compact computed tomographic apparatus (Ortho-CT) for use in dental practice. Ortho-CT is a cone-beam-type of CT apparatus consisting of a multifunctional maxillofacial imaging machine (Scanora, Soredex, Helsinki, Finland) in which the film is replaced with an X-ray imaging intensifier (Hamamatsu Photonics, Hamamatsu, Japan). The region of image reconstruction is a cylinder 32 mm in height and 38 mm in diameter and the voxel is a 0.136-mm cube. Scanning is at 85 kV and 10 mA with a 1 mm Cu filter. The scan time is 17 s comparable with that required for rotational panoramic radiography. A single scan collects 512 sets of projection data through 360 degrees and the image is reconstructed by a personal computer. The time required for image reconstruction is about 10 min. The resolution limit was about 2.0 lp mm-1 and the skin entrance dose 0.62 mGy. Excellent image quality was obtained with a tissue-equivalent skull phantom: roots, periodontal ligament space, lamina dura, and cancellous bone were clearly visualized. Ortho-CT provides three-dimensional images of excellent quality for dental use at a low entrance dose.
Article
Bone resorption of residual ridges is common. The rate of resorption varies among different individuals and within the same individual at different times. Factors related to the rate of resorption are divided into anatomic, metabolic, functional, and prosthetic factors. Anatomic factors include the size, shape, and density of ridges, the thickness and character of the mucosal covering, the ridge relationships, and the number and depth of sockets. Metabolic factors include all of the multiple nutritional, hormonal, and other metabolic factors which influence the relative cellular activity of the bone-forming cells (osteoblasts) and the bone-resorbing cells (osteoclasts). Age, sex, and general health are inadequate to describe the bone factor but do give some clinical clues. Functional factors include the frequency, intensity, duration, and direction of forces applied to bone which are translated into cellular activity, resulting in either bone formation or bone resorption, depending on the patient's individual resistance to these forces. Prosthetic factors include the myriad of techniques, materials, concepts, principles, and practices which are incorporated into the prostheses. Although the various factors can be divided into these four groups for academic purposes, they are all interrelated, and any one factor may be evaluated only if we place it in its proper perspective to all factors. Since bone resorption depends on the response of living cells to force, the more basic sciences concerned with the physiology and pathology of cells are understood, the more educated will be our clinical judgment.
Article
To compare the radiation doses from imaging protocols for dental implant planning either using conventional radiography only (dental panoramic radiography (DPR), cephalometry and linear cross-sectional tomography) or involving computed tomography (CT). Organ absorbed doses were measured using a female Rando anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters (TLD). Standard mandibular protocols for dental implant planning were followed using either a conventional dental radiographic unit (PM 2002 CC Planmeca, Helsinki, Finland) or CT scanner (Excel Twin Elscint, Haifa, Israel). Organ absorbed and effective doses were calculated. Effective dose was calculated using two approaches, one based on the ICRP method which excludes the salivary tissue from the remainder organs (designated E(exc)), and the other with its inclusion (E(inc)). The greatest individual organ doses for any examination were measured in the salivary tissue. E(exc) for panoramic, cephalometric and cross-sectional tomography using DPR was 0.004 mSv, 0.002 mSv and 0.002 mSv, respectively, whereas with CT it was 0.314 mSv. The value of E(inc) calculated using these data was between two and five times E(exc). E(inc) greatly increases the apparent radiation burden, especially with high dose procedures. CT techniques can provide excellent images, but at the cost of increased radiation detriment. DPR with a cross-sectional tomography facility may give adequate clinical information at a greatly reduced dose.
Article
Preoperative radiographic imaging of recipient sites for implant placement is imperative to obtain a functional and aesthetic implant-supported prosthesis. Although conventional radiographic techniques have inherent problems that restrict accurate imaging, the main drawback of panoramic and periapical radiography is the two-dimensional image. Computerized tomography provides cross-sectional radiographic images that facilitate proper assessment of potential recipient sites for implant placement. This paper reviews the role of computerized tomography in implant dentistry.
Article
We sought to compare a new limited cone beam computed tomography (CT) machine for dental use (3DX) with the multidetector CT machine for image quality and skin doses. Images of the right maxillary central incisor and the left mandibular first molar of an anthropomorphic phantom were taken by both the 3DX and the multidetector CT. A 5-point method was used to evaluate the depiction of cortical and cancellous bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura, and overall impressions. Furthermore, the skin doses for both modalities were compared. The image quality of the 3DX was better than the multidetector CT for all items (P < .01). Moreover, the mean skin doses with the multidetector CT were 458 mSv per examination, whereas the doses with the 3DX were 1.19 mSv per examination. These results clearly indicate the superiority of the 3DX in the display of hard tissues in the dental area while substantially decreasing the dose to the patient.
Article
Accurate assessment of the location of the maxillary sinuses, incisive canal, and nasal cavity, as well as the height, width, and angulation of bone is essential for implant treatment planning. The purpose of this study was to introduce the clinical application of a cone-beam computerized tomography system (Ortho-CT) to assess multiple two-dimensional (2D) images for the preoperative treatment planning of maxillary implants. To evaluate the multiple 2D images scanned using the Ortho-CT system the maxillary region placed with radiopaque template in the maxilla. Ortho-CT images provided useful information for evaluating the morphology of the maxilla, for locating the incisive canal, maxillary sinuses, nasal cavity, and for showing the relationship of the template to the bone. It is concluded that the Ortho-CT system is a useful aid for diagnosis and treatment planning for maxillary implant treatment.
Article
The aim of this study was to demonstrate the clinical applicability of limited cone beam computed tomography (Dental 3D-CT) for assessment of bone-grafted alveolar cleft. Seventeen bone bridges were examined after alveolar bone grafting in 13 patients with cleft lip and palate. All bone bridges, including cleft-adjacent teeth, were examined by plain radiography and the Dental 3D-CT imaging system. The plain radiographs showed the approximate condition of the bone bridge and cleft-adjacent teeth. The Dental 3D-CT images clearly showed precise three-dimensional (3D) morphology of the bone bridge, 3D relationships between the bone bridge and the roots of cleft-adjacent teeth, and their periodontal condition. In addition, the conditions surrounding dental implants installed in the bone bridge could be observed three-dimensionally. The results indicate that the Dental 3D-CT imaging system is suitable for clinical assessment of alveolar bone grafting before and after installation of dental implants or orthodontic treatment of the cleft-adjacent teeth.
Article
Orofacial diagnostic imaging has grown dramatically in recent years. As the use of endosseous implants has revolutionized oral rehabilitation, a specialized technique has become available for the preoperative planning of oral implant placement: cone beam computed tomography (CT). This imaging technology provides 3D and cross-sectional views of the jaws. It is obvious that this hardware is not in the same class as CT machines in cost, size, weight, complexity, and radiation dose. It is thus considered to be the examination of choice when making a risk-benefit assessment. The present review deals with imaging modalities available for preoperative planning purposes with a specific focus on the use of the cone beam CT and software for planning of oral implant surgery. It is apparent that cone beam CT is the medium of the future, thus, many changes will be performed to improve these. Any adaptation of the future systems should go hand in hand with a further dose optimalization.
Article
This study compares 2 measures of effective dose, E(1990) and E(2007), for 8 dentoalveolar and maxillofacial cone-beam computerized tomography (CBCT) units and a 64-slice multidetector CT (MDCT) unit. Average tissue-absorbed dose, equivalent dose, and effective dose were calculated using thermoluminescent dosimeter chips in a radiation analog dosimetry phantom. Effective doses were derived using 1990 and the superseding 2007 International Commission on Radiological Protection (ICRP) recommendations. Large-field of view (FOV) CBCT E(2007) ranged from 68 to 1,073 microSv. Medium-FOV CBCT E(2007) ranged from 69 to 560 microSv, whereas a similar-FOV MDCT produced 860 microSv. The E(2007) calculations were 23% to 224% greater than E(1990). The 2007 recommendations of the ICRP, which include salivary glands, extrathoracic region, and oral mucosa in the calculation of effective dose, result in an upward reassessment of fatal cancer risk from oral and maxillofacial radiographic examinations. Dental CBCT can be recommended as a dose-sparing technique in comparison with alternative medical CT scans for common oral and maxillofacial radiographic imaging tasks.
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