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Aktuna Belgin C, Serindere G, Hammudioglu ZE, Kucuk M. Evaluation of canalis sinuosus and accessory canal morphology by cone-beam computed tomography. Oral Radiol 2024; 40:530-537. [PMID: 39060842 DOI: 10.1007/s11282-024-00767-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE To evaluate canalis sinuosus (CS) and accessory canalis sinuosus (AC) morphology and their relationship with the impacted canine on cone-beam computed tomography (CBCT) images. METHODS The diameter and location of the CS, its distance from the nasal cavity (NC-CS), its distance from the buccal cortical plate (BC-CS), and its distance from the alveolar ridge crest (AR-CS) were evaluated on 1000 CBCT scans. The prevalence and termination of AC and the presence of impacted canines were also evaluated. RESULTS CS was detected in 89 (8.9%) of 1000 CBCTs. The mean CS diameter was found as 1.34 ± 0.53 mm. No statistically significant difference was found between gender, age, direction, and CS presence and diameter. CS was most frequently seen in regions 11 (23.6%) and 13 (23.6%). The average NC-CS, BC-CS, and AR-CS length was 6.14, 6.06 and 4.35 mm, respectively. AC was detected in 22 patients (24.71%). There was no statistically significant difference between the presence of AC and gender, age, CS diameter, NC-CS, BC-CS, and AR-CS distance. BC-CS length and AR-CS length were statistically significantly higher in patients with impacted canines. CONCLUSIONS It should be kept in mind that the CS diameter, NC-CS, BC-CS, and AR-CS distance may increase in the presence of an impacted canine and the integrity of the neurovascular structure should be preserved. The fact that the CS is often localized in the palatial region requires a detailed evaluation of the anterior maxillary region with three-dimensional imaging methods.
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Affiliation(s)
- Ceren Aktuna Belgin
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Hatay Mustafa Kemal University, 31060, Hatay, Türkiye.
| | | | - Zarif Ece Hammudioglu
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Hatay Mustafa Kemal University, Hatay, Türkiye
| | - Merve Kucuk
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Hatay Mustafa Kemal University, Hatay, Türkiye
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Bissoon A, Bandoo C, Naraynsingh C, Mohamed S. Canalis Sinuosus Mimicking Periapical Pathology on, Radiographic Assessment. J Endod 2024; 50:1159-1162. [PMID: 38692350 DOI: 10.1016/j.joen.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
The canalis sinuosus is an anatomical variation whereby the infraorbital canal sometimes generates a small, lateral branch (canal) close to its midpoint, to allow the passage of the anterior superior alveolar neurovascular bundle in the anterior maxilla. This article focuses on an incidental finding of this variant, in a 74-year-old Trinidadian female of Afro-Caribbean descent with an endodontic presenting complaint. The canalis sinuosus shadow on conventional radiography resulted in uncertainty as to the offending tooth until a 3-dimensional scan was undertaken in this region. This report will discuss the implications of the presence of this canal from radiologic, endodontic, and surgical perspectives.
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Affiliation(s)
- Arlana Bissoon
- Unit of Oral Diseases, School of Dentistry, The University of the West Indies, Trinidad.
| | - Charissa Bandoo
- Unit of Restorative Dentistry, School of Dentistry, The University of the West Indies, Trinidad
| | - Candy Naraynsingh
- Unit of Oral Diseases, School of Dentistry, The University of the West Indies, Trinidad
| | - Shaleema Mohamed
- Unit of Oral Diseases, School of Dentistry, The University of the West Indies, Trinidad
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Sun Z, Lou Y, Liu Z, Wang B, Yu M, Wang H. Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024:1-8. [PMID: 38763767 DOI: 10.3724/zdxbyxb-2023-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth, their corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, implantologists need to investigate strategies for preventing and treating canalis sinuosus injuries. Preoperatively, implantologists should use CBCT to identify the canalis sinuosus and virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, implantologists should assess bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT can be employed to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and its physiological functions in the anterior maxilla, and discusses strategies for effectively avoiding canalis sinuosus injuries during implant surgery, thereby enhancing implantologists' awareness and providing references for clinical decision-making.
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Affiliation(s)
- Zheyuan Sun
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China.
| | - Yiting Lou
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Zhichao Liu
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Baixiang Wang
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Mengfei Yu
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Huiming Wang
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China.
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Sun Z, Li D, Zhang X, Zhang J, Li H, He C. Cone-beam computed tomography of accessory canals of the canalis sinuosus and analysis of the related risk factors. Surg Radiol Anat 2024; 46:635-643. [PMID: 38517513 DOI: 10.1007/s00276-024-03339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/01/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Cone-beam computed tomography (CBCT) was used in this study for evaluating the diameter, prevalence, spatial location, and risk factors of the accessory canal (AC) of the canalis sinuosus. METHODS A comprehensive assessment of the incidence rate, diameter, three-dimensional (3D) spatial location, and direction of travel of AC was performed on 1003 CBCT images. The CBCT data were used to reconstruct a 3D model of the maxilla to determine the alveolar bone volume. The obtained data were further analyzed and processed. RESULTS AC was present in 50.1% of images. Male patients more frequently had ACs than female patients did (P < 0.01) and was positively correlated with the maxillary alveolar bone volume (P < 0.001, OR 1.532). Age or nasopalatine canal diameter were not significantly associated with the occurrence of AC (P > 0.05). Among the 502 patients with AC, AC was present on the left side, right side, and bilaterally in 189, 98, and 215, respectively. The maximum number of ACs observed per individual was eight. The average AC diameter was 0.89 ± 0.26 mm (minimum, 0.5 mm; maximum, 2.02 mm). CONCLUSIONS As the prevalence of AC and its trajectory display considerable variation among individuals, surgeons must consider the possibility of the presence of AC when devising surgical plans involving the anterior maxillary region.
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Affiliation(s)
- Zhenwei Sun
- Department of Prosthodontics, Affiliated Dental Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Dan Li
- Department of Prosthodontics, Affiliated Dental Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xuan Zhang
- Department of Prosthodontics, Affiliated Dental Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Jiaxin Zhang
- Department of Prosthodontics, Affiliated Dental Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Haoran Li
- Department of Prosthodontics, Affiliated Dental Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Chunyan He
- Department of Prosthodontics, Affiliated Dental Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China.
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Samunahmetoglu E, Kurt MH. Assessment of Canalis Sinuosus located in maxillary anterior region by using cone beam computed tomography: a retrospective study. BMC Med Imaging 2023; 23:46. [PMID: 36978007 PMCID: PMC10045502 DOI: 10.1186/s12880-023-01000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Background The aim of the study is to determine the distribution, location, diameter, and distance measurements of Canalis Sinusosus (CS) in relation with age and sex. Methods 300 Cone-Beam Computed Tomography (CBCT) images were evaluated. The distance between CS and nasal cavity floor (NCF), buccal cortical bone margin (BCM), alveolar ridge (AR), respectively.The presence of CS smaller than 1 mm, and the diameter of CS larger than 1 mm were determined. Accessory canals (AC) were classified according to their position relative to the teeth. Results 435 CS with a diameter of at least 1 mm and 142 CS < 1 mm were identified. The most frequently observed location of CS was the region of the right central incisors. The mean diameter of the canals ( CS ≥ 1) was 1.31 ± 0.19 on the right side and 1.29 ± 0.17 on the left side. No gender differences were found in canal diameter were observed (p > 0.05). There was no significant difference between men and women in the distance between CS and the NCF on the right side, and a significant difference was found in the distance of CS-NCF on the left side (p = 0.047). There were no significant differences between age groups in all parameters. Conclusion CBCT is a useful tool for identifying CS. Location and diameter of ACs could not be associated with a specific age group or sex.
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Affiliation(s)
- Ercin Samunahmetoglu
- grid.7256.60000000109409118Ankara University Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
| | - Mehmet Hakan Kurt
- grid.7256.60000000109409118Ankara University Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
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la Encina ACD, Martínez-Rodríguez N, Ortega-Aranegui R, Cortes-Bretón Brinkmann J, Martínez-González JM, Barona-Dorado C. Anatomical variations and accessory structures in the maxilla in relation to implantological procedures: an observational retrospective study of 212 cases using cone-bean computed tomography. Int J Implant Dent 2022; 8:59. [PMID: 36441355 PMCID: PMC9705638 DOI: 10.1186/s40729-022-00459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study used cone-beam computed tomography (CBCT) to analyze the prevalence of several maxillary anatomical/accessory structures, as well as variations within each type, assessing how accurate diagnosis can minimize the risk of intraoperative complications during implantological procedures in the oral cavity. METHODS 212 CBCT scans of the maxilla were analyzed, captured over a period of 18 months for surgical planning purposes. The prevalence of posterior superior alveolar arteries (PSAA), maxillary sinus septa (MSS), and branches of the canalis sinuosus (CS) were evaluated, as were the diameter and location of each anatomical structure in horizontal and vertical planes. P < 0.05 was considered statistically significant. RESULTS PSAAs were observed in 99.1% of cases, the intrasinus type being the most frequent; MSS were noted in 15.6% of the sample, mainly in the posterior region with sagittal orientation; CS branches were observed in 50% of patients, mainly in relation to the incisors and significantly more prevalent among males. CONCLUSIONS The use of CBCT significantly increases the possibility of clearly identifying these anatomical structures. The differences found between patients highlight the importance of carrying out an exhaustive radiological study of the individual to prevent complications, such as Schneiderian membrane perforation, neurovascular damage or bleeding during surgery.
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Affiliation(s)
- Augusto Cimolai-de la Encina
- grid.4795.f0000 0001 2157 7667Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Natalia Martínez-Rodríguez
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, Faculty of Dentistry, Universidad Complutense de Madrid, Pza Ramon y Cajal S/N, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Surgical and Implant Therapies in the Oral Cavity Research Group; University Complutense, Madrid, Spain
| | - Ricardo Ortega-Aranegui
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, Faculty of Dentistry, Universidad Complutense de Madrid, Pza Ramon y Cajal S/N, 28040 Madrid, Spain
| | - Jorge Cortes-Bretón Brinkmann
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, Faculty of Dentistry, Universidad Complutense de Madrid, Pza Ramon y Cajal S/N, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Surgical and Implant Therapies in the Oral Cavity Research Group; University Complutense, Madrid, Spain
| | - José María Martínez-González
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, Faculty of Dentistry, Universidad Complutense de Madrid, Pza Ramon y Cajal S/N, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Surgical and Implant Therapies in the Oral Cavity Research Group; University Complutense, Madrid, Spain
| | - Cristina Barona-Dorado
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, Faculty of Dentistry, Universidad Complutense de Madrid, Pza Ramon y Cajal S/N, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Surgical and Implant Therapies in the Oral Cavity Research Group; University Complutense, Madrid, Spain
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Lopes-Santos G, Salzedas LMP, Bernabé DG, Ikuta CRS, Miyahara GI, Tjioe KC. Assessment of the knowledge of canalis sinuosus amongst dentists and dental students: An online-based cross-sectional study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:488-498. [PMID: 34808014 DOI: 10.1111/eje.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Canalis sinuosus (CS) is a neurovascular canal that corresponds to a small branch of the infraorbital canal. This study aimed at assessing the knowledge and detection performance of CS amongst dentists and dental students. MATERIALS AND METHODS Four-hundred and five dentists and dental students answered a questionnaire with three parts: 1. Socio-demographical; 2. Clinical cases with cone- beam computed tomography (CBCT) sections showing CS and 3. Previous knowledge about CS. The chi-squared test and Spearman's correlation test were used to compare results as appropriate. p-values below .05 were considered statistically significant. RESULTS Most participants did not identify CS in any CBCT. There was an association between the number of correct answers and dental specialties. Most individuals had not learned about CS previously. There was an association between past knowledge of CS and gender, highest academic degree, working environment, dental specialty and number of correct answers but not with age or experience in Dentistry. CONCLUSION This study suggests that most dentists are not aware about CS and do not know how to diagnose it. Previous knowledge about CS positively influenced its identification in CBCT.
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Affiliation(s)
- Gabriela Lopes-Santos
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | | | - Daniel Galera Bernabé
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
- Department Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Carla Renata Sanomiya Ikuta
- Department Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Glauco Issamu Miyahara
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
- Department Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Kellen Cristine Tjioe
- Department Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
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Beyzade Z, Yılmaz HG, Ünsal G, Çaygür-Yoran A. Prevalence, Radiographic Features and Clinical Relevancy of Accessory Canals of the Canalis Sinuosus in Cypriot Population: A Retrospective Cone-Beam Computed Tomography (CBCT) Study. Medicina (B Aires) 2022; 58:medicina58070930. [PMID: 35888649 PMCID: PMC9316269 DOI: 10.3390/medicina58070930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives: This retrospective study aims to evaluate the prevalence, radiographic features, and clinical relevancy of the accessory canals (AC) of the canalis sinuosus (CS) in patients referred for implant surgery. Materials and Methods: Cone-beam computed tomography (CBCT) images of the patients were collected and ACs were evaluated. Age, sex, bilateral distribution, localization, diameter, distance to the buccal cortical plate, distance to the crest of the alveolar ridge, terminal ending localization, and the presence of tooth or implant were recorded. Ninety-one patients who were eligible for this study were enrolled. Results: A total of 188 ACs were found in 91 patients with 86 bilateral and 5 unilateral distributions. The mean age of the patients was 45.39. All ACs had a terminal ending at the palatal cortical border. All parameters showed a non-normal distribution; thus, the Mann–Whitney U test was preferred. Bilateral AC distribution (p = 0.761), AC distance to the crest of the alveolar ridge (p = 0.614), AC distance to the buccal cortical plate (p = 0.105), and AC diameter (p = 0.423) showed no significant difference between females and males. According to our study, a CS might be an anatomical structure rather than an anatomical variation, as all patients had at least one AC of the CS. It can be inferred that the detection of ACs will be achievable once clinicians are aware of these structures with continuous regular anatomy reworks and with small voxel-sized CBCT devices. Conclusion: This study was conducted to find the features and prevalence of the CS, and it was found that the CS is an anatomical structure rather than an anatomical variation. This argument is in line with the information on the CS in Gray’s Anatomy, 42nd Edition. Impaired healings and complications of the CS can be avoided if clinicians follow the American Academy of Oral and Maxillofacial Radiology guidelines regarding pre-operative implant examination. Otherwise, avertible complications may cause significant impairments in quality of life.
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Affiliation(s)
- Zafer Beyzade
- Department of Periodontology, Faculty of Dentistry, Near East University, Mersin 99138, Turkey; (H.G.Y.); (A.Ç.-Y.)
- Correspondence:
| | - Hasan Güney Yılmaz
- Department of Periodontology, Faculty of Dentistry, Near East University, Mersin 99138, Turkey; (H.G.Y.); (A.Ç.-Y.)
| | - Gürkan Ünsal
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Mersin 99138, Turkey;
| | - Ayşe Çaygür-Yoran
- Department of Periodontology, Faculty of Dentistry, Near East University, Mersin 99138, Turkey; (H.G.Y.); (A.Ç.-Y.)
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Prevalence of canalis sinuosus and accessory canals of canalis sinuosus on cone beam computed tomography: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2022; 52:118-131. [PMID: 35840447 DOI: 10.1016/j.ijom.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022]
Abstract
The aim of this systematic review was to determine the prevalence of the canalis sinuosus (CS) and accessory canals of the canalis sinuosus (ACCS) as identified on cone beam computed tomography (CBCT). Online searches were conducted in the MEDLINE (via PubMed), Scopus, LILACS, Cochrane CENTRAL, Web of Science, and SIGLE (via OpenGrey) databases. Primary studies that determined the prevalence of canalis sinuosus and/or its anatomical variations using CBCT were included. The risk of bias assessment was performed using the AQUA tool. The quality effects model using double arcsine transformation was used for the meta-analysis of prevalence. Heterogeneity, publication bias, and sensitivity analyses were performed. Of 3237 initial results, 17 papers were included for systematic review. The meta-analysis comprising 1994 patients showed a pooled prevalence of CS of 0.80 (95% confidence interval (CI) 0.51-0.99; P = 0.001; I2 = 99%). Publication bias analysis revealed minor asymmetry (LFK index 1.84). The meta-analysis of 4605 patients showed a pooled prevalence of ACCS of 0.54 (95% CI 0.38-0.69; P = 0.001; I2 = 99%). The sensitivity analysis showed a pooled prevalence of ACCS of 0.53 (95% CI 0.32-0.74; P = 0.001; I2 = 99%) for studies with ≥ 1000 patients and 0.55 (95% CI 0.33-0.76; P = 0.001; I2 = 98%) for studies with< 1000 patients. Canalis sinuosus showed a pooled prevalence of 0.80 and ACCS showed a pooled prevalence of 0.54; hence both should be considered as anatomical structures, which means that they are present in most people. Surgeons must be aware of the CS and ACCS on CBCT analysis during pre-surgical planning. PROSPERO REGISTRATION NUMBER: CRD42020154195.
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Yeap CW, Danh D, Chan J, Parashos P. Examination of Canalis Sinuosus using Cone Beam Computed Tomography in an Australian Population. Aust Dent J 2022; 67:249-261. [PMID: 35285958 DOI: 10.1111/adj.12910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Canalis sinuosus (CS) and its relationship with adjacent teeth is relevant for surgery in the anterior maxilla. Therefore, the aim of this study was to report the prevalence, characteristics, and variations of CS. METHODS Cone beam computed tomography (CBCT) scans of the anterior maxilla of 201 patients were reviewed. CS and the adjacent teeth were analysed by age, sex, and scan resolution, using analysis of variance, chi-squared and Fisher's exact tests. The widest and narrowest diameters of CS, and distance to tooth apex (DTA), were compared by quadrant, closest tooth, and location, and the associations were examined statistically with P < 0.05. RESULTS In the 201 scans, 412 CS were identified in 198 patients associated with 395 different teeth. Mean widest diameter was 1.08 ± 0.39 mm (range: 0.42-2.60 mm), while the narrowest diameter was 0.71 ± 0.26 mm (range: 0.25-1.59 mm), and mean DTA of 2.16 ±1.25 mm (range: 0-6.22 mm). CS detection was significantly lower with CBCT taken at resolution size of 0.250 voxels (P = 0.02). CONCLUSIONS CS was very common in the anterior maxilla. Clinicians would be well advised to identify this anatomical structure using CBCT before undertaking any surgery in the anterior maxilla. © 2022 Australian Dental Association.
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Affiliation(s)
- Chee Wei Yeap
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Dara Danh
- Clayray Dental Radiology, 24 Collins St, Melbourne Victoria, Australia; and Melbourne Dental X-ray, 723 Swanston St, Carlton, Victoria, Australia
| | - Julius Chan
- Clayray Dental Radiology, 24 Collins St, Melbourne Victoria, Australia; and Melbourne Dental X-ray, 723 Swanston St, Carlton, Victoria, Australia
| | - Peter Parashos
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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Morphological and Morphometric Characteristics of Anterior Maxilla Accessory Canals and Relationship with Nasopalatine Canal Type-A CBCT Study. Diagnostics (Basel) 2021; 11:diagnostics11081510. [PMID: 34441443 PMCID: PMC8394472 DOI: 10.3390/diagnostics11081510] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate principal morphological and morphometric characteristics of accessory canals (ACs) of the anterior maxilla, as well as to analyze the relationship with nasopalatine canal (NPC) type. The results of our study showed that ACs were observed in almost 50% of participants. They were mostly presented bilaterally and in a curved shape, with a palatal foramen position. The morphometric characteristics of ACs were significantly influenced by NPC type. NPC type had the strongest impact on the distance between the NPC and AC, as well as on the distance between the AC and the facial aspect of buccal bone wall, in inferior parts of the alveolar ridge. On the other hand, the distance between the AC and central incisors was not significantly influenced by NPC shape in the lower region of the anterior maxilla. However, the participants with the banana-type of the NPC expressed the reduction in distance from the AC to the central incisor at the upper part in comparison with the subjects with the cylindrical-type of the NPC. On the basis of the results of this study, the simultaneous estimation of ACs and the NPC seems reasonable, as this approach may be useful in the prevention of complications which could occur during implant surgery interventions.
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Evaluation of Location of Canalis Sinuosus in the Maxilla Using Cone Beam Computed Tomography. BALKAN JOURNAL OF DENTAL MEDICINE 2021. [DOI: 10.2478/bjdm-2020-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Summary
Background/Aim: The aim of this study is to evaluate the prevalence of a canalis sinuosus (CS) in the anterior maxilla.
Material and Methods: CBCT images of 673 patients (322 females and 351 males) were examined retrospectively with regard to age, gender, location of CS and relation to impacted canines. The age of the patients ranged from 14 to 82 years; the mean age of the female patients was 43.54 years and that of the males was 45.75 years. IBM SPSS 22 for Windows was used for statistical analysis of the results. Statistical comparisons between two categorical variables were conducted using chi-square tests. Significance was set at (p< 0.05).
Results: It was observed that 8.17% of the patients in this study exhibited accessory canals (AC) of CS (n= 55). There was no significant difference in CS prevalence between ages, age groups, and location in our study (p> 0.5). There was significant difference in CS prevalence between the genders (p< 0.5).
Conclusions: It is important to take into consideration the presence of AC of the CS during surgical procedures in the anterior maxilla. It was also found that CBCT is more helpful than other techniques in detecting accessory canals in the region of interest.
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13
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Rosano G, Testori T, Clauser T, Del Fabbro M. Management of a neurological lesion involving Canalis Sinuosus: A case report. Clin Implant Dent Relat Res 2021; 23:149-155. [PMID: 33438293 DOI: 10.1111/cid.12977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
This case report describes the management of a lesion involving the Canalis Sinuosus (CS), that is a bone channel originating from the infraorbital canal below the orbital margin and posterior to the infraorbital foramen and coursing in an anterolateral direction to the anterior wall of the nasal cavity. A female patient, 62y, ASA 1, wearing full mobile dentures, came to our clinic asking for upper jaw rehabilitation. Due to a severe bone atrophy, a graft procedure was performed and the placement of eight implants was planned. One week after implants were positioned, the patient referred pain in the upper right central incisor region, that was compatible with a normal post-operative healing. After 15 days, since the symptoms worsened and became localized and persistent, a more detailed CBCT analysis was carried out. The images demonstrated that a CS on the right side was compressed by the apex of the implant in position #11. The implant was replaced with a shorter one and adequate pharmacological therapy was prescribed. All the symptoms completely disappeared after 30 days.
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Affiliation(s)
- Gabriele Rosano
- Senior Lecturer at Lake Como Institute Implant Advanced Training Center, Como, Italy.,Private Practitioner in Barzanò (Lecco), Barzanò, Italy
| | - Tiziano Testori
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Head of Section of Implantology and Oral Rehabilitation, Milan, Italy.,Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.,Private Practitioner, Como, Italy
| | - Tommaso Clauser
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Milan, Italy
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Shintaku WH, Ferreira CF, Venturin JDS. Invasion of the canalis sinuosus by dental implants: A report of 3 cases. Imaging Sci Dent 2020; 50:353-357. [PMID: 33409145 PMCID: PMC7758265 DOI: 10.5624/isd.2020.50.4.353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022] Open
Abstract
The canalis sinuosus (CS) and its accessory canals (ACs) are anatomical structures in the anterior maxilla. These structures are often neglected when planning implant surgery because their clinical significance is still not well-defined. After a retrospective evaluation of 194 patients rehabilitated with dental implants in the anterior maxilla, 3 patients were identified who presented unexpected chronic neurosensory disturbances without any clinical signs supportive of implant failure. Tomographic assessment using cone-beam computed tomography (CBCT) revealed the invasion of the CS and ACs by dental implants, which appeared to explain the patients' symptoms. The purpose of this report was to familiarize practicing dentists and specialists with the CS and its ACs. Unanticipated neurosensory symptoms after implant placement in the anterior maxilla justify the use of CBCT to rule out an injury to this neurovascular bundle.
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Affiliation(s)
- Werner Harumiti Shintaku
- Department of Diagnostic Sciences, University of Tennessee Health Sciences College of Dentistry, Memphis, TN, USA
| | - Cimara Fortes Ferreira
- Department of Periodontology, University of Tennessee Health Sciences College of Dentistry, Memphis, TN, USA
| | - Jaqueline de Souza Venturin
- Department of Diagnostic Sciences, University of Tennessee Health Sciences College of Dentistry, Memphis, TN, USA
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15
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Shan T, Qu Y, Huang X, Gu L. Cone beam computed tomography analysis of accessory canals of the canalis sinuosus: A prevalent but often overlooked anatomical variation in the anterior maxilla. J Prosthet Dent 2020; 126:560-568. [PMID: 33004226 DOI: 10.1016/j.prosdent.2020.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM Accessory canals of the canalis sinuosus, a bony canal carrying the anterior superior alveolar nerve and vessels, can often be present but overlooked in the anterior maxilla. Dental implant placement in this area may damage neurovascular branches if this anatomic variation is not carefully identified, resulting in unexpected complications. PURPOSE The purpose of this retrospective study was to identify accessory canals of the canalis sinuosus and analyze their relationship to the terminal canalis sinuosus and anterior maxilla in Chinese patients to provide a warning for surgeons operating in the anterior maxilla. MATERIAL AND METHODS Cone beam computed tomography (CBCT) scans of 1007 Chinese patients were examined to identify the prevalence and size of accessory canals with at least 1.0-mm diameter. Axial position of this canal was classified referring to the nasal cavity and adjacent teeth. Its sagittal position was determined by the distance from the bifurcation site of canalis sinuosus to the buccal alveolar crest and the distance from the canal opening to the palatal alveolar crest. Diameter of the terminal canalis sinuosus, distance from the terminal canalis sinuosus to the buccal alveolar crest, and anterior maxillary volume were measured on all scans. Binary logistic regression and the Spearman rank correlation coefficient were used for prevalence and diameter analysis. RESULTS The prevalence of the accessory canal was 36.9%, positively correlated the anterior maxillary volume (OR 1.408) and negatively correlated with the distance from the terminal canalis sinuosus to the buccal alveolar crest (OR 0.921). Average diameter of such canal was 1.1 ±0.1 mm, significantly higher in men, positively correlated with the diameter of terminal canalis sinuosus (rs=0.163) and the distance from the canal opening to the palatal alveolar crest (rs=0.192). All accessory canals started below the buccal cortical bone, 19.3 ±2.7 mm away from the buccal alveolar crest. There were 61.9% accessory canals opened between the central and the lateral incisors. Openings here and in the central incisor region were closer to the alveolar crest than that between the lateral incisor and the canine (P<.05). CONCLUSIONS Accessory canals of the canalis sinuosus have high prevalence in the anterior maxilla in a Chinese population. Large anterior maxillary volume has been demonstrated as a risk factor associated with the presence of such canals. The region between the central and the lateral incisors was a predominant location. Openings in this region were closer to the alveolar crest than those between the lateral incisor and the canine.
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Affiliation(s)
- Tiantian Shan
- Graduate student, Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Yang Qu
- Graduate student, Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Xiangya Huang
- Associate Professor, Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Lisha Gu
- Professor, Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China.
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Value of Performing Routine Vascular Mapping Synchronous with Radiographic Assessment of Endodontic Lesions: Case Series. J Endod 2020; 47:112-124. [PMID: 32941891 DOI: 10.1016/j.joen.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/20/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
With the adoption of limited-volume cone beam computed tomographic (CBCT) imaging in dentistry, high resolution of the maxillomandibular complex has led to the recognition of numerous accessory neurovascular canals. The preoperative identification of these structures is essential to facilitate the safe performance of an assortment of invasive dental procedures; however, there is limited information in the endodontic literature regarding mapping of these neurovascular canals and their anatomic variants. To emphasize the utility of accessory neurovascular channel mapping in conjunction with endodontic therapy, we have presented the clinical findings of 4 diverse cases. Comprehensive evaluation of the CBCT scans showed relevant underlying etiopathologies, prompting clinical modifications that led to enhanced patient outcomes.
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Lopes Dos Santos G, Ikuta CRS, Salzedas LMP, Miyahara GI, Tjioe KC. Canalis sinuosus: An Anatomic Repair that May Prevent Success of Dental Implants in Anterior Maxilla. J Prosthodont 2020; 29:751-755. [PMID: 32902120 DOI: 10.1111/jopr.13256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Canalis sinuosus (CS) is a neurovascular canal that corresponds to a small branch of the infraorbital canal. It contains the anterior superior alveolar nerve and vessels, supplying the anterior maxilla. Despite having been described 81 years ago, CS is not recognized by many dental practitioners and may be the cause of unintended injuries during dental procedures. The aims of this study are to report a case of a patient who suffered pain due to exposure of the CS, to provide a comprehensive review of other CS cases that were challenging to diagnose, and to propose guidelines for preoperative examination of patients undergoing surgical procedures in the anterior maxilla. The review of the literature revealed six cases, in addition to the one presented here, of unintended or potential damage to CS. Five out of seven cases were related to dental implant placement and resulted in postoperative pain and/or paresthesia. The dental implant was removed in 4 out of the 5 cases. This study reinforces the importance of awareness of CS by dental practitioners and provides a protocol for the preoperative examination of the patient to prevent avoidable injuries to CS.
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Affiliation(s)
| | - Carla Renata Sanomiya Ikuta
- Department Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, São Paulo, Brazil
| | | | - Glauco Issamu Miyahara
- Oral Oncology Center, São Paulo State University (Unesp), School of Dentistry, São Paulo, Brazil
| | - Kellen Cristine Tjioe
- Oral Oncology Center, São Paulo State University (Unesp), School of Dentistry, São Paulo, Brazil
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Tomrukçu DN, Köse TE. Assesment of accessory branches of canalis sinuosus on CBCT images. Med Oral Patol Oral Cir Bucal 2020; 25:e124-e130. [PMID: 31880280 PMCID: PMC6982980 DOI: 10.4317/medoral.23235] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/16/2019] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study is to describe the presence, to reveal the frequency and characteristics of accessory canals (ACs) of the canalis sinuosus (CS) by cone beam computed tomography (CBCT).
Material and Methods A total of 326 CBCT examinations were scanned retrospectively. The anatomical views were evaluated on sagittal, axial, coronal and cross sectional imaging. The following parameters were recorded: age, sex, presence or absence of ACs, location in relation to the adjacent teeth and distance to the nasal cavity floor (NCF), alveolar ridge crest (ARC) and buccal cortical bone (BCB), and incisive canal. All the collected data were statistically analyzed.
Results 113 patients (34,7%); presented ACs in total 214 foramina of the sample. There were no statistically significant changes in the presence of ACs regarding age groups excluding 80-89 years. But there is a statistically significant difference regarding the frequency of ACs and the gender. The prevalence for male patients was higher than female patients. Curved-shape configuration of CS prevalence is found as 69,15%. The prevalence of vertical tracing is 26,16% and Y-shape configuration of CS prevalence is 4,67%. Diameter of the foramens of the CS branches was 1.30 mm. The mean distance of the AC to the NCF, BCB, and ARC were found 13,83 mm, 6,60 mm and 5,32 mm, respectively.
Conclusions In the anterior palatal region, ACs are mostly related to CS’s branches. So; knowing the course of CS branches in surgical planning and radiographic evaluations in this region is extremely important for preventing complications and avoiding misdiagnosis. Key words:Anterior superior alveolar nerve, canalis sinuosus, maxilla.
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Affiliation(s)
- D-N Tomrukçu
- Faculty of Dentistry, Recep Tayyip Erdogan University Oral and Maxillofacial Radiology Department Fener Street., 53100 Rize Center/Rize, Turquía
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Kim JH, Shibata S, Abe H, Murakami G, Rodríguez-Vázquez JF. Topographical variations of the incisive canal and nasopalatine duct in human fetuses. Anat Cell Biol 2019; 52:426-435. [PMID: 31949982 PMCID: PMC6952684 DOI: 10.5115/acb.19.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/02/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022] Open
Abstract
The incisive canal for nerves and vessels is generally thought to run along a suture between the incisive bone (IN) and maxilla. In contrast, there was a report saying the canal passes through the IN or primary palate in human fetuses. Examination of sagittal and frontal sections from 69 fetuses (31 of gestational age [GA] 9-15 weeks and 38 of GA 26-34 weeks) showed that the canal often penetrated the IN at the nasal half of its course and that, in other fetuses, the canal penetrated the IN along its entire course, irrespective of involvement of the nasopalatine duct. Canals developing in and corresponding to parts of the suture resulted in partial enlargement of the thin and tight sutures, which contained loose tissue, vessels, nerves and even a duct. Small processes of the IN were identified as upper irregular parts continuous with inferior main masses of bone in frontal sections but as bone fragments in sagittal sections. In some sections, a thin layer of the maxilla along the canal covered the medial or inferior aspect of the IN. Therefore, the incisive canal with or without duct exhibited a spectrum of variations in topographical relation to the IN-maxillary border. Because the primitive oronasal communication passes through the suture, the nasopalatine duct may have originated from the secondary developed elongation of the nasal epithelium at midterm. A large incisive fossa along the midline on the oral surface of the palate might make a macroscopic finding of variants difficult even in adults.
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Affiliation(s)
- Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea
| | - Shunichi Shibata
- Department of Maxillofacial Anatomy, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Abe
- Department of Anatomy, Akita University School of Medicine, Akita, Japan
| | - Gen Murakami
- Division of Internal Medicine, Jikoukai Clinic for Home Visit, Sapporo, Japan
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Sedov YG, Avanesov AM, Mordanov OS, Zurnacheva DD, Mustafaeva RS, Blokhina AV. Visualization features of canalis sinuosus with cone beam computed tomography. Indian J Dent Res 2019; 30:656-660. [PMID: 31854352 DOI: 10.4103/ijdr.ijdr_26_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction One of the key stages of evaluating an edentulous ridge prior to dental implant placement is the analysis of neighboring anatomical structures such as canalis sinuosus (CS) with cone-beam computed tomography (CBCT). CBCT visualization has its own features, such as the change of slice thickness. The aim of the study was to analyze CS prevalence in relation to the slice thickness and CS diameter according to CBCT scans. Materials and Methods In total, 100 CBCT scans of 39 males and 61 females in the age span of 46 to 81 years were retrospectively studied. Terminal alveolar part of CS was analyzed in Ez3D2009 (Vatech) software on panoramic and cross-sectional views with 0.5 mm, 1 mm, 3 mm, and 10 mm slice thicknesses. The prevalence was documented with regard to the diameter and slice thickness and was statistically compared in age and gender groups. Results This CBCT study demonstrated 55.5% CS prevalence. There was no statistically significant difference in presence between age and gender groups regarding diameter as well as within different slice thickness. The study also showed the importance of the slice thickness choice for CS visualization: the best visualization was reached with 0.5 mm and 1 mm slice thicknesses. Visualization with 0.5 mm and 1 mm slice thicknesses was absolutely the same (55.5%). General CS prevalence with a 10 mm slice thickness (16.5%) was significantly lower (P < 0.05) than the prevalence with a 3 mm slice thickness (20.5%). The correlation between the slice thickness and a diameter more than 1.5 mm in size was not found. Conclusion CBCT analysis showed that the highest CS prevalence was detected with the use of 0.5/1 mm slice thickness. As well, the higher CS diameter, the better is its visualization.
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Affiliation(s)
- Yuri G Sedov
- Department of General and Clinical Dentistry, Medical Institute, RUDN University, Moscow, Russia
| | - Anatoly M Avanesov
- Department of General and Clinical Dentistry, Medical Institute, RUDN University, Moscow, Russia
| | - Oleg S Mordanov
- Department of General and Clinical Dentistry, Medical Institute, RUDN University, Moscow, Russia
| | - Dina D Zurnacheva
- Department of General and Clinical Dentistry, Medical Institute, RUDN University, Moscow, Russia
| | - Rita S Mustafaeva
- Department of General and Clinical Dentistry, Medical Institute, RUDN University, Moscow, Russia
| | - Anastasia V Blokhina
- Department of General and Clinical Dentistry, Medical Institute, RUDN University, Moscow, Russia
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Canalis Sinuosus Damage after Immediate Dental Implant Placement in the Esthetic Zone. Case Rep Dent 2019; 2019:3462794. [PMID: 31934462 PMCID: PMC6942755 DOI: 10.1155/2019/3462794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
Dental implant failure in the anterior maxilla can be caused by the range of the features. One of them is neighboring neurovascular structure damage, such as the canalis sinuosus (CS), that carries the superior anterior alveolar nerve. The aim of the report is to demonstrate clinical symptomatology and radiographic signs of CS damage in a 45-year-old female patient who underwent upper left lateral incisor extraction and immediate implant placement and implant removal in 16 days secondary to pain and paresthesia in the maxillary left region.
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22
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Canalis sinuosus: anatomical variation or structure? Surg Radiol Anat 2019; 42:69-74. [PMID: 31606782 DOI: 10.1007/s00276-019-02352-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The main goal of the present study was to verify the presence, spatial location, the end of the canalis sinuosus (CS) trajectory and size of CS using cone beam computed tomography (CBCT) to characterise it as either a structure or an anatomical variation. METHODS A trained examiner specialist in dental radiology and imagenology selected 200 CBCT images of the maxilla from 107 (53.5%) female and 93 (46.5%) male individuals aged between 18 and 85 years. RESULTS A total of 133 (66.5%) patients had CS, being 61 (45.86%) unilateral and 72 (54.14%) bilateral. A higher frequency of CS was observed in males (P < 0.05) and no relationship was found between its presence and age. The end of the CS trajectory was more frequent in the regions of central incisor (n = 91; 44.39%), followed by lateral incisor (n = 45; 21.95%) and canine (n = 29; 14.15%). In our sample, the majority of these canals had a diameter of up to 1 mm (n = 198/205; 96.6%). No statistically significant relationship between diameter and the end of the CS trajectory, with location (i.e. bilateral or unilateral) was found. Gender and age had no influence on diameter, spatial location and the end of the CS trajectory (P > 0.05%). CONCLUSION As CS was frequently found in our sample, it can be considered an anatomical structure, and as such, it is fundamental that the dentist requests a CBCT examination before performing any invasive procedure in the maxillary region to preserve this important structure.
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Supernumerary incisive canals in a cadaver: a rare anatomical variation. Surg Radiol Anat 2019; 41:977-978. [PMID: 30694357 DOI: 10.1007/s00276-019-02191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
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.
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Canalis sinuosus: a systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:545-551. [PMID: 30772255 DOI: 10.1016/j.oooo.2018.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/09/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a systematic review of the frequency, location, diameter, variations in course, relationship to the course of the anterior superior alveolar nerve (ASAN), patient age and gender, and surgical implications of canalis sinuosus (CS), identified through imaging examinations, macerated skulls, or cadaver heads. STUDY DESIGN Medline, Scopus, and Web of Science databases were searched, and the retrieved articles were analyzed by 2 reviewers. The articles were selected by using well-established inclusion criteria. The Hawker scale was used for quality analysis. A kappa test was used to measure interobserver agreement. RESULT The search identified 70 articles, of which 11 were selected for extraction and data analysis. Most studies consisted of cone beam computed tomography examinations of the location, diameter, and variable presence of accessory channels (ACs) in the CS. In total, 90.9% of the studies were of high or moderate quality. CONCLUSIONS The CS may present variations in its course, location, and diameter. It involves ASAN and a extension to the anterior palate region, the ACs. No statistically significant differences with regard to age or gender were discovered in the studies. Most articles report the relevance of the CS identification in surgical procedures close to the canal and emphasize the importance of awareness of the variable appearance of the CS.
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25
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Leven AJ, Sood B. Pathosis or Additional Maxillary Neurovascular Channel? A Case Report. J Endod 2018; 44:1048-1051. [DOI: 10.1016/j.joen.2018.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 11/24/2022]
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Ghandourah AO, Rashad A, Heiland M, Hamzi BM, Friedrich RE. Cone-beam tomographic analysis of canalis sinuosus accessory intraosseous canals in the maxilla. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc20. [PMID: 29308063 PMCID: PMC5738502 DOI: 10.3205/000261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to assess the frequency, location and width of accessory canals (AC) of canalis sinuosus (CS) using cone beam computed tomography and compare our findings with recent literature. Additionally, intraosseous canals (IOC) in the sinus wall other than the CS were noted. A retrospective analysis of 219 scans from our university department was conducted. The registered parameters were age, sex, location and width of canals. Group A consisted of 201 (85 males and 116 females) adults ranged from 19 to 99 years of age (mean age = 47.5 years). A total of 136 patients (67.6%) presented at least 1 AC, of which 55 cases showed a foramen width greater than 1 mm (27.4%). Group B had a sample size of 18 adolescents (7 males and 11 females) with a range of age from 7 to 18 years (mean age = 15.8 years). Eight cases (44.4%) presented at least one AC, of which only 3 had a foramen width greater than 1 mm (3.6%). ACs were found to occur predominantly at central incisors region (Group A) and the left lateral incisor and canine as well as the central incisors regions (Group B). Adolescents showed a lower prevalence of accessory canals compared to adults. These findings supplement earlier reports on the anatomical variations of the intraosseous vessel and nerve conduits of the maxilla. Surgical interventions in this area can be planned more precisely, taking into account the three-dimensional imaging, thus possibly protecting these sensitive structures.
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Affiliation(s)
- Abdalmalik O Ghandourah
- Department of Oral & Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashkan Rashad
- Department of Oral & Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Heiland
- Department of Oral & Maxillofacial Surgery, University Medical Center Charité, Berlin, Germany
| | - Badr M Hamzi
- Department of Oral & Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral & Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rusu MC, Săndulescu M, Bichir C, Muntianu LAS. Combined anatomical variations: The mylohyoid bridge, retromolar canal and accessory palatine canals branched from the canalis sinuosus. Ann Anat 2017; 214:75-79. [PMID: 28823708 DOI: 10.1016/j.aanat.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/13/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Abstract
The study of anatomical variations is important not only for collecting anthropometric data, but also for improving clinical protocols and understanding why a particular clinical procedure sometimes does not yield the expected results. We report the case of a 74 year-old patient, in which we observed combined anatomical variants of the mandible and maxillary bone. One of these was the unilateral mylohyoid bridge (MB) of the uncommon, lingular type. This MB extended posteriorly to the spine of Spix, over the sulcus colli behind the spine. It thus formed a common mandibular canal (MC) which further divided into a retromolar canal and the MC proper. This combination of variants in the mandible has not, to our knowledge, previously been reported, at least in studies using cone beam computed tomography (CBCT). Additionally we found multiple accessory canals (ACs) deriving from the canalis sinuosus, which opened opposite to each frontal tooth, presumably carrying either dental fibers of the palatine nerves, or palatine fibers of the anterior superior alveolar nerve. Although the ACs in the anterior palate are well established anatomical variants, the MB appears in publications rather as an anthropological identifier. However, when present, it can impede anaesthesia of the lower teeth and thus deserves to be included in anatomical descriptions. The evaluation of patients in CBCT should observe the anatomical features on a case-by-case basis and it also provide data for studies of MB prevalence in large numbers of patients.
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Affiliation(s)
- M C Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - M Săndulescu
- Division of Oral Implantology, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - C Bichir
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - L A S Muntianu
- Division of Removable Prosthodontics, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Dental Implant in the Canalis Sinuosus: A Case Report and Review of the Literature. Case Rep Dent 2017; 2017:4810123. [PMID: 28928992 PMCID: PMC5591911 DOI: 10.1155/2017/4810123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/17/2017] [Accepted: 07/06/2017] [Indexed: 11/18/2022] Open
Abstract
The canalis sinuosus is a neurovascular canal, a branch of nerve of infraorbital canal, through which the anterior superior alveolar nerve passes and then leans medially in course between the nasal cavity and the maxillary sinus, reaching the premaxilla in the canine and incisor region. The purpose of this article is to report a case with the presence of canalis sinuosus, in order to alert and guide professionals and discuss the morphology of this anatomical variation avoiding trans- and postsurgical disorders in dental implants. A 51-year-old female was attended to in a radiology clinic, reporting paresthesia in the right upper lip region and painful symptomatology after the installation of an implant in the corresponding region. The case revealed the presence of canalis sinuosus in imaging exams. The knowledge of this anatomical variation is essential for professionals, because attention to this region prevents irreversible damage. Therefore, the use of imaging examinations is recommended during the planning stages and treatment and after surgery in patients undergoing surgery in this area.
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Gurler G, Delilbasi C, Ogut EE, Aydin K, Sakul U. Evaluation of the morphology of the canalis sinuosus using cone-beam computed tomography in patients with maxillary impacted canines. Imaging Sci Dent 2017; 47:69-74. [PMID: 28680842 PMCID: PMC5489671 DOI: 10.5624/isd.2017.47.2.69] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose The nasopalatine canal is a well-known, important anatomical structure in the anterior maxilla, but this region contains many accessory canals. The canalis sinuosus (CS) is one of these canals; it contains the anterior superior alveolar nerve, along with veins and arteries. The purpose of this study was to evaluate the CS using conebeam computed tomography (CBCT) in patients with maxillary impacted canines. Materials and Methods A total of 111 patients admitted to the Istanbul Medipol University School of Dentistry for the exposure, orthodontic treatment, and/or extraction of an impacted canine were included in this study. CBCT images were obtained for these patients under standard conditions. Axial, coronal, and sagittal sections were evaluated to assess the prevalence of CS, the direction and diameter of the canal, its relation with the impacted canine, and its distance from the alveolar crest. Further, possible correlations with patient gender and age were analyzed. Results The CS could be detected bilaterally in all the evaluated tomography images. The mean canal diameter was significantly larger in males than in females (P=.001). The CS ran significantly closer to the impacted canine when the canal was located horizontally (P=.03). Variations of the canal, such as accessory canals, were identified in 6 patients. Conclusion CS is an anatomical entity that may resemble periapical lesions and other anatomical structures. Evaluation with CBCT prior to surgical procedures in the anterior maxilla will help to prevent overlooking such anatomical structures and to decrease possible surgical complications.
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Affiliation(s)
- Gokhan Gurler
- Department of Oral and Maxillofacial Surgery, Istanbul Medipol University School of Dentistry, Istanbul, Turkey
| | - Cagri Delilbasi
- Department of Oral and Maxillofacial Surgery, Istanbul Medipol University School of Dentistry, Istanbul, Turkey
| | - Emine Esen Ogut
- Department of Oral and Maxillofacial Surgery, Istanbul Medipol University School of Dentistry, Istanbul, Turkey
| | - Kader Aydin
- Department of Oral and Maxillofacial Radiology, Istanbul Medipol University School of Dentistry, Istanbul, Turkey
| | - Ufuk Sakul
- Department of Anatomy, Istanbul Medipol University School of Medicine, Istanbul, Turkey
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Kim JH, Oka K, Jin ZW, Murakami G, Rodríguez-Vázquez JF, Ahn SW, Hwang HP. Fetal Development of the Incisive Canal, Especially of the Delayed Closure Due to the Nasopalatine Duct: A Study Using Serial Sections of Human Fetuses. Anat Rec (Hoboken) 2017; 300:1093-1103. [DOI: 10.1002/ar.23521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Ji Hyun Kim
- Department of Anatomy; Seonam University College of Medicine; Namwon Korea
| | - Kyoko Oka
- Department of Oral Growth and Development; Fukuoka Dental College; Fukuoka Japan
| | - Zhe Wu Jin
- Department of Anatomy, Histology and Embryology; Yanbian University Medical College; Yanji City Jilin Province China
| | - Gen Murakami
- Division of Internal Medicine; Iwamizawa Asuka Hospital; Iwamizawa Japan
| | | | - Sung Woo Ahn
- Department of Surgery; Chonbuk National University Hospital; Jeonju Korea
- Research Institute of Clinical Medicine; Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital; Jeonju Korea
| | - Hong Pil Hwang
- Department of Surgery; Chonbuk National University Hospital; Jeonju Korea
- Research Institute of Clinical Medicine; Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital; Jeonju Korea
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Shah PN, Arora AV, Kapoor SV. Accessory branch of canalis sinuosus mimicking external root resorption: A diagnostic dilemma. J Conserv Dent 2017; 20:479-481. [PMID: 29430105 PMCID: PMC5799999 DOI: 10.4103/jcd.jcd_375_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to recognize the importance of canalis sinuosus in Endodontics. A 60-year-old male patient reported with the chief complaint of pain and swelling in upper front tooth region for 2 weeks with a history of trauma 21 years back. Clinical examination revealed fractured tooth 21 (maxillary left central incisor) with an associated sinus tract. Radiographic examination revealed diffuse periapical radiolucency in relation to tooth 21 and external resorptive defect in apical third of the root of tooth 11 (maxillary right central incisor). Cone-beam computed tomography advised to plan surgical treatment for the same disclosed the presence of an anatomic variation of canalis sinuosus. The location and course of this canal illuded as a resorptive defect, which is a very rare occurrence. This led to a change in diagnosis with relation to tooth 11 and treatment plan was formulated accordingly.
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Affiliation(s)
- Priyal Naresh Shah
- Department of Conservative Dentistry, Endodontics and Aesthetics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Ankit V Arora
- Department of Conservative Dentistry, Endodontics and Aesthetics, Sumandeep Vidyapeeth, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Sonali V Kapoor
- Department of Conservative Dentistry, Endodontics and Aesthetics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
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Assessment of accessory canals of the canalis sinuosus: a study of 1000 cone beam computed tomography examinations. Int J Oral Maxillofac Surg 2016; 45:1586-1591. [PMID: 27720336 DOI: 10.1016/j.ijom.2016.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/21/2016] [Accepted: 09/09/2016] [Indexed: 11/18/2022]
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Manhães Júnior LRC, Villaça-Carvalho MFL, Moraes MEL, Lopes SLPDC, Silva MBF, Junqueira JLC. Location and classification of Canalis sinuosus for cone beam computed tomography: avoiding misdiagnosis. Braz Oral Res 2016; 30:e49. [PMID: 27119586 DOI: 10.1590/1807-3107bor-2016.vol30.0049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/18/2015] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to assess the presence, location and, multiplanar distance of the canalis sinuosus (CS) between the incisive foramen and the anterior maxillary alveolar ridge using cone beam computed tomography (CBCT). Therefore, 500 CBCT maxillary images obtained from male and female patients aged 20 to 80 years were selected to assist in the dental treatment. Low-quality tomographic images were discarded. All images were captured with the i-CATTM Classic tomograph and assessed using the XoranCatTM software. The axial sections were analyzed at the incisive foramen in order to verify the CS presence in laterality and location. Furthermore, linear measurements of the nasal cavity floor, buccal cortical bone, and alveolar ridge crest were made. All the collected data were statistically analyzed. Results show a variation of the CS in relation to the classification and distance of anatomical structures, but no significant difference between the right and left sides. It should be highlighted that CBCT is necessary before invasive procedures in order to preserve important anatomical structures. In conclusion, the location of the CS varies in relation to the alveolar ridge crest and buccal cortical bone, assuming that it is going to be located by the upper lateral incisor palatine.
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Affiliation(s)
| | | | - Mari Eli Leonelli Moraes
- Department of Oral Radiology, Institute of Science and Technology, Universidade Estadual Paulista, São José dos Campos, SP, Brazil
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Branch of the canalis sinuosus: a rare anatomical variation—a case report. Surg Radiol Anat 2015; 37:879-81. [DOI: 10.1007/s00276-015-1432-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
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35
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Cone beam computed tomographic analysis of neurovascular anatomical variations other than the nasopalatine canal in the anterior maxilla in a pediatric population. Surg Radiol Anat 2014; 37:181-6. [DOI: 10.1007/s00276-014-1303-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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36
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Wanzeler AMV, Marinho CG, Alves Junior SM, Manzi FR, Tuji FM. Anatomical study of the canalis sinuosus in 100 cone beam computed tomography examinations. Oral Maxillofac Surg 2014; 19:49-53. [PMID: 24752931 DOI: 10.1007/s10006-014-0450-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/07/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify and describe the morphology and location of the canalis sinuosus (CS) and make correlations with gender, age, and distance of this canal to important adjacent structures on the region, thus mapping the anatomy of this structure. METHODOLOGY A total of 100 cone beam computed tomography (CBCT) examinations were collected from the files of a dental clinic in the Municipality of Belém, Pará, Brazil, and analyzed to identify the site of bifurcation, the diameter of CS right after such bifurcation and in its terminal portion as well as the direction of its course and the distance to the alveolar bone crest region. The anatomical views were evaluated using InVivoDental software on sagittal, axial, and coronal sections, and the results were submitted to Fisher's exact test, Kendall correlation coefficients, Mann-Whitney tests, and T tests. RESULTS CS was present in 88 % of the sample. There were no statistically significant changes in the presence of CS regarding gender, age and direction of course. A strong positive correlation between CS's diameter on its initial and terminal portions was observed (p < 0.0001). There was a statistically significant change in the distance to alveolar bone crest related to gender, which is higher in men (p = 0.0303). CONCLUSION In the sample, CS was frequent and similar in both genders, with course distance to the alveolar bone crest and termination in different locations that ought to be analyzed on CBCT prior to surgical procedures.
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Assessment of bone channels other than the nasopalatine canal in the anterior maxilla using limited cone beam computed tomography. Surg Radiol Anat 2013; 35:783-90. [DOI: 10.1007/s00276-013-1110-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
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38
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Rare anatomical variation related to the nasopalatine canal. Surg Radiol Anat 2013; 35:853-5. [DOI: 10.1007/s00276-013-1089-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
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