Rare anatomical variation related to the nasopalatine canal

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

Evaluation of the morphology of accessory canals of the canalis sinuosus via cone-beam computed tomography

PURPOSE

This study aims to assess the presence of accessory canal (AC) associated with canalis sinuous (CS), describing their frequency, lateralization, location, direction, and measurements in cone beam computed tomography (CBCT).

METHODS

Axial, coronal, sagittal, and cross-sectional reconstructions were analyzed in 248 CBCT images and the presence of CS, the presence of AC associated with CS, the lateralization, localization, and direction course of AC associated with CS was evaluated. CS diameter, AC diameter, the distance between the nasal cavity floor and CS (M1), CS and the buccal cortical bone (M2), and CS and the alveolar ridge (M3) were measured.

RESULTS

CS was detected in all CBCT scans as bilaterally. The prevalence of AC associated with CS was 35.5%. There was a significant difference between dental status anthe d presence of AC associated with CS. There was a significant difference between gender, dental status, and lateralization of AC associated with CS. While M1 was greater in male patients than females, M3 was greater in female patients. M2 and M3 were greater in younger patients.

CONCLUSION

Clinicians performing surgical procedures should keep in mind that anatomical variations of the vascular nerve bundle may be seen. M1, M2, and M3 measurements can be affected by gender, age, and dental status.

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

Background

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

Aims

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

Patients and Methods

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

Results

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

Conclusion

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

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

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

Radiographic Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

Topographical variations of the incisive canal and nasopalatine duct in human fetuses

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.

Evaluation of Anatomical and Volumetric Characteristics of the Nasopalatine Canal in Anterior Dentate and Edentulous Individuals: A CBCT Study

OBJECTIVE

To examine the nasopalatine canal (NPC) anatomical and volumetric measurements in anterior edentulous (AE) and anterior dentate (AD) individuals and to compare these findings according to sex, age, shape, and severity of resorption in the premaxilla.

METHODS

Two hundred cone beam computed tomography images were divided into 2 groups: AE and AD. The diameter, the length of the NPC and the width, the length of the buccal bone anterior to the NPC were measured and recorded. Linear and volumetric measurement results were evaluated in terms of age, sex, dental status, shape, and severity of resorption.

RESULTS

No significant differences were observed between the AE and AD groups in terms of the NPC volume (P = 0.289). In the AE group, the spindle shape had the highest volume, and in the same group, with aging, the volume significantly increased (P = 0.00). The mean NPC volume was found to be statistically significantly larger in males than females (P = 0.02). A statistically significant relation was observed between NPC volume and resorption status.

CONCLUSION

Severe bone resorption due to sustained edentation complicated implant surgery because of the increase in incisive and nasal foramen diameters and decrease in buccal residual bone dimensions. The NPC volume was found fewer in edentulous patients, and by the resorption, the volume was decreased.

Vomero-premaxillary joint: A marker of evolution of the species

OBJECTIVE

According to evolutionary developmental (evo-devo) theory, the vomers are bones derived from the secondary palate. Growth of the palatine processes of the maxillae, including the precursors of vomer bones, results in midline fusion posteriorly to the primary palate, which forces the ascension of the vomer bones towards the primary nasal septum, formed by septal cartilage and the perpendicular plate of the ethmoid. According to this hypothesis, the anterior border of the vomer articulates with the posterior surface of the premaxilla in the incisive canal (IC).

MATERIAL AND METHOD

The objective of this retrospective study was to measure the degree of impaction of the anteroinferior angle of the vomer in the IC on CT scans showing a non-deformed nasal septum. Thirty-two out of a series of 506 nasal sinus CT scans were used to obtain measurements on coronal sections of non-deformed septa through the IC.

RESULTS

Thirty-one of the 32 vomers were impacted in the IC. In the case of a Y-shaped vomer (n=26), 43% of the length of the vomer was impacted in 41% of the length of the IC. In the case of I-shaped vomers (n=6), 34% of the length of the vomer was impacted in 41% of the length of the IC. The only vomer that did not impact into the IC was Y-shaped.

CONCLUSION

Impaction of the vomer in the IC posteriorly to the premaxilla can be explained by the evo-devo concept of the formation of the nasal cavities. In contrast, the classical embryological description of the formation of the nasal septum cannot provide an explanation for impaction of the vomer.

Three-Dimensional Analysis of the Anatomical Characteristics and Dimensions of the Nasopalatine Canal Using Cone Beam Computed Tomography

AIM

Placement of implants in the maxillary anterior region needs to be preceded by careful analysis of the area as in addition to the functional aspect the esthetic outcome is of prime importance. This descriptive study evaluated anatomical characteristics and dimensions of the nasopalatine canal (NC) from coronal, sagittal and axial aspects using cone beam computed tomography (CBCT) giving it a three dimensional analytical approach. Also the dimensions of the corresponding buccal bone plate (BBP) of the alveolar process were evaluated. Additionally, the influence of age and gender on these characteristics was also analyzed.

METHODS

A total of 81-CBCT scans of patients with one or no upper central incisors present were selected. Sagittal slices were used for measurements of the NC and BBP and to evaluate shape of the NC. Coronal slices were used to assess NC shape and axial slices to assess number of incisive foramina and foramina of Stenson.

RESULTS

The most prevalent canal shape was: cylindrical (48.14 %) in sagittal aspect; Y-type (49.38 %) in coronal aspect; and one incisive foramen with two Stenson's foramina [1-(2-5)] (60.49 %) in axial aspect. Mean NC length was 11.13 ± 3.23 mm; statistically significant differences were detected between genders (p < 0.001). Mean nasopalatine angle was 69.32° ± 7.70. Mean BBP length was 17.12 ± 3.97 mm and mean BBP width was 5.71 ± 1.29 mm, significant differences were detected between genders (p < 0.001).

CONCLUSION

The current study demonstrates variability of the NC in terms of anatomical characteristics and dimensions; hence, a thorough CBCT analysis is highly recommended for better surgical outcomes and to reduce the post-operative complications in implant dentistry.

Three-dimensional analysis of incisive canals in human dentulous and edentulous maxillary bones

Background

The purpose of this study was to reveal the structural properties that need to be considered in dental implant treatment by investigating differences between dentulous and edentulous maxillae in the three-dimensional (3D) microstructure of the incisive canals (ICs) and their surrounding bone.

Methods

A total of 40 maxillary bones comprising 20 dentulous maxillae and 20 edentulous maxillae were imaged by micro-CT for 3D observation and measurement of the IC and alveolar bone in the anterior region of the IC.

Results

The Y-morphology canal was most frequently observed at 60% in dentulous maxilla and 55% in edentulous maxilla. There was a significant difference between dentulous and edentulous maxillae in IC diameter and volume, but no significant difference between the two in the major axis of the ICs.

Conclusions

The anatomic structure surrounding the IC has limited area for implant placement. Therefore, where esthetic and long-term maintenance requirements are taken into account, careful attention is needed when setting the placement position. Also, due to the resorption of bone, edentulous maxillae have a different IC morphology from dentulous maxillae, and therefore, a cautious approach is required.

Morphological and volumetric evaluation of the nasopalatinal canal in a Turkish population using cone-beam computed tomography

PURPOSE

To establish (nasopalatine canal) NPC morphology and obtain linear and volumetric measurements using CBCT images.

METHODS

We evaluated CBCT scans of 252 patients. NPC shape was classified as belonging to six groups. Following measurements were recorded: M1, nasal foramen diameter; M2, incisive foramen diameter; M3, NPC length; M4, distance from the buccal border of the incisive foramen to the facial aspect of the buccal bone plate; M5, distance from the buccal bone wall of the NPC to the facial aspect of the buccal bone plate; and M6, distance from the buccal border in the middle of the NPC to the facial aspect of the buccal bone plate. Volume and surface area measurements of the NPC were also conducted. Sex, age and maxillary anterior teeth status (MCI) were recorded. Four-way repeated ANOVA was performed. Significance level was set at p < 0.05.

RESULTS

With the exception of M4 and M5, the relationship between MCI and all linear measurements was statistically significant. Patient sex had a significant effect on all NPC measurements with the exception of nasal foramen diameter, with all measurements greater in males than females (p < 0.001). NPC volume was found to vary significantly by patient sex (p = 0.042), with mean NPC volume values of 55.171 mm(3) for females and 72.966 mm(3) for males.

CONCLUSION

The measurements conducted around nasopalatine canal provided useful information prior to implant placement in the anterior maxilla.

Three-dimensional study of nasopalatine canal morphology: a descriptive retrospective analysis using cone-beam computed tomography

PURPOSE

For dental implant treatment planning and placement, a precise anatomic description of the nasopalatine canal (NC) is necessary. This descriptive retrospective study evaluated dimensions of the NC and buccal bone plate (BBP) and the tridimensional association of the anatomic variants of NC, using cone-beam computed tomography (CBCT).

METHODS

This study included 230 CBCTs. Sagittal slices were used for measurements of the NC and BBP and to evaluate shape and direction-course of the NC. Coronal slices were used to assess NC shape and axial slices to assess number of incisive foramina and foramina of Stenson.

RESULTS

Mean NC length was 12.34 ± 2.79 mm, statistically significant differences were detected between genders (p < 0.001). Mean BBP length was 20.87 ± 3.68 mm, statistically significant differences were found for the dental status (p < 0.001) and mean BBP width was 6.83 ± 1.28 mm, significant differences were detected between genders (p < 0.001). Mean nasopalatine angle was 73.33° ± 8.11°, significant differences were found in sagittal and coronal classifications. The most prevalent canal was: cylindrical sagittal shape (48.2 %); slanted-straight direction-course (57.6 %); Ya-type coronal shape (42.4 %); and one foramen incisive with two Stenson's foramina (1-2) (50.9 %). Sagittal shape was associated with sagittal direction-course (p < 0.001). Coronal shape was associated with axial classification (p < 0.001).

CONCLUSIONS

The NC anatomy is highly variable. Gender is related to the NC length and BBP width, while dental status is related to BBP length. There was an association between the different sagittal classifications of the NC and between the coronal shape and axial classification.

Cone-beam computed tomographic analysis of the morphological characterization of the nasopalatine canal in a pediatric population

PURPOSE

Knowledge of the nasopalatine canal (NPC) is necessary for understanding the morphology and pathogenesis of lesions that occur in this region. The purpose of the present study was to analyze the dimensions and anatomic characteristics of the NPC in a pediatric population using cone-beam computed tomography (CBCT).

STUDY DESIGN

Reformatted sagittal, coronal, and axial slices of 368 individual CBCT images were analyzed with regard to dimensions and anatomic features of the NPC.

RESULTS

Funnel shape of the NPC was most commonly found [26.9 % (99)], followed by banana shape [19.6 % (72)]. There was no statistically significant difference (p = 0.317) between girls and boys in terms of NPC shape. The mean width of incisive foramen was found to be 2.53 mm with a significant difference (0.002). The mean NPC length was found to be 10.83 mm and the mean canal length was found to be significantly longer in boys than girls (p < 0.000).

CONCLUSION

The present study provides new information on the literature concerning the identification of the anatomical structure of NPC. This finding may assist clinicians in understanding the morphology and preventing possible complications in this region.