Evaluation of canalis sinuosus in individuals with cleft lip and palate: a cross-sectional study using cone beam computed tomography

[Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery]

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 and the 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, strategies for preventing and treating canalis sinuosus injuries need to be investigated. Preoperatively, CBCT is used to identify the canalis sinuosus and to virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, assessing bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT is used 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 the physiological functions in the anterior maxilla, and discusses strategies for avoiding canalis sinuosus injuries during implant surgery, thereby enhancing clinical awareness and providing references for clinical decision-making.

Retrospective evaluation and descriptive analysis of the prevalence of anatomical structures and variations in CBCT images before dental implant planning in a group Turkish population, part I

PURPOSE

The aim of this study is to emphasize the importance of using cone-beam computed-tomography in order to determine the anatomical structures and their variations before the treatment in patients who apply to the dentist clinic for implant treatment.

METHODS

In the study, CBCT images of 500 adult patients (240 female and 260 male), aged between 21 and 82 years, who applied for implant treatment due to missing teeth, were retrospectively analyzed. Anatomical structures and variations such as nasopalatine canal(NPC), canalis sinuosus(CS), antral alveolar artery(AAA), were evaluated in multiplanar reformation(MPR) sections which are axial, sagittal and coronal can be viewed in consistence with each other.

RESULTS

The incidence of anatomical variation of CS in the right region was similar according to gender. The "Funnel" appearance of the NPC shape was found most common shape in both female and male patients (n = 89; 37.1% for females and n = 71; 27.3% for males).

CONCLUSION

CBCT has become the most popular 3D imaging method in dental practice especially for planning dental implants. Understanding the relationship with important anatomical structures before implant applications is crucial in dealing with potential complications that may arise afterward. Assessing significant anatomical structures by CBCT and taking precautions against possible risks facilitate the work of dentists during and after procedures.

Prevalence, Radiographic Features and Clinical Relevancy of Accessory Canals of the Canalis Sinuosus in Cypriot Population: A Retrospective Cone-Beam Computed Tomography (CBCT) Study

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.

Prevalence of canalis sinuosus and accessory canals of canalis sinuosus on cone beam computed tomography: a systematic review and meta-analysis

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.

Examination of Canalis Sinuosus using Cone Beam Computed Tomography in an Australian Population

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.