MDCT evaluation of nasopalatine canal morphometry and variations: An analysis of 100 patients

Assessment of variations in the nasopalatine canal on CBCT: considerations from an anatomical point of view

PURPOSE

The nasopalatine canal (NPC) is one of the most significant anatomical markers in the anterior maxillary region. Its location is quite important, especially for implant placement. Therefore, the purpose of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphology, size, and anatomic variations of the NPC.

METHODS

A total of 150 individual CBCT images were assessed in various sections to evaluate the dimensions, morphology, and extent of the NPC. Reformatted sagittal images were chosen to classify the shape and course of the canal. The Student's t-test, the χ² test, and Pearson correlation coefficients were used.

RESULTS

The NPC was longer in males than in females, and the mediolateral diameter of the canal was greater in older adults. In sagittal sections, the canal predominantly exhibits a cylindrical shape, while a spindle shape is the least common. In coronal sections, a single shape is most frequently observed, with a Y-shape being the least common. Regarding the orientation of the canal, slanted canals are more prevalent, whereas vertically curved canals are rare. Typically, 2 canal openings are observed, with 4 openings being the least common.

CONCLUSION

The current study highlights the challenges associated with identifying the anatomical appearance and variations of the NPC. Consequently, possessing a thorough understanding of this anatomy is essential before undertaking any surgical procedures, such as implant placement. This knowledge helps prevent complications such as nerve injury-related loss of sensation, bleeding due to blood vessel injury, and the development of a nasopalatine duct cyst following trauma to the canal during surgery.

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

OBJECTIVE

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

SETTING

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

PATIENTS, PARTICIPANTS

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

INTERVENTIONS

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

RESULTS

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

CONCLUSIONS

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

Assessment of the Nasopalatine Canal in Patients Requiring Dental Implants in the Maxillary Anterior Region Using Cone Beam Computed Tomography

AIM

To assess the nasopalatine canal in patients requiring dental implants in the maxillary anterior region using cone beam computed tomography (CBCT).

METHODOLOGY

About 56 patients requiring dental implants in the maxillary anterior region of either gender reporting to the daily Outpatient Department, Department of Oral Medicine and Radiology aged between 18 and 60 years were selected. They were subjected to a CBCT scan using Newtom Giano CBCT machine (NewTom, Imola, Italy). Newtom New Technology software and a slice thickness of 0.3 mm were used. For assessment of the implant site at the maxillary anterior region, alveolar bone width in the anterior region of the canal at the upper, middle, and lower third, incisive foramen diameter (IFD), nasopalatine canal length (NPCL), canal diameter in the floor of the nasal fossa and nasopalatine canal morphology was determined.

RESULTS

Out of 56 patients, males comprised 30 and females 26. The mean bone height in 11 regions was 15.6±3.9, in 12, 16.2±2.7 mm, in 13 was 15.5±2.4 mm, in 21 was 13.7±4.2 mm, in 22 was 14.7±3.6 mm, in 23 was 16.7±1.5 mm. A non-significant difference was observed when comparing the bone height at different implant sites (p>0.05). The mean bone width at 3 mm and 6 mm from an alveolar crest in 11 regions was 4.3 mm and 5.3 mm, in 12 was 5.7 mm and 6.2 mm, in 13 was 3.7 mm and 4.6 mm, in 21 regions was 4.1 mm and 5.5 mm, in 22 regions was 4.6 mm and 5.7 mm and in 23 regions was 4.0 mm and 4.9 mm, respectively. A significant difference was observed when comparing the bone width at 3 mm and 6 mm at different implant sites (p<0.05). Nasopalatine canal type was A in 42 (75%), B in 13 (23.2%), and C in 1 (1.8%) patient. The mean alveolar bone width in the anterior region of the canal at the upper third was 10.1 mm, in the middle third was 7.4 mm, and in the lower third was 5.2 mm. The mean IFD was 4.6 mm, the NPCL was 13.5 mm, and the canal diameter on the floor of the nasal fossa was 3.8 mm. A significant difference was observed in comparing nasopalatine canal type (p<0.05).

CONCLUSION

For the clinician to assess implant placement in the maxillary esthetic zone, CBCT imaging of the nasopalatine canal is crucial. It is possible to prevent intraoperative and postoperative complications such as hemorrhage, sensory impairment, osseointegration failure, and nasopalatine duct cyst formation.

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.

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

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

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.

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

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

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

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

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

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

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

INTRODUCTION

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Alteraciones anatómicas del conducto nasopalatino en pacientes dentados y desdentados en el sector anterosuperior utilizando tomografía computarizada de haz cónico

Introducción: el conducto nasopalatino (CNP) es un trayecto intraóseo largo y delgado presente en la línea media anterior del maxilar, conecta el paladar con el piso de la cavidad nasal. El objetivo del estudio fue comparar las medidas del conducto nasopalatino y su forma mediante tomografía de haz cónico en pacientes dentados y pacientes desdentados en el sector anterosuperior. Materiales y métodos: estudio descriptivo y comparativo, se tomaron del archivo del Departamento de Imagenología 150 tomografías de pacientes dentados anterosuperiores y 52 tomografías de pacientes desdentados anterosuperiores. Mediante Excel y su herramienta “aleatoria” se seleccionaron 30 tomografías de pacientes dentados y 30 tomografías de pacientes desdentados. Se midió en el plano sagital oblicuo la distancia anteroposterior del conducto nasopalatino a nivel de su tercio superior, medio e inferior. Para determinar su altura se tomó el plano axial del nivel de la bifurcación superior hasta la desembocadura palatina. La adquisición de imágenes se realizó través del software i-Dixel del equipo 3D Accuitomo 170 MORITA, sistema DICOM. Resultados: los pacientes dentados presentan alturas mayores en relación a los pacientes edéntulos. En diámetro transversal los pacientes edéntulos presentan mayor tamaño a nivel del canal del CNP. Las medidas a nivel inferior, medio y superior en las corticales del diámetro del CNP en pacientes dentados son menores en relación a los pacientes edéntulos. Conclusión: los pacientes de 40 a 70 años de ambos sexos con edentulismo anterosuperior presentaron variaciones estructurales topográficas que consisten en mayor anchura, menor longitud y mayor dimensión transversal, siendo conductos agrandados.