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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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Bissoon A, Bandoo C, Naraynsingh C, Mohamed S. Canalis Sinuosus Mimicking Periapical Pathology on, Radiographic Assessment. J Endod 2024:S0099-2399(24)00239-5. [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] [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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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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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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Berlin-Broner Y, Levin L. Retrospective evaluation of endodontic case reports published in the International Endodontic Journal and the Journal of Endodontics for their compliance with the PRICE 2020 guidelines. Int Endod J 2020; 54:210-219. [PMID: 32961626 DOI: 10.1111/iej.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/15/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate, retrospectively, the quality of previously published case reports in Endodontics according to the PRICE 2020 guidelines. METHODOLOGY An electronic literature search was conducted in PubMed database on 12 March 2020, to identify case reports published during the last five years in the International Endodontic Journal and the Journal of Endodontics. For each of the included case reports, information regarding fulfilment of each of the items of the PRICE 2020 guidelines was extracted as '0' (not present in the manuscript), '1' (present in the manuscript) and 'NA' (not applicable) and translated into a score (percentage of items fulfilled). Additionally, the percentage of papers fulfilling each item was calculated. RESULTS Overall, 70 endodontic case reports were identified. The scores of the papers ranged between 56.41% and 79.55%, with a mean score of 70.26 ± 4.36% (SD). The percentage of papers fulfilling each item of the applicable PRICE 2020 items ranged widely, between 0% and 100%. The median of the percentage of all the items (n = 47) was 97.01% and mean 73.33 ± 36.28% (SD). The lowest scores were recorded for specific items in the following domains: 'Case Report Information'-Items 6c, 6g-i, 'Patient Perspective'-Item 8a and 'Quality of Images'-Items 12c-d. CONCLUSIONS Several areas with low reporting rates were identified in case reports published over the last 5 years in Endodontics. Authors should be encouraged to follow the PRICE 2020 guidelines in order to increase the quality and improve reproducibility of their case reports.
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Affiliation(s)
- Y Berlin-Broner
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - L Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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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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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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