Evaluation of Changes in Nasopalatine Canal Morphology According To Dentition Status by Computed Tomography

Abstract

Objective: The nasopalatine canal (NPC) is one of the important anatomic structures in anterior maxilla. The aim of this study was to evaluate the changes in NPC morphology according to dentition status in the maxillary anterior region by computed tomography (CT). Methods: Computed tomography images of 100 patients were screened retrospectively. Images were divided into two groups by dental status: an edentulous group (EG) of 50 patients who have edentulous premaxilla and a control group (CG) of 50 patients who have all incisor teeth in the premaxillary region. After recording the age, sex, and dentition status of the patients, the NPC diameter, NPC length, incisive foramen (IF) diameter, and angle between the NPC and palatine bone were measured in sagittal sections, and the number of NPCs was determined in axial sections. Results: There was no significant difference between NPC angle and dentition status (p=0.151). The NPC diameter was significantly higher in the EG (p=0.002), as was the IF diameter (p=0.041). In addition, NPC length was significantly higher in the CG (p<0.001). A statistically significant and negative correlation was found between age and NPC length (p<0.001), and a positive correlation was found between age and NPC diameter (p=0.004). In addition, no statistically significant difference was found between sex and other parameters (p>0.05). Conclusion: The NPC length and diameter vary according to the age and dentition status of the patient. Changes in this anatomic structure should be evaluated pre-operatively in elderly patients by three-dimensional radiographic evaluation.

Keywords

• Computed tomography
• nasopalatine canal
• anatomy
• dentition
• incisive foramen

Nazopalatin Kanal Morfolojisinin Dentisyon Durumuna Göre Değişiminin Bilgisayarlı Tomografi ile İncelenmesi

Abstract

Amaç: Nazopalatin kanal maksiller anterior bölgedeki önemli anatomik oluşumlardan biridir. Bu çalışmanın amacı nazopalatin (NP) kanal morfolojisinin dentisyon durumuna göre değişimini bilgisayarlı tomografi (BT) ile incelemektir. Yöntem: Toplam 100 hastaya ait bilgisayarlı tomografi görüntüleri retrospektif olarak taranmıştır. Bilgisayarlı tomografi görüntüleri iki gruba ayrıldı: maksiller ön bölgesi dişsiz olan (DG) 50 hasta ve maksiller ön bölgede diş kaybı olmayan, kontrol grubu (KG) olarak adlandırılan 50 hasta. Hastaların yaş, cinsiyet ve dentisyon durumları not edildikten sonra sagittal kesit üzerinde NP kanal uzunluğu, insiziv foramen çapı, NP kanal çapı ve NP kanal ile sert damak arasındaki nazopalatin kanal açısı ölçülmüştür. Aksiyal kesitler üzerinde ise NP kanal sayısı tespit edilmiştir. Bulgular: Nazopalatin açısı ile dentisyon durumu arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p=0,151). IF çapı DG da istatistiksel olarak anlamlı derecede daha yüksek bulunmuştur (p=0,041). Nazopalatin kanal uzunluğu ise KG da anlamlı derecede yüksek bulunmuştur (p<0,001). Yaş ve NP uzunluğu arasında anlamlı derecede negatif (p<0,001), yaş ve NP kanal çapı arasında ise anlamlı derecede pozitif korelasyon tespit edilmiştir (p=0,004). Buna karşılık cinsiyet ve parametreler arasında anlamlı bir fark bulunmamıştır (p>0,05). Sonuç: Nazopalatin kanal uzunluğu ve çapı hastaların yaşı ve dentisyon durumuna göre değişmektedir. İleri yaştaki hastalarda üç boyutlu radyografilerle bu anatomik yapıların değişimi preoperative olarak değerlendirilmelidir.

Keywords

• Bilgisayarlı tomografi
• nazopalatin kanal
• anatomi
• dentisyon
• insiziv foramen

References

1. Thakur AR, Burde K, Guttal K, Naikmasur VG. Anatomy and morphology of the nasopalatine canal using cone-beam computed tomography. Imaging Sci Dent. 2013;43(4):273-281. doi:10.5624/isd.2013.43.4.273
2. Artzi Z, Nemcovsky CE, Bitlitum I, Segal P. Displacement of the incisive foramen in conjunction with implant placement in the anterior maxilla without jeopardizing vitality of nasopalatine nerve and vessels: a novel surgical approach. Clin Oral Implants Res. 2000;11(5):505-510. doi:10.1034/j.1600-0501.2000.011005505.x
3. Casado PL, Donner M, Pascarelli B, Derocy C, Duarte ME, Barboza EP. Immediate dental implant failure associated with nasopalatine duct cyst. Implant Dent. 2008;17(2):169-175. doi:10.1097/ID.0b013e3181776c52.4
4. Mardinger O, Namani-Sadan N, Chaushu G, Schwartz-Arad D. Morphologic changes of the nasopalatine canal related to dental implantation: a radiologic study in different degrees of absorbed maxillae. J Periodontol. 2008;79(9):1659-1662. doi:10.1902/jop.2008.080043
5. Kraut RA, Boyden DK. Location of incisive canal in relation to central incisor implants. Implant Dent. 1998;7(3):221-225. doi:10.1097/00008505-199807030-00010
6. Song WC, Jo DI, Lee JY, et al. Microanatomy of the incisive canal using three-dimensional reconstruction of micro CT images: An ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(4):583-590. doi:10.1016/j.tripleo.2009.06.036
7. Jacobs R, Lambrichts I, Liang X, et al. Neurovascularization of the anterior jaw bones revisited using high-resolution magnetic resonance imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(5):683-693. doi:10.1016/j.tripleo.2006.11.0148
8. Cavalcanti MG, Yang J, Ruprecht A, Vannier MW. Accurate linear measurements in the anterior maxilla using orthoradially reformatted spiral computed tomography. Dentomaxillofac Radiol. 1999;28(3):137-140. doi:10.1038/sj/dmfr/4600426

9. Besimo C, Lambrecht J, Nidecker A. Dental implant treatment planning with reformatted computed tomography. Dentomaxillofac Radiol. 1995;24(4):264-267. doi:10.1259/dmfr.24.4.9161173
10. Demiralp KÖ, Kurşun-Çakmak EŞ, Bayrak S, Sahin O, Atakan C, Orhan K. Evaluation of anatomical and volumetric characteristics of the nasopalatine canal in anterior dentate and edentulous individuals: A CBCT Study. Implant Dent. 2018;27(4):474-479. doi:10.1097/ID.0000000000000794.
11. Al-Amery SM, Nambiar P, Jamaludin M, John J, Ngeow WC. Cone beam computed tomography assessment of the maxillary incisive canal and foramen: considerations of anatomical variations when placing immediate implants. PLoSOne. 2015;10(2):e0117251. doi:10.1371/journal.pone.0117251
12. Angelopoulos C, Scarfe WC, Farman AG. A comparison of maxillofacial CBCT and medical CT. Atlas Oral Maxillofac Surg Clin North Am. 2012;20(1):1-17. doi:10.1016/j.cxom.2011.12.008.
13. Kraut R. Interactive CT diagnosis, planning and preparation for dental implants. Implant Dent. 1998;7(1):19-25. doi:10.1097/00008505-199804000-00002
14. Bahşi I, Orhan M, Kervancıoğlu P, Yalçın ED, Aktan AM. Anatomical evaluation of nasopalatine canal on cone beam computed tomography images. Folia Morphol (Warsz). 2019;78(1):153-162. doi:10.5603/FM.a2018.0062
15. Bornstein MM, Balsiger R, Sendi P, von Arx T. Morphology of the nasopalatine canal and dental implant surgery: a radiographic analysis of 100 consecutive patients using limited cone-beam computed tomography. Clin Oral Impl Res. 2011;22(3):295-301. doi:10.1111/j.1600-0501.2010.02010.x
16. Neves FS, Oliveira LK, Ramos Mariz AC, Crusoé-Rebello I, de Oliveira-Santos C. Rare anatomical variation related to the nasopalatine canal. Surg Radiol Anat. 2013;35(9):853-855. doi:10.1007/s00276-013-1089-1
17. Moya-Villaescusa MJ, Sánchez- Pérez A. Measurement of ridge alterations following tooth removal: A radiographic study in humans. Clin Oral Implants Res. 2010;21(2):237-242. doi:10.1111/j.1600-0501.2009.01831.x
18. Liang X, Jacobs R, Martens W, et al. Macro- and micro-anatomical, histological and computed tomography scan characterization of the nasopalatine canal. J Clin Periodontol. 2009;36(7):598-603. doi:10.1111/j.1600-051X.2009.01429.x.
19. Swanson KS, Kaugars GE, Gunsolley JC. Nasopalatine duct cyst: an analysis of 334 cases. J Oral Maxillofac Surg. 1991;49(3):268-271. doi:10.1016/0278-2391(91)90217-a
20. Kreidler JF, Raubenheimer EJ, Van Heerden WF. A retrospective analysis of 67 cystic lesions of the jaw–the Ulm experience. J Craniomaxillofac Surg. 1993;21(8):339-341. doi:10.1016/s1010-5182(05)80494-9