Assessment of the Canalis Sinuosus on Cone-Beam Computed Tomography: Implications for Dental Implant Placement

Year 2025, Volume: 26 Issue: 3 , 54 - 68 , 28.09.2025

Hamide Dursun Zahitovic Emrah Bilen

https://izlik.org/JA76YY24XU

Abstract

Aim: The aim of this study was to determine the surgical procedure limits for anterior maxilla implant placement by evaluating the canalis sinuosus (CS) and its adjacents.
Methods: In this study, 400 CBCT images were screened for the presence of the canalis sinuosus. Detailed morphometric measurements were performed only in patients in whom the canal was identified (n = 42), and the images were evaluated in the coronal, sagittal, and axial sections. The relationship between the CS and the incisive canal (IC), buccal bone (BB), buccal crest tip and nasal cavity (NC) was examined. The ratios of these relationships were evaluated according to age (18-50 years, 51-75 years), gender and dental arch toothed or edentulous. In the statistical evaluation of the findings obtained in the study, IBM SPSS.25 program was used in all analyzes, and a p<0.05 value was accepted as the level of significance.
Results: It was found that the incidence of CS was not significantly related to the presence of teeth in the dental arch and gender, but increased with advanced age. The CS-IC distance was greater in patients with teeth and in the 18-50 age group. The relationship between the CS and its neighbors was not dependent on age and gender, but the CS-ARC and NC-ARC distances increased with the presence of teeth.
Conclusion: It has been found that CS can be seen frequently in the maxilla and is adjacent to important anatomical structures. Since cases of canalis sinuosus have been reported in the literature as the cause of persistent pain that does not pass after implant surgery placed in this area, it is very important for dentists to evaluate this structure in detail before surgical procedures in this area for a successful treatment protocol.

Keywords

Canalis sinuosus , dental implant , maxilla

References

• 1. Von Arx T, Lozanoff S, Sendi P, Bornstein MM. Assessment of bone channels other than the nasopalatine canal in the anterior maxilla using limited cone-beam computed tomography. Surg Radiol Anat. 2013;35(9):783–790.
• 2. Tomrukçu DN, Köse TE. Assessment of accessory branches of the canalis sinuosus on CBCT images. Med Oral Patol Oral Cir Bucal. 2020;25(1):e124–e130.
• 3. Orhan K, Gorurgoz C, Akyol M, Ozarslanturk S, Avsever H. An anatomical variant: evaluation of accessory canals of the canalis sinuosus using cone-beam computed tomography. Folia Morphol (Warsz). 2018;77(3):551–557.
• 4. Jones FW. The anterior superior alveolar nerve and vessels. J Anat. 1939;73(Pt 4):583–591.
• 5. Shintaku WH, Ferreira CF, Venturin JF. Invasion of the canalis sinuosus by dental implants: a report of three cases. Imaging Sci Dent. 2020;50(4):353–357.
• 6. Maló P, Rangert B, Nobre M. “All-on-Four” immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 2003;5(Suppl 1):2–9.
• 7. Jensen OT, Adams MW, Cottam JR, Parel SM, Phillips WR. The All-on-4 Shelf: Maxilla. J Oral Maxillofac Surg. 2010;68(10):2520–2527.
• 8. Allareddy V, Vincent SD, Hellstein JW. Incidental findings on cone beam computed tomography images. Int J Dent. 2012;2012:8715.
• 9. 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 Implants Res. 2011;22(3):295–301.
• 10. Wanzeler AMV, Marinho CG, Alves SM Jr, Manzi FR, Tuji FM. Anatomical study of canalis sinuosus in 100 cone beam computed tomography examinations. Oral Maxillofac Surg. 2015;19(1):49–53.
• 11. Manhães LRC Jr, Villaça-Carvalho MF, Moraes ME, Lopes SL, Silva MB, Junqueira JL. Location and classification of canalis sinuosus for cone beam computed tomography: avoiding misdiagnosis. Braz Oral Res. 2016;30(1):e49.
• 12. Volberg R, Mordanov O. Canalis sinuosus damage after immediate dental implant placement in the esthetic zone: case report. Case Rep Dent. 2019;2019:3462794
• 13. Oliveira-Santos C, Souza PH, Berti-Couto SA, Stinkens L, Moyaert K, Van Assche N. Characterisation of additional mental foramina through cone beam computed tomography. J Oral Rehabil. 2011;38(11):595–600.
• 14. Machado VC, Chrcanovic BR, Felippe MB, Manhães Júnior LRC, de Carvalho PSP. Assessment of accessory canals of the canalis sinuosus: a study of 1000 cone beam computed tomography examinations. Int J Oral Maxillofac Surg. 2016;45(12):1586–1591.
• 15. 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(9):751–755.
• 16. McCrea SJJ. Aberrations causing neurovascular damage in the anterior maxilla during dental implant placement. Case Rep Dent. 2017;2017:5969643.
• 17. Shelley AM, Rushton VE, Horner K. Canalis sinuosus mimicking a periapical inflammatory lesion. Br Dent J. 1999;186(8):378–379.
• 18. Aoki R, Massuda M, Zenni LTV, Fernandes KS. Canalis sinuosus: anatomical variation or structure? Surg Radiol Anat. 2019;42(1):69–74.
• 19. Sones AD. Complications with osseointegrated implants. J Prosthet Dent. 1989;62(5):581–585.
• 20. Torres MGG, de Faro Valverde L, Vidal MTA, et al. Branch of the canalis sinuosus: a rare anatomical variation—a case report. Surg Radiol Anat. 2015;37(7):879–881.
• 21. Gürler G, Delilbaşı Ç, Oğur EE, Aydın K, Sakul Ü. Evaluation of the morphology of the canalis sinuosus using cone-beam computed tomography in patients with maxillary impacted canines. Imaging Sci Dent. 2017;47(2):69–74.
• 22. Etöz M, Yılmaz S. Anterior palatal açıklığı olan canalis sinuosus varyasyonları. Turkiye Klinikleri J Dent Sci. 2019;25(3):241–247.
• 23. Ghandourah AO, Rashad A, Heiland M, Hamzi BM, Friedrich RE. Cone-beam tomographic analysis of canalis sinuosus accessory intraosseous canals in the maxilla. GMS Ger Med Sci. 2017;15:Doc01.
• 24. Shan T, Qu Y, Huang X, Gu L. Cone beam computed tomography analysis of accessory canals of the canalis sinuosus: A prevalent but often overlooked anatomical variation in the anterior maxilla. J Prosthet Dent. 2021;126(4):565–571.
• 25. Caparlar O, Donmez A. What is scientific research and how can it be done? Turk J Anesth Reanim. 2016;44(4):212–218.
• 26. Mann CJ. Observational research methods. Research design II: cohort, cross-sectional, and case-control studies. Emerg Med J. 2003;20(1):54–60.