The Shape of Nasopalatine Canal as a Determining Factor in Therapeutic Approach for Orthodontic Teeth Movement—A CBCT Study

The aim of this study was to evaluate the impact of the nasopalatine canal (NPC) shape and its morphometric characteristics on expected teeth movement by assessing the distance to maxillary central incisors (MCIs) according to NPC type. The retrospective study was performed on 133 CBCT images. The following parameters were obtained: the antero-posterior diameter (A-P) of the nasal foramen (NF), canal length, A-P and mediolateral diameter (M-L) of the incisive foramen (IF), and the distance between NPC and MCIs. With the exception of being hourglass-shaped, each NPC shape showed specific impacts of NPC shape on the relationship between NPC diameters at different sections and distances to MCIs. In banana-shaped NPC, a significant correlation was observed for A-P NF diameter, while in cylindrical-shaped NPC, a significant correlation was observed for NPC length. The increase in M-L IF, A-P IF, A-P NF, and NPC length in funnel-shaped NPC may be a risk factor for interventions that could result in teeth movement. According to the results, it seems that the proposed methodological approach for analysis of CBCT slices in the anterior maxilla may offer detailed information that could be an additional tool in planning the procedures that result in expected teeth movement.

Anatomical Patterns of the Nasopalatine Canal and Incisive Foramen in an African Setting – a Cross-sectional Study

Purpose: Surgical procedures revolving around the anterior maxilla are of great interest due to their debilitating facial aesthetics and nerve injury effects if complications arise. Hence, sufficient knowledge concerning the morphology and morphometry of the nasopalatine canal (NPC) and incisive foramen (IF) is necessary to prevent such complications from arising. Materials and Methods: Measurements of the NPC and the IF were carried out on 150 CBCT scans. The maxillary bone thickness anterior to the NPC was measured at 3 levels. Independent t-test and chi-square test were performed to determine the presence of sexual dimorphism. Results: The presence of one Stenson’s foramen was most prevalent. The mean length of NPC was 13.21 ± 3.25 mm with significantly longer canals in males. The most prevalent shape of NPC was cylindrical in sagittal view and a single canal in coronal view. The mean angulation of NPC was 118.42° to the horizontal plane. The average dimensions of the IF were 3.53 mm and 3.07 mm in the anteroposterior and mediolateral diameter respectively while the most common shape was round. The anterior maxillary bone was thicker in males and generally reduced in thickness from the anterior nasal spine superiorly towards the alveolar crest inferiorly. Conclusion: This study highlights the anatomical characteristics of the NPC and IF, with significant sexual dimorphism observed regarding the number of Stenson’s foramina, length of NPC, shapes of the NPC and IF as well as alveolar bone thickness anterior to NPC.

The nasopalatine canal and its relationship with the maxillary central incisors: a cone-beam computed tomography study

Objective: To evaluate the dimensions of the nasopalatine canal (NPC) and its relationship with the maxillary central incisors (MCI) using cone-beam computed tomography (CBCT) and to determine variations in the NPC in relation to age and gender. Methods: CBCT scans from 333 patients (67% female; 35.9 ± 14.6 years) were included. The CBCT scan was analyzed to determine the length and diameter of the NPC, the distance between the NPC and the MCI, and to evaluate the morphology of the NPC. The data were analyzed using the independent Student's t-test, the Mann–Whitney and Kruskal–Wallis tests, and Dunn's post-test (p < 0.05). Results: The average diameter and length of the NPC were 2.92 ± 0.91 mm and 12.67 ± 3.32 mm, respectively. The minimum and maximum distance between the MCI and the NPC were 0.78 ± 0.42 mm and 2.56 ± 1.38 mm, respectively. The NPC of male patients was greater in length compared with the female patients (p < 0.05). The majority presented a funnel-like morphology (34.1%), followed by a cylindrical morphology (27.5%). Conclusions: There was variability in the dimensions of the NPC and its relationship with the MCI, which was influenced by gender and age.

Measurements of Dimensions of Nasopalatine Canal Using Cone Beam Computed Tomography in Patients Reporting to A Local Tertiary Care Dental Hospital in Lahore

Objective: To measure the mean length and width of NPC in patients reporting to Fatima Memorial hospital Lahore, for implant surgery. Methods: This crossectional study was conducted at Department of Periodontology, Fatima Memorial Hospital, Lahore. Fatima Memorial Hospital is a tertiary care dental hospital affiliated with University of Health Sciences. After taking informed written consent history was taken, clinical examination was done and CBCT from SIRONA CBCT machine will be taken to assess the outcome i.e the mean length and width of NPC. Result: Total of 72 patients requiring CBCT for dental procedures were included. 38 patients were males (52.8%) & 34 patients were females (47.2%) with the mean age of 40.944+7.507 years. The mean length and width of Nasopalatine canal (NPC) was 8.787+1.534 mm and 3.919+0.738 mm respectively. Conclusion: Significant differences in nasopalatine canal length and width were observed among the patients and CBCT was useful in determining nasopalatine canal length and width before implant placement Key words: Cone-Beam Computed Tomography; nasopalatine canal, length, width

Surgical Digitally Guided Planning for the Mini-Screw Assisted Rapid Palatal Expansion (MARPE) and Suture Perforation: MARPE Guide

The surgical planning digitally guided for the mini-screw assisted rapid palatal expansion (MARPE) technique consists of a three-dimensional positioning of MARPE and its mini-implants by a nasomaxillary anatomic evaluation. This technique also includes the simulation of the perforation areas on the midpalatal and transpalatal sutures. This type of planning is performed by superimposing the patients’ files (STL and DICOM). Correct positioning without colliding with the lateral tissues of the palate and the bicortical positioning of each mini-implant are important components of the case study. The MARPE device permits individualization of the height of the mini-implant rings in each region. To avoid incorrect insertion of the drill, the location of the midpalatal and transpalatal sutures was determined using digital planning. A positioning that avoids contact with important structures, such as the nasopalatine canal, while permitting bicortical drilling of the sutures is recommended. Then, a guide that reproduces MARPE positioning and another guide that reproduces the perforations are fabricated, providing exact reproducibility as performed virtually.

Supernumerary tooth in nasopalatine canal: a rare cause of septal cartilage collapse

Mesiodens is the most common type of supernumerary tooth, located between the maxillary central incisors in close relation to the nasopalatine canal. A 20-year-old man presented with right-sided nasal blockage, nasal discharge and collapsed nose without history of trauma. Imaging revealed a calcified mass in the inferior meatus extending into dilated nasopalatine canal. Endoscopic removal of the mass revealed tuberculate appearance of an incompletely developed tooth, consistent with mesiodens. Based on the history of septal cartilage collapse with right-sided mucopurulent discharge, endoscopic findings of the right inferior turbinate being adherent to the septal cartilage and the underlying mesiodens, we believe that the patient developed a septal abscess secondary to infection in nasal mucosa surrounding the mesiodens causing collapse of septal cartilage. While a tooth or tooth-like mass causing nasal passage air-flow obstruction is uncommon, we believe that this is the first reported case of mesiodens presenting with septal cartilage collapse.

Morphological and Morphometric Characteristics of Anterior Maxilla Accessory Canals and Relationship with Nasopalatine Canal Type—A CBCT Study

This study aimed to evaluate principal morphological and morphometric characteristics of accessory canals (ACs) of the anterior maxilla, as well as to analyze the relationship with nasopalatine canal (NPC) type. The results of our study showed that ACs were observed in almost 50% of participants. They were mostly presented bilaterally and in a curved shape, with a palatal foramen position. The morphometric characteristics of ACs were significantly influenced by NPC type. NPC type had the strongest impact on the distance between the NPC and AC, as well as on the distance between the AC and the facial aspect of buccal bone wall, in inferior parts of the alveolar ridge. On the other hand, the distance between the AC and central incisors was not significantly influenced by NPC shape in the lower region of the anterior maxilla. However, the participants with the banana-type of the NPC expressed the reduction in distance from the AC to the central incisor at the upper part in comparison with the subjects with the cylindrical-type of the NPC. On the basis of the results of this study, the simultaneous estimation of ACs and the NPC seems reasonable, as this approach may be useful in the prevention of complications which could occur during implant surgery interventions.

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.