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Hindawi Radiology Research and Practice Volume 2019, Article ID 6151253, 5 pages https://doi.org/10.1155/2019/6151253 Research Article Maxillary Incisive Canal Characteristics: A Radiographic Study Using Cone Beam Computerized Tomography 1 2 Penala Soumya , Pradeep Koppolu , 3 4 Krishnajaneya Reddy Pathakota, and Vani Chappidi Department of Dentistry, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India Department of Preventive Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia Department of Peroiodontics, Sri Sai College of Dental Surgery, Vikarabad, India Department of Oral Medicine and Radiology, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India Correspondence should be addressed to Penala Soumya; firstname.lastname@example.org Received 1 November 2018; Accepted 5 March 2019; Published 27 March 2019 Academic Editor: Paul Sijens Copyright © 2019 Penala Soumya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. eTh incisive canal located at the midline, posterior to the central incisor, is an important anatomic structure of this area to be considered while planning for immediate implant placement in maxillary central incisor region. The purpose of the present study is to assess incisive canal characteristics using CBCT sections. Materials and Methods. CBCT scans of 79 systemically healthy patients, with intact maxillary incisors, were evaluated by two calibrated and independent examiners. Assessments included (1) mesiodistal diameter, (2) labiopalatal diameter, (3) length of the incisive canal, (4) shape of incisive canal, and (5) width of the bone anterior to the incisive foramen. Results. eTh mean width of the foramen labiopalatally and mesiodistally was 3.12 ± 0.94 mm and 3.23± 0.98 mm, respectively. Mean canal length was 18.63± 2.35 mm and males have significantly longer incisive canal than females. The mean width of bone anterior to the incisive canal was 6.32 ± 1.43 mm. As age of the subjects increased, incisive foramen diameter and incisive canal length were found to be increased. Cylindrical shaped incisive canals were seen in most of the individuals followed by funnel shaped and hour-glass shaped canals, and banana-like canal is least prevalent type. Conclusion. eTh findings from the present study suggest that the diameter and length of incisive canal vary among different individuals and presence of very thin bone anterior to the canal would suggest that a pretreatment CBCT scan is a valuable tool to evaluate anatomic variations, morphology, and dimensions of incisive foramen before immediate implant placement in maxillary central incisor region. 1. Introduction incisive canal shape as cylindrical, funnel like, banana like, and hour-glass like. Size, shape, position, and number of Immediate implant placement is gaining much of clinical foramina vary in different individuals. Presence of wider importance in recent years and requires a thorough knowl- foramina andthinalveolarboneanteriortothecanalmay edge of important anatomic structures in concerned area. make an implant placement almost impossible in this area. Implant placement in maxillary central incisor region is oen ft Careful evaluation and planning are necessary before an challenging due to anatomical variations in dimensions of immediate implant placement in anterior maxilla. Clinically incisive canal and foramen. Incisive canal has two openings: sound and sophisticated radiograph techniques such as den- incisive foramen and nasopalatine foramen . eTh nasopala- tal CTs can assist in diagnosing deficiencies. Preoperative tine nerves and vessels traverse through this canal. Placement CBCT of maxillary incisor region helps in diagnosing any of implant into incisive canal results in nervous tissue injury, anatomical difficulties before proceeding with an implant sensory dysfunction, and nonosseointegration of implant. placement. CBCT is noninvasive, has high resolution, low Several morphological alterations in the incisive canal dose of radiation, and financial advantage, and allows full 3D shape have been described; Mardinger et al.  classified characterization of alveolar bone. 2 Radiology Research and Practice (a) Sagittal section showing mea- (b) Axial section showing measurement of mesiodistal surement of labiopalatal width of width of incisive foramen incisive foramen (c) Sagittal section showing measurement of (d) Sagittal section showing measure- length of incisive canal ment of width of labial bone anterior to the incisive canal Figure 1 The aim of this study was to determine maxillary incisive 2.1. Interexaminer Calibration. Two observers were cali- canal characteristics in relation to the maxillary central brated using 10 randomly selected scans. An assessment incisors using CBCT images. of the reproducibility of measurement between observers measuring the same quantity to one-tenth of a millimeter was calculated at a correlation of 0.95 for the 10 scans. Each of the 2. Materials and Methods two observers measured 79 scans independently at the exact Hundred systemically healthy dentulous and/or partially same slice and magnification. edentulous patients (53 males and 47 females) aged between 17 and 72 years (with a mean age of 42.7 years) scheduled 2.2. Parameters Evaluated. The following characteristics of for implant insertion in different dental clinics in Hyderabad incisive were evaluated: were included in the study. Written informed consent was obtained from all the patients and the Ethical Committee of (1) Width of the nasopalatine canal labiopalatally and SriSaiCollegeofDentalSurgeryapprovedthisstudy.Subjects mesiodistally (Figures 1(a) and 1(b)) with missing maxillary incisors, with evident nasopalatine (2) Length of the canal (Figure 1(c)) pathology, and images with poor quality are excluded. All CBCT scans were obtained with 1 mm slice thickness (3) Width of the bone anterior to the canal (Figure 1(d)) and the tomographic scanner CS 9000C 3D CBCT scanner with exposure settings of 120 kV, 15 mA, and 12-inch field of (4) Shape of the canal (Figures 2(a)–2(d)) view wasusedtoobtainCBCTscan.Asoftware program, Care stream 3D Imaging software, was used to reconstruct Comparison of characteristics between males and females the images and perform the measurements. and correlation with age is done. Radiology Research and Practice 3 (a) Funnel shaped incisive canal in sagittal (b) Hour-glass shaped incisive canal in sagittal view view (c) Cylindrical shaped incisive canal in sagittal (d) Banana-like incisive canal in sagittal view view Figure 2 3. Statistical Analysis Table 1: Demographic variables and descriptive statistics of 79 individuals. Mean and standard deviations (SD) were calculated for all the Descriptive statistics Mean± SD variables. All statistical analysis was performed using SPSS Age 42.36± 16.44 years version 18.0. Independent sample t test was used to compare Canal length 18.63± 2.35 mm the incisive canal characteristics between male and female Mesiodistal width 3.23± 0.98 mm subjects. Analysis of variance (ANOVA) was used to evaluate Labiopalatal width 3.12± 0.94 mm theinufl enceofage on theincisivecanal characteristics. A Width of the bone anterior to the canal 6.32± 1.43 mm pvalue<0.05 was considered to be statistically significant andapvalue<0.001 is considered to be highly statistically significant. When the inu fl ence of age on the canal length was assessed, it was observed to be increasing with age. Younger 4. Results individuals are found to have significantly smaller length of Initially CT scans of 100 patients were assessed, of which 21 incisive canal when compared to older individuals and this were excluded. A total of 79 scans were evaluated for the was found to be statistically significant (Table 2). When males determined parameters. Mean length of canal was 18.63± and females were compared, i.e., when the effect of gender 2.35 mm. Mean diameter of the nasopalatine canal mesiodis- was evaluated, there was no significant difference between tally was 3.23 ± 0.98 mm, and labiopalatally it was 3.12 ± male and female subjects (Table 2). 0.94 mm. Mean width of the bone anterior to the foramen was When the eeff ct of age on the diameter of incisive canal foundtobe6.32± 1.43 mm (Table 1). was evaluated, there was a statistically significant (p <0.05) 4 Radiology Research and Practice Table 2: Comparison of incisive canal characteristics according to age using ANOVA. Parameter <30 years (n=23) 31-50 (n=23) >50 (n=33) p value Canal length 14.7± 1.41 16.93± 1.25 19.13± 1.61 <0.0001 Mesiodistal width 3± 0.75 2.92± 0.89 3.71± 1.07 0.003 Labiopalatal width 2.81± 0.98 2.86± 0.87 3.6± 0.83 0.001 Width of the bone anterior to the canal 6.73± 1.67 6.3± 1.33 6.02± 1.34 0.2 Values are presented as mean± standard deviation. Statistically significant difference between the age groups. Table 3: Comparison of incisive canal characteristics between male of 10.86 ± 2.67. Liang et al.  examined 120 spiral CTs and female subjects. and found a length of 9.9 ± 2.6 mm. Song et al.  have demonstrated that mean length of canal in dentate maxillae Male (n=43) Female (n=36) p value Parameter is 12 mm (8.4 mm to 15.6 mm). Mraiwa et al.  reported a 19.07± 1.09 18.38± 2.87 0.72 Canal length mean length of 8.1± 3.4 mm. The longer incisive canal length 3.25± 1.05 3.21± 0.92 0.42 Mesiodistal width seen in the present study compared to other studies can be 3.23± 0.89 2.99± 1.0 0.13 attributed to variations in the anatomical characteristics in Labiopalatal width Indian population. Width of the bone anterior 6.50± 1.52 6.10± 1.32 0.11 Mean canal diameter measured 3.23± 0.98 mm and 3.12 to the canal ± 0.94 mm, mesiodistally and labiopalatally, respectively. In Values are presented as mean± standard deviation. a similar study Tozum et al.  measured mean foramen diameter at two different points, i.e., superior and inferior increase in diameter of incisive foramen both labiopalatally orifice, and it was found to be 2.76 ± 1.40 mm and 2.93± 1.01 mm. In the present study foramen width was measured and mesiodistally (Table 2) and when effect of gender was evaluated, there was no significant difference between males in two different CBCT sections (axial and sagittal sections) and females (Table 3). and the measurements were comparatively larger than Tozum et al.study; thiscanbeattributedtovariationsinthe Bone width anterior to the canal was in the range of 4to10.4mmwithameanwidthof6.32± 1.43 mm; when anatomical characteristics in Indian population. different age groups were compared, with increasing age there Immediate implant placement is advantageous as it decreases the time elapse between tooth loss and restoration seems to be a decrease in mean width of bone anterior to the incisive canal, although it was not statistically significant and reduces the number of surgical procedures. Initial stabil- ity of an implant placed in maxillary incisor area is primarily (p=0.2) (Table 2). Male subjects had a mean bone width of 6.50± 1.52 mm dependent on the width of the bone anterior to the canal and and female subjects had a width of 6.10± 1.32 mm anterior length of the bone apical to the roots. Although augmentation procedurescanbedonetomodifythewidthofboneanterior to the incisive canal. Females had a thin bone plate anterior to the incisive canal when compared to males, which was not to the canal, it is a determinant of dimensions of implant statistically signicfi ant (Table 1). in that area. In the present study width of bone anterior to the canal was found to be 6.32± 1.43 mm. This value is in Of the79scans evaluatedmostprevalentshapeofthe canal was found to be cylindrical followed by funnel shaped accordance with Tozum et al.  study, where they have found canal, hour-glass like canal, and banana-like canals (Figures ameanwidthof 7.38± 1.42 mm. In the present study no signicfi ant correlation was 2(a)–2(d)). detected between gender and incisive canal characteristics. Many studies have reported gender influence on incisive 5. Discussion canal characteristics (Mraiwa et al. , Mardinger et al. , Liangetal. ,Song et al.,Bornsteinet al.,Kovisto Close proximity of incisive canal to maxillary central incisor et al. , and Tozum et al. ). Mraiwala et al.  found region and a thin anterior labial bone may sometimes hamper no significance relation between gender and incisive canal the immediate implant placement or one may end up in characteristics, which is in accordance with the present study. encroachment of the canal leading to sensory dysfunction Bornstein et al.  found higher canal length in males when and nonosseointegration. Careful planning and evaluation compared to females. Liang et al.  reported greater canal using CBCT help in diagnosing such anatomical deficiencies. length and width in males when compared to female subjects. Several studies mentioned the anatomic features of this Guncu et al.  examined CTs of 417 male and 516 female area. In the present study incisive canal characteristics were patients and concluded that there are statistically signicfi ant measured usingCBCTsections. To thebestofthe authors' gender related differences in anatomical features of incisive knowledge this was the first study evaluating the incisive canal like canal length, diameter, and bone thickness anterior canal characteristics using CBCT sections in Indian subjects. Mean canal length was found to be 18.63 ± 2.35 mm, to the incisive canal. Ageofthepatienthadasignicfi antinufl enceonthelength which is longer when compared to other studies. Tozum et al.  in their multicentered trial found a mean canal length of the incisive canal and diameter of incisive foramen; with Radiology Research and Practice 5 increasing age there was an increase in incisive canal length Conflicts of Interest and diameter of incisive foramen. Similarly, Bornstein et al. No potential conflicts of interest relevant to this article were  reported that age of the subjects had a significant influence reported. on the length of the incisive canal. However, Tozum et al.  andMriawaetal.couldnotfindanyrelationbetween age and incisive canal characteristics. References Incisive canal morphology was classified in various ways.  W.-C. Song, D.-I. Jo, J.-Y. Lee et al., “Microanatomy of the inci- Mardingeretal. classiefi d theshapeoftheincisivecanals sive canal using three-dimensional reconstruction of microCT based on how they look in cross sectional view of CBCT images: an ex vivo study,” Oral Surgery, Oral Medicine, Oral scans into cylindrical, funnel shaped, hour-glass shaped, and Pathology, Oral Radiology, and Endodontology,vol.108,no. 4, banana-like canals. In the present study the most predomi- pp. 583–590, 2009. nant shape of the canal was cylindrical shaped followed by  O. Mardinger, N. Namani-Sadan, G. Chaushu, and D. Schwartz- funnel shaped, hour-glass shaped, and banana-like. eTh se Arad, “Morphologic changes of the nasopalatine canal related results are in accordance with Guncu et al. study  in which to dental implantation: a radiologic study in different degrees the predominant canal shape was cylindrical; they further of absorbed maxillae,” JournalofPeriodontology,vol.79,no.9, analyzed percentage of different shapes of incisive canal in pp.1659–1662,2008. males and females. Similarly Kajan et al.  reported pre-  T.F.Toz ¨ um, ¨ G. N. Gunc ¨ u, ¨ Y. D. Yildirim et al., “Evaluation dominance of cylindrical shaped incisive canal. In contrast of maxillary incisive canal characteristics related to dental to these studies Etoz et al.  examined 500 CBCT scans implant treatment with computerized tomography: a clinical of dentate patients and found predominance of hour-glass multicenter study,” Journal of Periodontology,vol.83, no.3,pp. 337–343, 2012. shaped incisive canals.  X. Liang, R. Jacobs, W. Martens et al., “Macro- and micro- In edentulous patients with severe atrophic maxilla, anatomical, histological and computed tomography scan char- invasive procedures like removal of neurovascular bundle acterization of the nasopalatine canal,” JournalofClinical fromtheincisivecanalandsubsequentgraftingoftheincisive Periodontology,vol.36, no.7,pp. 598–603, 2009. canal, followed by placement of dental implants, have been  N. Mraiwa, R. Jacobs, J. Van Cleynenbreugel et al., “eTh presented [11, 12]. A recent clinical study proposed removal of nasopalatine canal revisited using 2D and 3D CT imaging,” neurovascular bundle from the incisive canal and subsequent Dentomaxillofacial Radiology,vol.33, no.6,pp. 396–402,2004. placement of implant in seven patients, with only few patients  M. M. Bornstein, R. Balsiger, P. Sendi, and T. Von Arx, experiencing minor complications . “Morphology of the nasopalatine canal and dental implant This signifies the importance of assessing incisive fora- surgery: a radiographic analysis of 100 consecutive patients men characteristics before planning for implant placement; using limited cone-beam computed tomography,” Clinical Oral a clinician requires a thorough knowledge of incisive canal Implants Research, vol. 22, no. 3, pp. 295–301, 2011. anatomical variations. CBCT is an advanced diagnostic aid  T.Kovisto,M.Ahmad,andW.R. Bowles,“Proximity ofthe which helps in diagnosing anatomical difficulties before mandibular canal to the tooth apex,” Journal of Endodontics,vol. planning for implant placement in maxillary incisor area. 37, no. 3, pp. 311–315, 2011.  G. N. Gunc ¨ u, ¨ Y. D. Yildirim, H. G. Yilmaz et al., “Is there a gender difference in anatomic features of incisive canal and maxillary environmental bone?” Clinical Oral Implants 6. Conclusion Research,vol.24, no.9,pp. 1023–1026,2013.  Z.D.Kajan,J.Kia,S.Motevasseli,andS. R.Rezaian,“Evaluation Within the limitations of the study, the present study sug- of the nasopalatine canal with cone-beam computed tomogra- gests that the diameter and length of incisive canal vary phy in an Iranian population,” Dental Research Journal,vol.12, among different individuals and presence of very thin bone no. 1, pp. 14–19, 2015. anterior to the canal would suggest that a pretreatment  M. Etoz and Y. Sisman, “Evaluation of the nasopalatine canal CBCT scan is a valuable tool to evaluate anatomic variations, and variations with cone-beam computed tomography,” Surgi- morphology, and dimensions of incisive foramen before cal and Radiologic Anatomy,vol.36,no.8,pp.805–812,2014. immediate implant placement in maxillary central incisor  J. B. Rosenquist and E. Nystrom, ¨ “Occlusion of the incisal region. Findings from this study suggest that age has a canal with bone chips. A procedure to facilitate insertion of significant influence over incisive canal characteristics. implants in the anterior maxilla,” International Journal of Oral and Maxillofacial Surgery, vol. 21, no. 4, pp. 210-211, 1992.  Z. Artzi, C. E. Nemcovsky, I. Bitlitum, and P. Segal, “Dis- Data Availability placement of the incisive foramen in conjunction with implant placement in the anterior maxilla without jeopardizing vitality ed Th ata usedtosupportthefindingsofthisstudy are of nasopalatine nerve and vessels: a novel surgical approach,” available from the corresponding author upon request. Clinical Oral Implants Research,vol.11,no.5,pp. 505–510, 2000.  M. Pen˜arrocha, C. Carrillo, R. Uribe, and B. Garc´ıa, “The nasopalatine canal as an anatomic buttress for implant place- ment in the severely atrophic maxilla: a pilot study,” The Disclosure International Journal of Oral & Maxillofacial Implants,vol.24, no.5,pp. 936–942, 2009. This study is self-funded. 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Published: Mar 27, 2019
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