Evaluation of a possible association between a history of dentoalveolar injury and the shape and size of the nasopalatine canal
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Maxillary incisors (MI) are often affected by dentoalveolar injury resulting in tooth devitalization and apical periodontitis. The aim of the present study was to analyze any association between a history of dentoalveolar injury and the shape and size of the nasopalatine canal (NC) using cone beam computed tomography (CBCT).
Material and methods
Patients were allocated to the trauma group if they had a history of dentoalveolar injury and a root filling in at least one MI and/or one missing MI. As controls, 100 matched-controlled (age and gender) patients were selected. NC dimensions including length, width at midway, and diameter of incisal and nasal foramen were measured in sagittal and axial CBCT planes. Furthermore, an evaluation of NC bulging signs, apical osteolysis of MI, and its fusion with NC was performed.
In the trauma group (n = 96), 31.3 % had at least one missing MI, and 95.8 % had a root filling in a MI. The antero-posterior dimension of the incisive foramen (p = 0.02) and of the NC at midway (p = 0.04) was significantly larger in the trauma group. Significantly more cases with a bulging sign were found in the trauma (n = 19) than in the control group (n = 3, p = 0.001). An apical osteolysis was identified in 5.1 % of MI, and 12/38 did show a fusion with the NC.
Wider dimensions of the NC and a bulging sign may suggest a former dentoalveolar injury to the anterior maxilla. Periapical osteolysis of central MI over 5 mm in diameter tends to fuse with the NC.
In patients with a history of dentoalveolar injury and/or apical periodontitis, the NC should be evaluated on available CBCT images. Any inflammatory processes in the neighboring teeth should be recognized and eliminated as they may initiate bulging of the NC and/or the formation of a nasopalatine duct cyst (NPDC). NC with bulging signs should be monitored clinically and radiographically to diagnose a NPDC in an early stage.
KeywordsAnterior maxilla Nasopalatine canal Incisive canal Incisive foramen Periapical lesion Cone beam computed tomography Dentoalveolar injury
The authors thank Mr. Lukas Martig, Institute of Mathematical Statistics and Actuarial Science, University of Bern, for his assistance during the statistical analysis and Mrs. Bernadette Rawyler, medical illustrator, School of Dental Medicine, University of Bern, for the preparation of Figs. 1, 2, and 4.
The study protocol was submitted and reviewed by the local ethical committee of the University Hospitals Leuven (S57587) but was exempt from formal approval due to its retrospective nature.
Conflict of interest
The authors declare that they have no competing interests.
- 4.Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, Kenny DJ, Sigurdsson A, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Tsukiboshi M, International Association of Dental Traumatology (2012) International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 28:88–96CrossRefPubMedGoogle Scholar
- 5.Di Angelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Pohl Y, Tsukiboshi M, International Association of Dental Traumatology (2012) International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 28:2–12CrossRefGoogle Scholar
- 13.Fernández-Alonso A, Suárez-Quintanilla JA, Muinelo-Lorenzo J, Bornstein MM, Blanco-Carrión A, Suárez-Cunqueiro MM (2014) Three-dimensional study of nasopalatine canal morphology: a descriptive retrospective analysis using cone-beam computed tomography. Surg Radiol Anat 36:895–905Google Scholar
- 21.Acar B, Kamburoğlu K (2015) Morphological and volumetric evaluation of the nasopalatinal canal in a Turkish population using cone-beam computed tomography. Surg Radiol Anat 37:259–265Google Scholar
- 24.Suter VG, Sendi P, Reichart PA, Bornstein MM (2011) The nasopalatine duct cyst: an analysis of the relation between clinical symptoms, cyst dimensions, and involvement of neighboring anatomical structures using cone beam computed tomography. J Oral Maxillofac Surg 69:2595–2603CrossRefPubMedGoogle Scholar
- 25.Suter VGA, Warnakulasuriya S, Reichart PA, Bornstein MM (2015) Radiographic volume analysis as a novel tool to determine nasopalatine duct cyst dimensions and its association with presenting symptoms and postoperative complications. Clin Oral Invest. doi: 10.1007/s00784-014-1391-2
- 28.European Commission. Radiation Protection No 172. Cone beam CT for dental and maxillofacial radiology. Evidence-based guidelines (2012). http://www.sedentexct.eu/files/radiation_protection_172.pdf [accessed on May 12, 2015]
- 30.Pauwels R. Cone beam CT for dental and maxillofacial imaging: dose matters (2015). Radiat Prot Dosimetry 165:156–161Google Scholar