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Clinical Oral Investigations

, Volume 20, Issue 3, pp 553–561 | Cite as

Evaluation of a possible association between a history of dentoalveolar injury and the shape and size of the nasopalatine canal

  • Valerie G. A. Suter
  • Reinhilde Jacobs
  • Marcia R. Brücker
  • Alberto Furher
  • Jim Frank
  • Thomas von Arx
  • Michael M. Bornstein
Original Article
  • 378 Downloads

Abstract

Objectives

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.

Results

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.

Conclusion

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.

Clinical relevance

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.

Keywords

Anterior maxilla Nasopalatine canal Incisive canal Incisive foramen Periapical lesion Cone beam computed tomography Dentoalveolar injury 

Notes

Acknowledgments

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.

Ethical approval

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.

References

  1. 1.
    Kaste LM, Gift HC, Bhat M, Swango PA (1996) Prevalence of incisor trauma in persons 6-50 years of age: United States, 1988-1991. J Dent Res 75(Spec Iss):696–705PubMedGoogle Scholar
  2. 2.
    Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM (1995) Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications. Endod Dent Traumatol 11:51–58CrossRefPubMedGoogle Scholar
  3. 3.
    Hermann NV, Lauridsen E, Ahrensburg SS, Gerds TA, Andreasen JO (2012) Periodontal healing complications following extrusive and lateral luxation in the permanent dentition: a longitudinal cohort study. Dent Traumatol 28:394–402CrossRefPubMedGoogle Scholar
  4. 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. 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
  6. 6.
    Liang X, Jacobs R, Martens W, Hu Y, Adriaensens P, Quirynen M, Lambrichts I (2009) Macro- and micro-anatomical, histological and computed tomography scan characterization of the nasopalatine canal. J Clin Periodontol 36:598–603CrossRefPubMedGoogle Scholar
  7. 7.
    Song WC, Jo DI, Lee JY, Kim JN, Hur MS, Hu KS, Kim HJ, Shin C, Koh KS (2009) Microanatomy of the incisive canal using three-dimensional reconstruction of microCT images: an ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:583–590CrossRefPubMedGoogle Scholar
  8. 8.
    de Oliveira-Santos C, Souza PH, de Azambuja B-CS, Stinkens L, Moyaert K, Rubira-Bullen IR, Jacobs R (2012) Assessment of variations of the mandibular canal through cone beam computed tomography. Clin Oral Investig 16:387–393CrossRefPubMedGoogle Scholar
  9. 9.
    de Oliveira-Santos C, Rubira-Bullen IR, Monteiro SA, León JE, Jacobs R (2013) Neurovascular anatomical variations in the anterior palate observed on CBCT images. Clin Oral Implants Res 24:1044–1048PubMedGoogle Scholar
  10. 10.
    von Arx T, Fodich I, Bornstein MM (2014) Proximity of premolar roots to maxillary sinus: a radiographic survey using cone-beam computed tomography. J Endod 40:1541–1548CrossRefGoogle Scholar
  11. 11.
    Mraiwa N, Jacobs R, Van Cleynenbreugel J, Sanderink G, Schutyser F, Suetens P, van Steenberghe D, Quirynen M (2004) The nasopalatine canal revisited using 2D and 3D CT imaging. Dentomaxillofac Radiol 33:396–402CrossRefPubMedGoogle Scholar
  12. 12.
    Bornstein MM, Balsiger R, Sendi P, von Arx T (2011) 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 22:295–301CrossRefPubMedGoogle Scholar
  13. 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
  14. 14.
    Etoz M, Sisman Y (2014) Evaluation of the nasopalatine canal and variations with cone-beam computed tomography. Surg Radiol Anat 36:805–812CrossRefPubMedGoogle Scholar
  15. 15.
    Meghji S, Qureshi W, Henderson B, Harris M (1996) The role of endotoxin and cytokines in the pathogenesis of odontogenic cysts. Arch Oral Biol 41:523–531CrossRefPubMedGoogle Scholar
  16. 16.
    Main DM (1970) Epithelial jaw cysts: a clinicopathological reappraisal. Br J Oral Surg 8:114–125CrossRefPubMedGoogle Scholar
  17. 17.
    Allard RH, van der Kwast WA, van der Waal I (1981) Nasopalatine duct cyst. Review of the literature and report of 22 cases. Int J Oral Surg 10:447–461CrossRefPubMedGoogle Scholar
  18. 18.
    Abrams AM, Howell FV, Bullock WK (1963) Nasopalatine cysts. Oral Surg Oral Med Oral Pathol 16:306–332CrossRefPubMedGoogle Scholar
  19. 19.
    Mealey BL, Rasch MS, Braun JC, Fowler CB (1993) Incisive canal cysts related to periodontal osseous defects: case reports. J Periodontol 64:571–574CrossRefPubMedGoogle Scholar
  20. 20.
    Tsuneki M, Maruyama S, Yamazaki M, Abé T, Adeola HA, Cheng J, Nishiyama H, Hayashi T, Kobayashi T, Takagi R, Funayama A, Saito C, Saku T (2013) Inflammatory histopathogenesis of nasopalatine duct cyst: a clinicopathological study of 41 cases. Oral Dis 19:415–424CrossRefPubMedGoogle Scholar
  21. 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
  22. 22.
    Mardinger O, Namani-Sadan N, Chaushu G, Schwartz-Arad D (2008) Morphologic changes of the nasopalatine canal related to dental implantation: a radiologic study in different degrees of absorbed maxillae. J Periodontol 79:1659–62CrossRefPubMedGoogle Scholar
  23. 23.
    Thakur AR, Burde K, Guttal K, Naikmasur VG (2013) Anatomy and morphology of the nasopalatine canal using cone-beam computed tomography. Imaging Sci Dent 43:273–281CrossRefPubMedPubMedCentralGoogle Scholar
  24. 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. 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
  26. 26.
    Chatriyanuyoke P, Lu CI, Suzuki Y, Lozada JL, Rungcharassaeng K, Kan JY, Goodacre CJ (2012) Nasopalatine canal position relative to the maxillary central incisors: a cone beam computed tomography assessment. J Oral Implantol 38:713–717CrossRefPubMedGoogle Scholar
  27. 27.
    Bornstein MM, Lauber R, Sendi P, von Arx T (2011) Comparison of periapical radiography and limited cone-beam computed tomography in mandibular molars for analysis of anatomical landmarks before apical surgery. J Endod 37:151–157CrossRefPubMedGoogle Scholar
  28. 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]
  29. 29.
    Hedesiu M, Baciut M, Baciut G, Nackaerts O, Jacobs R, SEDENTEXCT Consortium (2012) Comparison of cone beam CT device and field of view for the detection of simulated periapical bone lesions. Dentomaxillofac Radiol 41:548–552CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Pauwels R. Cone beam CT for dental and maxillofacial imaging: dose matters (2015). Radiat Prot Dosimetry 165:156–161Google Scholar
  31. 31.
    Lin LM, Huang GT, Rosenberg PA (2007) Proliferation of epithelial cell rests, formation of apical cysts, and regression of apical cysts after periapical wound healing. J Endod 33:908–916CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Valerie G. A. Suter
    • 1
  • Reinhilde Jacobs
    • 2
  • Marcia R. Brücker
    • 3
  • Alberto Furher
    • 2
  • Jim Frank
    • 2
    • 4
  • Thomas von Arx
    • 1
  • Michael M. Bornstein
    • 1
    • 2
  1. 1.Department of Oral Surgery and Stomatology, School of Dental MedicineUniversity of BernBernSwitzerland
  2. 2.OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity of LeuvenLeuvenBelgium
  3. 3.Radiologic Center, School of DentistryPontifical Catholic UniversityPorto AlegreBrazil
  4. 4.Department of Oral Health Sciences, Faculty of MedicineUniversity of LeuvenLeuvenBelgium

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