GUIDED IMPLANT PLACEMENT ON EDENTULOUS MAXILLA TO AVOID DAMAGE TO ACCESSORY BRANCHES OF THE CANALIS SINUOSUS: A CASE REPORT

Abstract

​Introduction The canalis sinuosus (CS) is an anatomical structure arising from the infraorbital nerve. It is a neuromuscular canal, carrying the anterior superior alveolar nerve and vessels. Rarely, accessory bilateral branches of CS are observed on cone beam computed tomography(CBCT) images, during implant planning, in the anterior maxilla region. It is an important anatomical structure often overlooked by surgeons and not visible by conventional radiographs. Case report A case of anatomical variation in the CS with accessory branches was detected after a CBCT was performed on an edentulous 72 years old male patient pre operatively for implant placement. On the examination of the axial slices of the CBCT, additional foramina lateral and anterior to the nasopalatine foramen were observed. By tracing into the bone from these foramina, it was observed that these accessory canals communicate with the CS. Implant planning was performed, respecting these canals and a surgical guide was fabricated, using the dual scan protocol from the patient’s denture. A post-op CBCT was performed to determine the accuracy of our guide and the position of the implants. No post-op complications were observed. Conclusion Several cases of intractable pain following implant placement in the anterior maxilla have been reported. Damage to the CS and its accessory canals may be the cause. Knowledge of these anatomical variations is of great importance and the use of guided implant placement is a useful tool to avoid iatrogenic surgical trauma and post-op surgical distress to the patient.