Incisive Canal Research Articles

Micro-XCT analysis of anatomical features and dimensions of the incisive canal: implications for dental implant treatment in the anterior maxilla

BackgroundThis study used micro-focus X-ray Computed Tomography (micro-XCT) to examine the anatomical differences and dimensions of the maxillary incisive canal (MIC) in a South African population. The accurate imaging yielded dependable results that support earlier research and enhance anterior maxilla surgery planning. Furthermore, these anatomical features are compared between various racial and gender groupings in the study.MethodsUsing a micro-XCT scanner, 108 human cadaver skulls from the Pretoria Bone Collection were scanned and included in the study. Advanced volume rendering software was employed for measuring the MIC length, diameter, shape, and the buccal bone wall measurements in relation to the MIC.ResultsSignificant anatomical variation in the size and shape of the MIC was identified in the population, with variations seen between racial and gender groups. The incisive foramen (ICO) mean diameter was 6.61 mm, and the MIC length varied from 4.96 to 20.10 mm. There were significant differences in the buccal alveolar bone height between different ethnic groups and gender. Regarding morphological patterns in coronal and sagittal views, single canals were more common in the black population while Y-shaped canals were more common in the white population. The study also introduced a new metric by measuring the mean distances between teeth #11 and #21 and the ICO (1.83 mm and 1.88 mm respectively).ConclusionsThe complex anatomical differences of the MIC in a South African population were clarified. Clinicians should be aware of tooth sockets in near proximity to the MIC and perform accurate preoperative assessment using sophisticated 3-D imaging and preferable guided implant placement in the anterior maxilla.

Assessment of the mandibular incisive and mental canal in dentate and edentulous mandibles using cone-beam computed tomography

ObjectivesThis study evaluated the prevalence, diameter and location of the mandibular incisive canal (MIC) and the transition pattern and anterior loop length (ALL) of the mental canal and compared these values between dentate and edentulous mandibles. MethodsA total of 187 cone-beam computed tomography (CBCT) images of mandibles, namely, 100 images of dentate mandibles and 87 images of edentulous mandibles, were obtained. CBCT data related to the incisive canal and mental canal were analyzed by one examiner. ResultsThe prevalence of the MIC was 75∼78 %, showing no difference based on laterality or the presence of teeth. The ALL significantly differed depending on the presence of teeth as well as sex. The presence of teeth affected the size of the MIC in the female group, and the diameter of the MIC in the edentulous group was significantly narrower than that in the dentate group. The diameter of the MIC was significantly greater in males than in females in the edentulous group. Meanwhile, the location of the MIC in the male group depended on the presence of teeth at each measuring point, and the MIC was significantly closer to the lower border of the mandible in the female group than in the male group at all measuring points except at 0 mm. ConclusionsThis study indicated that the presence of teeth significantly affects the type of transition of the mental canal, the ALL, and the diameter and location of the MIC. Additionally, sex could be a factor affecting MIC location, MIC diameter and anterior loop length.

Strategies for prevention and treatment of vascular and nerve injuries in mandibular anterior implant surgery

Important anatomical structures such as mandibular incisive canal, tongue foramen, and mouth floor vessels may be damaged during implant surgery in the mandibular anterior region, which may lead to mouth floor hematoma, asphyxia, pain, paresthesia and other symptoms. In severe cases, this can be life-threatening. The insufficient alveolar bone space and the anatomical variation of blood vessels and nerves in the mandibular anterior region increase the risk of blood vessel and nerve injury during implant surgery. In case of vascular injury, airway control and hemostasis should be performed, and in case of nerve injury, implant removal and early medical treatment should be performed. To avoid vascular and nerve injury during implant surgery in the mandibular anterior region, it is necessary to be familiar with the anatomical structure, take cone-beam computed tomography, design properly before surgery, and use digital technology during surgery to achieve accurate implant placement. This article summarizes the anatomical structure of the mandibular anterior region, discusses the prevention strategies of vascular and nerve injuries in this region, and discusses the treatment methods after the occurrence of vascular and nerve injuries, to provide clinical reference.

Reconstruction of Pathology Induced Anterior Maxillary Defect: A Case Report

A cyst is defined as a pathologic cavity lined by epithelium. Nasopalatine duct cysts (NPDC) are of non-odontogenic origin arising from epithelial remnants from two embryonic nasopalatine ducts. These cysts may form anywhere along the ducts’ course, which runs from posterior palatal midline to the soft tissue palatine papilla also known as the incisive papilla. NPDC often develop between the 4th and 5th decades of life with men being affected more than women (2:1 ratio). They are typically asymptomatic but present with palatal swelling in the anterior maxillary region. Larger cysts may create a labial expansion in addition to a midpalate expansion which is usually compressible due to resorption of bone beneath the mucosa. Radiography often shows a well demarcated round or pear-shaped radiolucency superimposed on the incisive canal, tooth displacement or divergence of roots may be observed. This pathology is usually greater than 6mm in size which differentiates it from the incisive canal. Differential diagnoses often include a periapical granuloma or radicular cyst from nonvital central incisors, however a palatal radiolucency and expansion represents a NPDC until proven otherwise. Typical treatment includes enucleation and curettage with low recurrence rates.

Radiologic study of the distance between the maxillary central incisor root and the incisive canal according to skeletal malocclusion classification

The aim of this study was to evaluate the distance between the maxillary central incisor root and the incisive canal based on skeletal malocclusion classification and to analyze the morphology of the incisive canal using cone-beam computed tomography (CBCT). Skeletal malocclusion was categorized into Class I, II, and III using lateral cephalometric analysis. Measurements of the distance between the maxillary central incisor root and the incisive canal were taken at two levels: 2 mm (L1) and 4 mm (L2) superior to the labial cementoenamel junction of the maxillary central incisor. At L1, the distance was found to be closer in the Class II group compared to the Class I or Class III groups. Similarly, at L2, the Class II group exhibited a closer distance than the Class III group. Interestingly, females showed a closer distance compared to males at both L1 and L2. Further analysis revealed a significant gender difference in the Class I and III groups, but not in the Class II group. These findings emphasize the significance of evaluating the distance between the maxillary central incisor root and the incisive canal in patients with skeletal Class II malocclusion, regardless of gender.

Cone-Beam Computed Tomography Study of Incisive Canal and Maxillary Central Incisors in Dravidian Population.

En-masse maxillary anterior retraction is necessary to attain an esthetic profile in Angle's class I bimaxillary dentoalveolar protrusion and Angle's class II division 1 malocclusion. The objective of this study was to evaluate configurational relationships between maxillary incisors and incisive canal in Angle's class I bialveolar protrusion and Angle's class II division 1 malocclusionby cone-beam computed tomography (CBCT). A total of 108 adult CBCT scans of 54-skeletal class I bialveolar protrusion and 54-skeletal class II division 1 malocclusions were retrospectively analyzed. Angles between palatal plane and axis of maxillary alveolar border (θ1),incisive canal (θ2), and maxillary right central incisor (θ3) were measured in relation to the midsagittal plane. Linear measurements such as incisive canal width (IC-IC), medial inter-root distance (Rm-Rm), posterior inter-root distance (Rp-Rp), anteroposterior distance from Rm to tangent of right central incisor (11 Rm-Cat), and left central incisor (21 Rm-Cat)corresponding to three vertical levels (L1, L2, and L3) were assessed in axial cross-sectional plane. Association among angular measurements was examined by Spearman correlation coefficient analysis. Mann-Whitney U test compared variables of linear measurements at three vertical levels. Estimated distance from incisor root to incisive canal was 5-6 mm in both groups slightly influenced by skeletal class and vertical levels but not gender. Mann-Whitney test demonstrated significant differences between groups at three vertical levels (p<0.05). Only θ2 revealed a significant difference (p<0.05) between malocclusions compared to θ1 and θ3. The angular measurements for both malocclusions were positively correlated (p<0.05). Sagittal root-canal cortical plate distance varied significantly in both malocclusions (5-6 mm). Inter-root distance (Rp-Rp) was greater than incisive canal width (IC-IC) at all three vertical levels indicating a reduced possibility of canal invasion after maximum retraction at posterior levels.

Evaluation of Visibility of Mandibular Incisive Canal by Using Cone-Beam Computed Tomography: An Observational Study.

Performing surgery on the anterior mandible could harm the mandibular incisive canal (MIC). To prevent it, preoperative radiographic assessment is essential. Aim of our study was to examine the visibility and presence of the MIC along with measurement of the length of MIC by utilizing cone-beam computed tomography (CBCT). Images from 50 subjects, ranging in age from 20 to 60 years, who had their mandibles examined by CBCT were taken from the archive. Reconstructed images included cross-sectional and panoramic views. The canal's visibility was obtained from the mesial to the mental foramen and finally to the incisal extension. The shortest distance between the mesial and distal portions of the canal was determined to be the length of the MIC. To analyze independent samples, t-tests were employed. In 40 cases (80%), the visibility of MIC was seen as bilateral, and in 10 cases (20%), as unilateral. The visible length among the population ranged from a minimum of 0.00 to a maximum of 25.25 mm, with an average of 15.37 ± 5.59. Future research could utilize the differences in prevalence with respect to gender and visibility as a point of reference.

Insertion guide for palatal TADs: Advantages and disadvantages from the clinical point of view

In recent years, there has been a growing trend in orthodontics to use the anterior palatal vault as an insertion site for temporary anchorage devices (TADs), to expand orthodontic possibilities and limit the collateral and unwanted dental effects. To improve accessibility and facilitate the procedure for clinicians, a guided approach for TAD insertion in the palatal vault, using insertion guides, has become increasingly prevalent. The manuscript primarily focuses on the real advantages and possible disadvantages that clinicians can expect when using insertion guides during TAD insertion into the palatal vault. Safety, precise evaluation of insertion depth, and the potential to execute a "one-visit protocol" are examined. Indeed, both direct and indirect palatal insertion protocols result to be efficient and safe in daily practice. The use of insertion guides result to be particularly beneficial for less experienced clinicians as well as for more complex patients and impacted teeth cases. Insertion guides can be created overlapping intraoral scanning to cbct or also to lateral teleradiograph, with sufficient accuracy and lower radiation exposure. However this method is limited in achieving bicortical evaluation, as well as relations to incisive canal and nasal floor. Finally a case report is presented, describing a full digital orthodontic treatment of a young adult patient presenting narrow maxilla. Slow maxillary expansion and fixed orthodontic treatment are described.

Measurement of mandibular incisive canal diameter using cone beam computed tomography

Cone beam computed tomography was used for measuring the diameter of a Mandibular incisive canal. The dental practice can now visualize small bone structures with low dose and high spatial resolution due to the introduction of CBCT (Cone Beam Computed Tomography). Therefore, it is of interest to measure the diameter of the MIC (Mandibular Incisive Canal) using the CBCT. Fifty CBCT scans obtained for implant placement preoperative planning were included in the study material. Observers carefully examined the CBCT data to determine the MIC’s presence &amp; position. The inner diameter of the MIC was measured by taking the longest distance between the inner cortical borders of the canal which was further analyzed using software CS3D software. The collected data were further subjected to statistical analysis. The average mean of the population was 1.7130±.5178. The average diameter of MIC in males was 1.735±.5406 and in females was 1.6800±.4934. Complications from implant surgery in the anterior mandible may be prevented by utilizing CBCT scans to analyze the smallest diameter of the MIC.

Is the collateral circulation pattern in the hard palate affected by cleft deformity?

ObjectivesTo evaluate the influence of collateral vascularization on surgical cleft palate closure and deformities.Materials and methodsCorrosion casting was performed using red-colored acrylic resin in twelve fresh adult cadavers with a normal hard palate. Additionally, white-colored barium sulfate was injected into a fetus with a unilateral complete cleft palate, and layer-by-layer tissue dissection was performed. Both substances were injected into the external carotid arteries. Corrosion casting involved dissolving the soft and hard tissues of the orofacial area utilizing an enzymatic solution.ResultsIn normal palates, bilateral intraosseous infraorbital arteries formed a network in the premaxilla with the intraosseous nasopalatine- and greater palatine arteries (GPAs). The perforating GPAs anastomosed with the sphenopalatine artery sub-branches. Bilateral extraosseous GPA anastomoses penetrated the median palatine suture. Complex vascularization in the retrotuberal area was detected. In the cleft zone, anastomoses were omitted, whereas in the non-cleft zone, enlarged GPAs were distributed along the cleft edges and followed the anatomical course anteriorly to initiate the network with facial artery sub-branches.ConclusionsThe anatomical subunits of the palate exhibited distinct anastomosis patterns. Despite omitted anastomoses with collateral circulation in the cleft zone, arteries maintained their anatomical pattern as seen in the normal specimen in the non-cleft zone.Clinical relevanceBased on the findings in normal- and cleft palates, surgeons may expect developed anastomosis patterns in the non-cleft zone. Due to the lack of microcirculation in the cleft zone, the existent anastomoses should be maintained as much as possible by the surgical technique. This applies anteriorly in the incisive canal territory, alveolar ridges, and posteriorly in the retrotuberal area.

Morphological assessment of the incisive canal using cone beam computed tomography in a Polish population sample

Morphological assessment of the incisive canal using cone beam computed tomography in a Polish population sample

A Retrospective Study of Location, Dimension, and Prevalence of Mandibular Incisive Nerve Canal with the Help of Cone-Beam Computed Tomography (CBCT).

To evaluate the mandibular incisive nerve canal's prevalence, location, and size. To ascertain the frequency, relationship to surrounding critical structures, and variance in the size and position of the mandibular incisive nerve canal. Mandibular incisive canal (MIC) measurements, locations, and prevalence were noted in 80 patients' cone-beam computed tomography (CBCT), ranging in age from 18 to 80. The overall incidence of missing canals was found to be 30% on the right side, 33.75% on the left, and 23.75% on both sides. Conclusion: In summary, magnetic resonance imaging (MRI) (3 Tesla) and other higher-resolution imaging modalities should be compared with CBCT for accurate MIC measurement and location assessment.

Reliability and safety of miniscrew insertion planning with the use of lateral cephalograms assessed on corresponding cone-beam computer tomography images.

Recently, lateral cephalograms have been proposed for guided miniscrew insertion planning. Therefore, the aim was to assess the reliability and safety of such planning on corresponding cone-beam computer tomography (CBCT) images. Intraoral scans, lateral cephalograms, and CBCT images of 52 subjects (even sexes distribution), aged 15.1 ± 2.5 years, were included. Miniscrew (n = 104) insertion planning was performed using lateral cephalograms superimposed on the maxillary intraoral scans, while the assessment of their bicortical placement, length in bone, contact with adjacent teeth, incisive canal, and nasal floor perforation was done on corresponding superimposed CBCT images. Moreover, maxillary incisor inclination, crowding, and the maxillary intercanine width were measured. The overall miniscrew length in bone was 7.2 ± 1.3mm. Bicortical placement was seen in 58.7% of the sample (38.5% of subjects). Incisive canal and nasal floor perforation was seen in 25% and 21.2% of subjects, respectively. No contact of the miniscrew with adjacent teeth was recorded. A negative significant interaction was seen between the miniscrew length in bone, the percentage of total miniscrew length and maxillary anterior teeth crowding (β, -0.10, P = .047 and β, -0.90, P = .006, respectively). Moreover, a positive significant interaction was seen between the incisive canal perforation and maxillary anterior teeth crowding (OR = 1.32, P = .021). Exclusion of subjects with impacted teeth. Miniscrew insertion planning using lateral cephalograms, despite being safe in preventing contact with adjacent teeth, is limited in achieving bicortical placement and insufficient in completely avoiding incisive canal and nasal floor perforation.

Measurement of the mandibular canal and mandibular incisive canal using cone beam tomography in adults from South Brazil.

To identify and measure the distance from the dental apices to the mandibular (MC) and mandibular incisive (MIC) canals, the diameter of the MC and the distances of the mental foramen (MF). In this retrospective study, cone-beam computed tomography scans of 144 adult patients (males and females) from a dental school in South Brazil were evaluated. Cross-sections were selected on the MC and the MIC paths, perpendicular to the mandibular base, and measurements were taken from the dental apices to the mandibular cortices. The measurement and location of the mandibular and mental foramen on both sides were compared. Paired t-tests compared sides, while Student's t-tests compared sexes (P < 0.05). The distance from the dental apices to the upper wall of the MC was closest in the third molar and farthest in the central incisor region. In both sexes and sides, the path of the MC is in most cases lingually in the molar regions and moves to the buccal region from the second premolar. The MF emerges in the regions between the premolars or near the second premolar. The results of this study highlight the importance of evaluating specific individual characteristics of a given population.

Invasión radicular del conducto incisivo durante el tratamiento de ortodoncia debido a un torque radicular palatino excesivo. Reporte de un caso

Aim: Patients presenting with bimaxillary proclinati-on often have an accompanying maxillary alveolar pro-cumbency. Case Report: Posterior relocation of the anterior alveolus is an important mechanism to reduce this prominence. Torquing the maxillary incisor roots palatally allows the anterior alveolus (point A) to remodel distally. This technique is non-invasive and therefore has good patient acceptance. Results: The following case report demonstrates the involvement of the incisive canal due to increased palatal root torque of the maxillary left central incisor root Conclusions: The use of 3D imaging in the diagnosis, its clinical complications as well as their remedial measures is also discussed. Keywords: Incisive canal; Root resorption; Torque; Orthodontics; Maxilla; Cone-beam computed tomography.

Atypical Neurofibroma Masquerading an Odontogenic Cyst-A Case Report

Neurofibroma is a benign tumor characterized by perineural fibroblast proliferation. It is common in the head and neck region but rare in the oral cavity. Most of these lesions are asymptomatic but sometimes may be associated with pain and paraesthesia. Neurofibromas with atypical features are quite rare and only a few cases are reported in literature. Here is a case of a female patient presented with pain and swelling in the anterior maxilla, which was clinically diagnosed as a periapical cyst. Radiographic evaluation of the lesion revealed dilated incisive canal and a Nasopalatine duct cyst was suspected. The patient was advised to take antibiotics for one week. The symptoms were sustained in the follow-up visit and an incision biopsy was made. Microscopic examination revealed pleomorphic spindled and round cells. Immunohistochemistry was performed to identify the origin of these pleomorphic cells. Based on the histopathological examination, special staining, and immunohistochemistry, we concluded the diagnosis as neurofibroma with atypical features. The current case emphasizes the significance of clinical, radiological, histopathological, and immunohistochemical evaluation of oral lesions. The presence of atypical features in Neurofibroma must be considered cautiously as as it is more prone to progress into Malignant Peripheral Nerve Sheath Tumor (MPNST).

Morphological Evaluation of the Incisive Canal in the Aspect of the Diagnosis and Planning of Orthodontic Treatment—CBCT Study

Background: Understanding the anatomy of the incisive canal is crucial for effective diagnosis and treatment planning in clinical orthodontics. This is because, during orthodontic tooth movement, there is a risk of contact between the roots of the upper central incisors and the incisive canal. Objective: The aim of this study was to assess the anatomical variability of the incisive canal using cone beam computed tomography (CBCT), as well as to evaluate its correlation with age, sex, and the position of the maxillary central incisors. There are only a few studies on this topic. Materials and methods: We analysed CBCT data from 67 patients aged from 13 to 49 years. This study was conducted at the Wroclaw Medical University. Measurements were performed twice by two independent researchers, and intra-observer error and correlation were calculated. The mean difference between the first and second observations and between observers was also assessed. We examined the dimensions of the incisive canal and its relationship to the roots of the upper central incisors in relation to age and gender. Results: Our study results revealed a significant correlation between the width and length of the incisive canal. Males exhibited a significantly greater canal length at the lowest point of the incisive canal on the palatal wall. Additionally, males had wider canals compared to females. The analysis of canal width and distance between the most mesial point of the root and the line passing through the most anterior point of the incisive canal showed a negative correlation in all age groups of men. The analysis of incisal inclination and incisal canal inclination showed a very strong relationship, especially in the age group of 13 to 20 years. Several potential risk groups of contact between the roots of central incisors and the incisive canal have been identified based on their structure and the planned incisors’ orthodontic movement. Conclusions and implications: Knowledge of the anatomy of the incisive canal and the use of 3D imaging in high-risk patients can prevent resorption of the incisor root by considering the individual anatomical conditions of the patient when planning orthodontic tooth movement. We recommend performing a CBCT scan before starting orthodontic treatment in the case of moderate and significant retraction of the incisors, or a significant change in their inclination due to the wide anatomical diversity of the incisive canal, especially in adult patients.

A unique artificial intelligence-based tool for automated CBCT segmentation of mandibular incisive canal.

To develop and validate a novel artificial intelligence (AI) tool for automated segmentation of mandibular incisive canal on cone beam computed tomography (CBCT) scans. After ethical approval, a data set of 200 CBCT scans were selected and categorized into training (160), validation (20), and test (20) sets. CBCT scans were imported into Virtual Patient Creator and ground truth for training and validation were manually segmented by three oral radiologists in multiplanar reconstructions. Intra- and interobserver analysis for human segmentation variability was performed on 20% of the data set. Segmentations were imported into Mimics for standardization. Resulting files were imported to 3-Matic for analysis using surface- and voxel-based methods. Evaluation metrics involved time efficiency, analysis metrics including Dice Similarity Coefficient (DSC), Intersection over Union (IoU), Root mean square error (RMSE), precision, recall, accuracy, and consistency. These values were calculated considering AI-based segmentation and refined-AI segmentation compared to manual segmentation. Average time for AI-based segmentation, refined-AI segmentation and manual segmentation was 00:10, 08:09, and 47:18 (284-fold time reduction). AI-based segmentation showed mean values of DSC 0.873, IoU 0.775, RMSE 0.256 mm, precision 0.837 and recall 0.890 while refined-AI segmentation provided DSC 0.876, IoU 0.781, RMSE 0.267 mm, precision 0. 852 and recall 0.902 with the accuracy of 0.998 for both methods. The consistency was one for AI-based segmentation and 0.910 for manual segmentation. An innovative AI-tool for automated segmentation of mandibular incisive canal on CBCT scans was proofed to be accurate, time efficient, and highly consistent, serving pre-surgical planning.

EVALUATION OF PALATAL BONE THICKNESS ON LATERAL CEPHALOGRAM AND ITS COMPARISON WITH CBCT SCANS

Aim: Aim of this study is to evaluate the palatal bone thickness on lateral cephalogram and its comparison with CBCT scans in different growth patterns and to find the gender differences if exists in palatal bone thickness at various measuring sites. Materials and Method: In this study 90 subjects with age ranging from 16-25 years visiting the Department of Orthodontics were chosen. Subjects were categorized into average, horizontal and vertical growth pattern groups according to Jarabaks ratio. They were further divided into male and female group to determine gender dimorphism if any. Palatal bone height was measured antero-posteriorly at a distance of 3, 6, 9, 12, 15, 18, 21 and 24 mm posterior to incisive canal both on lateral cephalogram and CBCT. Results: This study showed the palatal bone thicknessonlateral cephalograms is less when compared to CBCT at all the distances from incisive canal (p&lt;0.0001). The horizontal growth pattern showed highest palatal bone thickness at all the intervals followed by average and vertical and a statistically significant difference was found between the three groups (p&lt;0.0001). Independent t test reported higher amount of bone thickness in males as compared to females on both lateral cephalogram and CBCT (p&lt;0.05). Conclusion: Lateral Cephalogram showed less bone thickness when compared to CBCT. Horizontal growth pattern showed highest amount of bone thickness followed by average and vertical growth pattern.

APPLICATION AND ANALYSIS OF CUSTOMIZED BONE GRAFT OF A PATIENT UNDERGOING MANDIBLE AUGMENTATION AND DENTAL IMPLANTATION

The mandibular bone may be damaged for a variety of reasons. One of the methods used to facilitate and stimulate the bone to improve hard tissue formation is the use of bone grafts. In this study, a novel methodology was introduced to take a step towards making a custom xenograft for a patient with a mandibular bone defect. The application of the finite element method and evaluation of the graft simulation results was proposed, then the customized xenograft was provided using micro-milling. Also, 3D printing technology was used as a preoperative assessment of bone-graft interface conformity. Afterward, the graft was implemented for mandibular augmentation and the patient was prepared for further dental implantation. Finally, cone-based computer tomography images in different time intervals were taken for clinical assessment. Results showed that six months after the graft placement, the vertical distance from the alveolar ridge to the incisive canal and the mandibular canal was increased by 261% and 250%, respectively. Furthermore, the images taken after the insertion of dental implants and frequent observations by the dental surgeon approved the success of the treatment. Additionally, several quantitative parameters were compared to and established with the previous literature. Combining the conventional clinical examination method with an initial computational simulation by the criteria proposed in this study aided in predicting the success of mandibular augmentation and the subsequent dental implantation. More numerical analysis criteria can be added and assessed in future studies to improve the proposed method.