Nasopalatine Duct Cyst, a Delayed Complication to Successful Dental Implant Placement: Diagnosis and Surgical Management
The dental literature reports frequently on both the success and survival of dental implants, whereby the focus remains on the biological response of hard and soft tissue to the implants. The predication and anticipation of adverse implant events can then lead to the preemption of implant loss. However, biological situations can arise that are outside the control of the clinician. The author reports a case history of the late manifestation of a nasopalatine duct cyst in close proximity to a dental implant and its subsequent surgical management.
Figure 1. (a) Initial diagnostic periapical radiograph. (b) Periapical radiograph taken immediately after surgery. (c) Periapical radiograph taken 24 months postoperatively. Figure 2. (a) Initial diagnostic linear tomogram. (b) Linear tomogram taken immediately after surgery. (c) Linear tomogram taken 24 months postoperatively.
(a) Intrasulcular incisions were made to allow the complete raising of the palatal mucoperiosteal flap, taking care not to penetrate the midline underlying friable cystic wall. (b) The implant palatal surface appears completely devoid of osseous tissue. (c) The buccal flap has been raised over tooth 11 to relieve an apical bony dehiscence and underlying cavity. (d) The dimensions of the required symphyseal graft have been mapped out onto the bony cortex. (e) The symphyseal cortex has been completely penetrated using a small round bur (no. 1) and elevated slightly from the underlying trabecular bone. (f) The harvested cortical plate. (g) The screw holes for fixation of the graft have been made. (h) The symphyseal graft is secured in place with 11-mm screws, thus covering the underlying Bio-Oss granules. (i) The palatal and buccal flaps have been replaced and secured with 4.0 Vicryl sutures.
(a) Palatal tissues 24 months postoperatively. (b) Buccal operative site 24 months postoperatively.
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