Editorial Type:
Article Category: Other
 | 
Online Publication Date: 01 Dec 2014

Implants Placed in the Nasopalatine Canal to Rehabilitate Severely Atrophic Maxillae: A Retrospective Study With Long Follow-up

DDS, MSc, PhD,
DDS, MSc,
DDS, PhD,
DDS, PhD, and
MD, DDS, PhD
Page Range: 699 – 706
DOI: 10.1563/AAID-JOI-D-12-00145
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To assess the survival rate of implants placed in the nasopalatine canal for the rehabilitation of patients with atrophic maxillae and the level of satisfaction of these patients. A retrospective study was performed between 2000 and 2009 of patients with severe atrophy of edentulous maxillae (Cawood and Howell's class V) rehabilitated with implant-supported prostheses with 1 implant placed in the nasopalatine canal. A preoperative computed tomography scan was obtained of all patients and all surgeries were performed by the same surgeon. The following parameters were assessed: neurosensory status of the anterior palate (using the pointed/blunt discrimination method); implant success rate according to criteria described by Albrektsson et al; patient satisfaction with the prosthetic treatment (using visual analogue scales). Thirteen patients with a mean age of 54.8 years were treated, 5 men and 8 women. Seventy-eight implants were placed: 13 in the nasopalatine canal, 6 in the zygomatic bone, 12 in the pterygomaxillary region, 2 in the frontomaxillary buttress and 45 in other locations. Six patients reported a slight decrease in sensitivity in the anterior palate after surgery, which disappeared in all cases within a few weeks. Two early failures (before prosthetic loading) and no late failures (after prosthetic loading) of nasopalatine implants were recorded, yielding a success rate for these implants of 84.6% after a mean follow-up of 70 months (range 24 to 132 months. High patient satisfaction with the prosthetic restoration was generally achieved in terms of comfort, stability, function, esthetics, and ease of cleaning. Residual bone is associated with the nasopalatine canal, even in patients with severe maxillary atrophy. This canal may be considered a possible location for an anterior implant when rehabilitating atrophic patients using implant-supported prostheses.

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(a) Initial panoramic radiograph showing severe maxillary atrophy. (b) Axial view of the preoperative computerized tomography (CT) scan; the nasopalatine canal can be observed. (c) Planning of implant positions on the CT scan. (d) Identification of the nasopalatine canal after flap elevation. (e) Removal of the neurovascular bundle with a drill. (f) Preparation of the implant site using osteotomes. (g) Occlusal view of the implant site in the nasopalatine canal prepared using osteotomes. (h) Placement of particulated bone graft in the nasopalatine canal.


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continued. (i) Compaction of the particulate bone graft in the nasopalatine canal with an osteotome. (j) Implant insertion in the nasopalatine canal. (k) Occlusal view of the 7 implants placed. (l) Regeneration of the peri-implant palatal bone defects with particulate bone graft. (m) Healed tissues. (n) Screwed fixed prosthesis. (o) Final panoramic radiograph. (p) Intraoral radiograph taken after 24 months of follow-up.


Contributor Notes

Corresponding author, e-mail: Maria.Penarrocha@uv.es
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