Successful Treatment of Nasopalatine Duct Cyst After Maxillary Anterior Implant Surgery: A Case Report
Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded 1 year after maxillary anterior implant placement following periodontally hopeless teeth extraction. The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant’s surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. Seven years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.
(a and b) Preoperative CBCT showed the palatal concavity depth (PCD) was 2.7 mm and the minimum bone width anterior to the nasopalatine canal (BW) measured at 8 mm subcrestal level was 1.1 mm.
(a) The nasopalatine duct was penetrated during anterior implant insertion.
(b) A resorbable collagen membrane was used to cover the perforated area.
The restoration was accomplished 7 months after implant placement.
(a) During 1-year follow-up, no swelling was observed in the anterior palate. (b) The radiographic image showed oval radiolucency lesions with clear boundaries in the apical of the implant 12, 21.
(a) Mild swelling was observed in the midline of the anterior palate. (b) The radiographic image showed a round, low-density resorption shadow in the apical area of the implants.
(a) Abutments were removed before incision. (b) A large amount of cystic fluid overflowed during the horizontal incision. (c) The cyst was detected on the palatal side between implants 12 and 21. (d) The cyst wall was intactly removed. (e and f) The alveolar bone around implant 12 was mostly absorbed except for the distal wall, while only 1/3 of a circle of bone was left around implant 21. (g and h) BPBM-i-PRF complex following a collagen membrane was applied to cover the defect. (i) The wound closure was obtained with 5-0 sutures.
The histopathological findings showed a cyst lined by 3 types of epithelium: respiratory, cuboidal, and nonkeratinized stratified squamous. (a) H&E stain, ×100. (b) H&E stain, ×400.
(a and b) Seven years after surgery, implants were stable and in good function. (c, d, and e) The radiographic image showed the bone regenerated well in the bone-grafted area.
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