Management of the Nasopalatine Canal and Foramen Associated With Dental Implant Therapy.

In some patients, the contents of the nasopalatine canal must be removed to facilitate placement of a dental implant into the canal. Reasons to enucleate the canal in preparation for a bone graft or a dental implant include inadvertent perforation into the canal when creating an osteotomy for an implant, severe atrophy of the maxilla, and a large foramen that precludes placing an implant into the desired location along the bony ridge. The authors searched the dental literature for clinical reports in humans that addressed placement of dental implants into or adjacent to the nasopalatine canal. They found that the nasopalatine canal is usually around 10-mm long and 4-mm wide and slants from the horizontal plane at a 66-degree angle, and there is considerable variation regarding these measurements. Several clinical reports demonstrate that the canal can be enucleated and bone grafted before successful implant placement. It is also possible to place an implant into the canal at the time of surgery and this procedure may or may not be combined with an adjunctive bone graft. Numerous case reports indicate there is usually no permanent loss of sensation of the anterior palate when an implant is placed into the nasopalatine canal. The authors concluded that placing an implant into the nasopalatine canal is a viable procedure as part of a surgical and prosthetic treatment plan when there is a dearth of alternate sites for implant placement. In patients with severe atrophy of the maxilla, combination syndrome, or who have a large or malpositioned nasopalatine canal, the canal can be used as a site to place a dental implant to support a fixed or removable dental prosthesis.