Pikos Online Journal - Case Challenge

Nasopalatine Canal Grafting

There are times where we need to address the nasopalatine foramen and canal especially when we are dealing with maxillary central incisor implant placement. This particular case involved a 57 year old gentleman who in Figures 1 and 2 represents approximately 8 months status post flapless extraction of the maxillary right central incisor with simultaneous placement of mineralized allograft and recombinant PDGF (Gem 21), along with use of a pedicle tunnel connective tissue graft. Reentry at 8 months shows the extent of the nasopalatine neurovascular bundle to be continuous with the proposed implant osteotomy site (Figures 3, 4).

The contents of this canal are subsequently removed and the osteotomy for implant placement is completed (Figure 5). Figure 6 shows implant placement along with simultaneous grafting of the nasopalatine canal with MinerOss. It is important that this grafting be done prior to implant placement to assure that the particulate graft reaches the full extent of the implant osteotomy and canal. Next, Figure 7 shows a veneer xenograft (contour graft) performed on the facial aspect in a subperiosteal mode with primary closure obtained (Figure 8). One can compare the pre-extraction clinical image with the 7 month follow up implant abutment provisional crown (Figures 9,10). Please see the attachment for the video to see the sequential removal of the contents of the neurovascular bundle and subsequent grafting prior to implant placement in a nonsubmerged mode.

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