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Augmentation of upper central incisor area: with or without removing of nasopalatinal canal contents?

Last Updated: Mar 19, 2017

I have treatment planned the #8 edentulous site for a bone augmentation and implant placement after osseointegration. The bone defect in the #8 site is very large and connected to the incisive canal. The periodontal health of the surrounding teeth is stable. I would prefer leaving the canal’s contents, as that is less traumatic, but alternatively it is a consideration to remove the canal contents to prevent soft tissue growth into the bone defect instead of osseous tissue. I could deliver a graft of 50% autogenous bone mixed with beta-tricalcium phosphate and hydroxyapatite or xenograft, use a titanium mesh as a scaffold, thin collagen membrane and PRF. What is your opinion? Leave or remove the canal contents? May soft tissue of the canal interfere with augmentation material and lead to:
1) grow of soft/fibrous tissue instead of osseous tissue
2) post-op pain symptoms (transient or worse – permanent) due to close contact of granules and nasopalatinal nerves?

3 Comments on Augmentation of upper central incisor area: with or without removing of nasopalatinal canal contents?

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Bill

3/21/2017

Would appreciate all follow-up on this case. Thank you.

Vipul G Shukla

3/21/2017

Hmmmm... large defect, is it after a nasopalatine cyst or granuloma was surgically enucleated in this area? Since the bone loss and defect is mostly on the buccal aspect, and the Nasopalatine foramen exits palatally, I see no reason for canal extirpation and its associated sequelae. If anything, push the contents more palatally with blunt instruments and then graft on the buccal and Ti-mesh all you want. If required, use a Collagen membrane towards the nasopalatine defect also. I steer clear of any and all vital structures, especially nerve bundles, because who wants to have a perfectly emerging #8 implant and crown, but constant burning lip and palate issues afterward?

Elijah Arrington III

3/22/2017

I have done tons of these and I always remove contents with cautery & round bur and graft place implant with versah burs, graft, membrane buccal and lingual. U won't get burning lip with cautery and round bur removal. Versah burs will get 50NcM plus.

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