Incisive foramen: can we place an implant in this site?
I have planned a case for immediate extraction and implant placement of a Nobel Active implant. We will be doing the socket shield technique and loading it on the same day with an acrylic temporary crown. The CBCT shows the incisive foramen just palatal to the tooth. Do you think we can place an implant in this site?
3 Comments on Incisive foramen: can we place an implant in this site?
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David Levitt
9/11/2018
Research has shown that invasion of the intact incisive canal with an implant is likely to cause fibrous encapsulation of the implant and failure. The solution is to remove the contents of the canal. No patient ever complained when they had a numb central papilla post op. Get a high speed surgical length bur and ream out the canal. A peso reamer could also be used. Pack HA or FDBP into the canal. Place your implant ideally.
Robert J. Miller
9/12/2018
The nasopalatine canal causes the roots of the central incisors to be canted to the distal. Follow the direction of the osteotomy for axial positioning. As this is a type I tooth position, start your osteotomy 3-4mm up on the palatal wall. This will take out the canal anatomically. RJM
Greg Kammeyer, DDS, MS, D
9/13/2018
I agree with David Levitt. I would wipe out the canal with a burr. I would pack a little xenograft bone in the apex of the canal and then put pieces of L-PRF both ON the apex of the implant and IN the apex of the osteotomy to act as a short term barrier to promote bone growth and prevent soft tissue from growning into the implant.
