| Abstract|| |
Introduction: One of the key stages of evaluating an edentulous ridge prior to dental implant placement is the analysis of neighboring anatomical structures such as canalis sinuosus (CS) with cone-beam computed tomography (CBCT). CBCT visualization has its own features, such as the change of slice thickness. The aim of the study was to analyze CS prevalence in relation to the slice thickness and CS diameter according to CBCT scans. Materials and Methods: In total, 100 CBCT scans of 39 males and 61 females in the age span of 46 to 81 years were retrospectively studied. Terminal alveolar part of CS was analyzed in Ez3D2009 (Vatech) software on panoramic and cross-sectional views with 0.5 mm, 1 mm, 3 mm, and 10 mm slice thicknesses. The prevalence was documented with regard to the diameter and slice thickness and was statistically compared in age and gender groups. Results: This CBCT study demonstrated 55.5% CS prevalence. There was no statistically significant difference in presence between age and gender groups regarding diameter as well as within different slice thickness. The study also showed the importance of the slice thickness choice for CS visualization: the best visualization was reached with 0.5 mm and 1 mm slice thicknesses. Visualization with 0.5 mm and 1 mm slice thicknesses was absolutely the same (55.5%). General CS prevalence with a 10 mm slice thickness (16.5%) was significantly lower (P < 0.05) than the prevalence with a 3 mm slice thickness (20.5%). The correlation between the slice thickness and a diameter more than 1.5 mm in size was not found. Conclusion: CBCT analysis showed that the highest CS prevalence was detected with the use of 0.5/1 mm slice thickness. As well, the higher CS diameter, the better is its visualization.
Keywords: Canalis sinuosus, CBCT, dental implant placement, implant complications, superior anterior alveolar nerve
|How to cite this article:|
Sedov YG, Avanesov AM, Mordanov OS, Zurnacheva DD, Mustafaeva RS, Blokhina AV. Visualization features of canalis sinuosus with cone beam computed tomography. Indian J Dent Res 2019;30:656-60
|How to cite this URL:|
Sedov YG, Avanesov AM, Mordanov OS, Zurnacheva DD, Mustafaeva RS, Blokhina AV. Visualization features of canalis sinuosus with cone beam computed tomography. Indian J Dent Res [serial online] 2019 [cited 2022 Jul 7];30:656-60. Available from: https://www.ijdr.in/text.asp?2019/30/5/656/273420
| Introduction|| |
One of the key stages of evaluating an edentulous ridge prior to dental implant placement is the analysis of neighboring anatomical structures. In the anterior maxilla, one of these structures is the canalis sinuosus (CS).,, The CS is an intrabony structure that carries the anterior superior alveolar neurovascular bundle. It begins on the infraorbital canal behind the homonymous foramen and goes in the anterior-lateral direction. After the canal reaches the anterior wall of the maxilla, it turns medially and goes along the lateral wall of the nasal cavity. Some authors call the terminal part of CS, residing in the alveolar process of maxilla, differently: continuation of the CS,,, the accessory canal of the CS, or the lateral incisive canal [Figure 1]a and [Figure 1]b. The terminal part of CS may be located in three directions: palatal, central, and buccal.,,,
|Figure 1: CS different views (red arrows show the CS topography): A. Panoramic view CBCT, CS is visualized in the lateral wall of nasal cavity, passing through maxillary alveolar crest. B. Cross-sectional view CBCT, the part of CS has the palatal location in the maxillary alveolar crest|
Click here to view
Damage of this canal during implant placement can lead to a range of complications such as bleeding and sensory disturbances., For example, Arruda et al. presented the description of the clinical case, where a 51-year-old woman suffered from paresthesia for 22 months after dental implant placement in the maxillary lateral incisor region. A cone-beam computed tomography (CBCT) scan analysis revealed that the implant was placed into the CS that led to pain and sensory disturbance in the upper lip region on the right side. After removing the implant, the pain disappeared. There are other clinical reports describing the appearance of pain after dental implant placement with CS damage.,
It is difficult to locate CS on conventional radiography., This could be owing to the small diameter of the canal, porous cortical layers, and variable course. CBCT is advantageous in such case scenarios as it clearly delineates these delicate findings.
It is known that thinner CBCT slices provide less partial volume averaging and better image quality with more detailed visibility. However, several studies demonstrated different conclusions on the dependence of the slice thickness and the detection of the anatomical and other structures.,,,,,,,,, Nothing is known about whether slice thickness parameters influence the visibility of CS in CBCT.
The aim of the study was to analyze CS prevalence and visualization in relation to the slice thickness and CS diameter according to CBCT scans for better radiographic estimation.
| Materials and Methods|| |
In total, 100 CBCT scans of 39 males and 61 females in the age span of 46 to 81 years (mean age is 63.27 ± 6.8) with 10 × 8.5 field of view were retrospectively studied between February and April 2018 who attended the radiologic diagnostic center for three-dimensional radiological scanning for different diagnostic purposes required by the clinical practices where patients had their appointments. Written consent was signed by all individuals before taking the procedure.
All CBCT scans were made with the device with the following characteristics: 0.2 mm/0.3 mm voxel size; 0.5 mm focal spot; 18 s scanning time; 55–99 kB/4–16 mA tube voltage.
The patients with trauma, bone disorders, undergoing bisphosphonate therapy, with anamnesis of surgical procedures, and pathological disorders of the anterior maxilla were excluded from the study.
These scans were analyzed in Ez3D Plus (Vatech Co., Korea, 2009) software on panoramic and cross-sectional views with 0.5 mm, 1 mm, 3 mm, and 10 mm slice thicknesses. CS was identified according to its description in the literature. Then, the slice thickness was sequentially changed from 0.5 mm to 1 mm to 3 mm and to 10 mm. Images with different slice thicknesses were evaluated separately. The diameter was measured with 0.5 mm slice thickness.
One-way ANOVA test was provided with StatPlus 6 (AnalystSoft) with regard to CS prevalence with different slice thicknesses. Age and gender groups were analyzed within slice thickness groups and with regard to diameter.
| Results|| |
The alveolar part of CS was evident in 74 of 100 patients (74% of total patients) evaluating CBCT scans with 0.5 mm slice thickness. The canal was found only on the right side in 20 of these 74 patients (27.1%) and on only the left side in 17 (22.9%) and 37 patients (50%) presented CS on both sides.
In total, 111 CS (55.5% while analyzing 200 sides in 100 patients) were visualized with 0.5 mm slice thickness and 1 mm slice thickness. The CS prevalence (%) on CBCT scans with different slice thicknesses is presented in [Figure 2].
|Figure 2: CS visualization in general, on the left and right maxilla with regard to slice thickness. P value in the diagram shows the difference between left and right sides|
Click here to view
CS visualization with different slice thicknesses with regard to age and gender is demonstrated in [Figure 3] and [Figure 4].
|Figure 3: General CS visualization depending on the slice thickness with regard to gender. P value in the diagram shows the difference between genders|
Click here to view
|Figure 4: General CS visualization depending on the slice thickness with regard to age. P value in the diagram shows the difference between ages|
Click here to view
[Table 1] shows the diameter data for CS terminal part according to age and gender.
|Table 1: CS terminal part diameter. All data are in millimeters except for P value|
Click here to view
Then, we analyzed the dependence on visualization between two criteria mentioned above: the diameter and the slice thickness [Figure 5].
|Figure 5: Dependence of CS visualization between different slice thicknesses and its diameter. The CS prevalence was considered as 100% with 0.5 and 1 mm slice thicknesses. Note the drop in the CS prevalence with 3 mm and 10 mm slice thicknesses in 0.3–0.6 mm and 0.7-1 mm slice thicknesses|
Click here to view
| Discussion|| |
CS was first described by Wood-Jones in 1939. Von Arx et al. established that more than half of the accessory canals in the maxilla are connected with this structure. Owing to only a few publications on anatomical variants of CS available in the literature and the fact that these variations are commonly seen in CBCT evaluation as an incidental finding, practitioners do not know much about this anatomical variation.
Several studies and clinical cases showed that CBCT is the best radiographic technique for CS visualization.,,,,,, This 100 CBCT scan study showed 57.6% of CS prevalence with 0.5 mm and 1 mm slice thickness, which is lower than it was in K. Orhan et al. study (70.8%), Ghandourah et al., and Gurler et al. (both 100%) and Machado et al. (97.4%). CS prevalence with 3 mm slice thickness (43.5%) was closer to Manhaes et al. data (34.86%) and Von Arx et al. data (27.8%).
The total diameter was 0.95 ± 0.23 mm that is lower than CS diameter in Gurler et al. study (1.37 mm) and in Von Arx et al. study (1.37 mm). However, our study showed no statistical difference in the diameter data with age and gender groups,. Von Arx et al. showed statistically higher diameter in males than in females.
This 100 CBCT scan study did not find any statistically significant difference between slice thicknesses for CS visualization on the right and left sides. Visualization with 0.5 mm and 1 mm slice thicknesses were absolutely the same (55.5%). CS general prevalence with a 10 mm slice thickness (16.5%) were significantly lower (P < 0.01) than the prevalence with a 3 mm slice thickness (20.5%).
As well, the difference between CS visualization with 0.5 mm/1 mm and 0.3 mm slice thicknesses was statistically significant (P < 0.01).
There are some other research with different methods that concluded the positive effect of slice thickness. Mühler et al. studied the accuracy and reliability of age estimation, using a clavicular epiphyseal plate in forensic medicine, and the best result was obtained with a slice thickness of 1 mm. Jung et al. studied the multiplanar reformation using 1.25, 2.5, 3.75, and 5 mm slice thicknesses for quantitative measurement in CT and demonstrated that thinner slice thicknesses result in better image quality. Sirin et al. studied diagnostic accuracy of reconstructed CBCT images, using different slice thicknesses, in the detection of simulated mandibular condylar fracture and concluded that the diagnosis will be more accurate using slice thickness of 0.2 and 1 mm, compared to 2 and 3 mm.
In our CBCT-study, the CS diameter values varied from 0.3 mm to 2.1 mm, however, our age/gender analysis did not reveal any statistically significant differences both in general and on the left and right sides separately.
The analysis between the diameter and slice thicknesses showed that visualization with 0.5 mm/1 mm slice thickness is statistically higher than 3 mm and 10 mm slice thicknesses (P < 0.01) for diameters of 0.3 mm–1 mm in size. Visualization of diameters of 1.1 mm and more in size did not have any statistically significant difference with 0.5 mm, 1 mm, 3 mm, and 10 mm slice thicknesses (P = 0.3, P = 0.6, and P = 0.6 consequently).
| Conclusion|| |
CBCT examination demonstrated high diagnostic efficiency in CS visualization (74%). In addition, this study showed the importance of slice thickness choice for CS visualization. The best visualization was reached with 0.5 mm and 1 mm slice thicknesses. The dependence in prevalence between slice thicknesses and the diameters greater than 1.1 mm in size was not revealed. It is important to note that dentists have a visual estimation of anatomical structures because CBCT is not calibrated with the Hounsfield scale. Using 0.5 mm and 1 mm slice thicknesses for the analysis, it is more efficient for defining CS, but for eliminating the risk of the inaccurate visual interpretation, the slice thicknesses should be changed to 3 mm and 10 mm to differentiate CS from spongious bone structure. Dentists should change slice thickness in CBCT software while estimating anatomical structures such as CS.
Although CBCT is an accurate estimation technique of anatomical structures, it is important to consider the software settings.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tolstunov L. Horizontal Alveolar Ridge Augmentation in Implant Dentistry: A Surgical Manual. Wiley-Blackwell; 2016. p. 320.
Williams PL, Warwick R, Dyson M, Bannister L H. Gray's Anatomy. 37th
. Livingstone: Edinburgh: Churchill; 1989.
Mraiwa N, Jacobs R, Van Cleynenbreugel J, Sanderink G, Schutyser F, Suetens P, et al
. The nasopalatine canal revisited using 2D and 3D CT imaging. Dentomaxillofac Radiol 2004;33:396-402.
White SC. Pharoah MJ. Oral radiology: Principles and Interpretation. 4th
. St Louis: Mosby; 2000.
von Arx T, Lozanoff S. Anterior superior alveolar nerve (ASAN). Swiss Dent J 2015;125:1202-9.
Manhães Júnior LR, Villaça-Carvalho MF, Moraes ME, Lopes SL, Silva MB, Junqueira JL. Location and classification of Canalis sinuosus for cone beam computed tomography: Avoiding misdiagnosis. Braz Oral Res2016;30:1-8.
Gurler G, Delilbasi C, Ogut EE, Aydin K, Sakul U. Evaluation of the morphology of the canalis sinuosus using cone-beam computed tomography in patients with maxillary impacted canines. Imaging Sci Dent 2017;47:69-74.
Machado VDC, Chrcanovic BR, Felippe MB, Manhães Júnior LRC, de Carvalho PSP. Assessment of accessory canals of the canalis sinuosus: A study of 1000 cone beam computed tomography examinations. Int J Oral Maxillofac Surg 2016;45:1586-91.
Von Arx T, Lozanoff S, Sendi P, Bornstein MM. Assessment of bone channels other than the nasopalatine canal in the anterior maxilla using limited cone beam computed tomography. Surg Radiol Anat 2013;35:78390.
Neves FS, Crusoé-Souza M, Franco LCS, Caria PHF, Bonfim-Almeida P, Crusoé-Rebello I. Canalis sinuosus: A rare anatomical variation. Surg Radiol Anat 2012;34:563-6.
Arruda JA, Silva P, Silva L, Álvares P, Silva L, Zavanelli R, et al
. Dental implant in the canalis sinuosus: A case report and review of the literature. Case Rep Dent 2017;2017:4810123. Published online 2017 Aug8.
Shelley AM, Rushton VE, Horner K. Canalis sinuosus mimicking a periapical inflammatory lesion. Br Dent J 1999;186:378-9.
Shah PN, Arora AV, Kapoor SV. Accessory branch of canalis sinuosus mimicking external root resorption: A diagnostic dilemma. J Conserv Dent 2017;20:479-481.
] [Full text]
Whyms BJ, Vorperian HK, Gentry LR, Schimek EM, Beers ET, Chung MK. The effect of computed topographic scanner parameters and 3-dimensional volume rendering techniques on the accuracy of linear, angular, and volumetric measurements of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:682-91.
Jasa GR, Shimizu M, Okamura K, Tokumori K, Takeshita Y, Weerawanich W, et al
. Effects of exposure parameters and slice thickness on detecting clear and unclear mandibular canals using cone beam CT. Dentomaxillofac Radiol 2017;46:20160315
Pour DG, Arzi B, Shamshiri AR. Assessment of slice thickness effect on visibility of inferior alveolar canal in cone beam computed tomography images. Dent Res J 2016;13:527-31.
] [Full text]
Sezgin OS, Kayipmaz S, Sahin B. The effect of slice thickness on the assessment of bone defect volumes by the Cavalieri principle using cone beam computed tomography. J Digit Imaging 2013;26:115-8.
Jia MX, Zhang X, Li N, Han CB. Impact of different CBCT imaging monitor units, reconstruction slice thicknesses, and planning CT slice thicknesses on the positioning accuracy of a MV-CBCT system in head-and-neck patients. J Appl Clin Med Phys 2012;13:3766.
Mühler M, Schulz R, Schmidt S, Schmeling A, Reisinger W. The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics. Int J Legal Med 2006;120:15-7.
Dogan H, VeldkampWJ, Dibbets-Schneider P, Spijkerboer AM, Mertens BJ, Kroft LJ, et al
. Effects of heart rate, filling and slice thickness on the accuracy of left ventricular volume measurements in a dynamic cardiac phantom using ECG-gated MDCT. Br J Radiol 2008;81:577-82.
Guggenbuhl P, Chappard D, Garreau M, BansardJY, Chales G, Rolland Y. Reproducibility of CT-based bone texture parameters of cancellous calf bone samples: Influence of slice thickness. Eur J Radiol 2008;67:514-20.
Rubinstein D, Escott EJ, Mestek MF. Computed tomographic scans of minimally displaced type II odontoid fractures. J Trauma 1996;40:204-10.
Jung H, Kim HJ, Kim DO, Hong SI, Jeong HK, Kim KD, et al
. Quantitative analysis of three-dimensional rendered imaging of the human skull acquired from multi-detector row computed tomography. J Digit Imaging 2002;15:232-9.
Sirin Y, Guven K, Horasan S, Sencan S, Bakir B, Barut O, et al
. The influence of secondary reconstruction slice thickness on NewTom 3G cone beam computed tomography-based radiological interpretation of sheep mandibular condyle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:638-47.
Orhan K, Gorurgoz C, Akyol M, Ozarslanturk S, Avsever H. An anatomical variant: Evaluation of accessory canals of the canalis sinuosus using cone beam computed tomography. Folia Morphol 2018;77:551-7.
Oliveira-Santos C, Rubira-Bullen IRF, Monteiro SAC, Léon JE, Jacobs R. Neurovascular anatomical variations in the anterior palate observed on CBCT images. Clin Oral Implants Res 2013;24:1044-8.
Ghandourah AO, Rashad A, Heiland M, Hamzi BM, Friedrich RE. Cone-beam tomographic analysis of canalis sinuosus accessory intraosseous canals in the maxilla. GMS German Med Sci 2017;15:Doc20.
Manhães Júnior LR, Villaça-Carvalho MF, Moraes ME, Lopes SL, Silva MB, Junqueira JL. Location and classification of Canalis sinuosus for cone beam computed tomography: Avoiding misdiagnosis. Braz Oral Res2016;30:e49. Epub April 26, 2016.
Mr. Yuri G Sedov
Miklukho-Maklaya Str, 10/2, 117198, Moscow
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]