Abstract: Objective: To explore the management of nasopalatine canal associated with implant placement in maxillary central sites and assess the efficacy and safety. Method: A case series retrospective study was performed between July 2016 and June 2018 of patients who were treated with implants in maxillary central incisor sites. The inclusion criteria were that cases with perforation into the nasopalatine canal during the digital treatment planning and implant osteotomy. According to the size of the perforation, different approaches were adopted to facilitate the implant placement in the compromised sites. The following parameters were assessed: neurosensory status of the anterior palate, postoperative pain and implant survival rate. Results:Of the 48 patients (71 implant sites), a total of 10 patients (10 implant sites) fulfilled the inclusion criteria. Osseointegration was achieved in all of the 10 implants. Only one patient reported minor sensory alterations in the anterior palatal zone after implant placement, which disappeared in 3 months. At the final examination (follow-up of 6-18 months), no fixtures had been lost, and no marginal bone loss exceeding 1 mm was observed at the mesial and distal aspects of any implant, and all peri-implant tissues had a healthy appearance. Conclusion: The morphology and dimensions of the nasopalatine canal should be properly evaluated prior to dental implant insertion to replace missing maxillary central incisors. If penetration into the nasopalatine duct cannot be avoided during the osteotomy following the principle of prosthetically driven implant placement in the maxillary central incisor site, proper approaches could be adopted according to the size of the penetration, and predictable effects of rehabilitation of the atrophied premaxilla could be obtained.

Key words: nasopalatine canal, nasopalatine neurovascular bundle, maxillary central incisor, dental implants