Clin Oral Impl Res 2000: 11: 505–510 Copyright C Munksgaard 2000 Printed in Denmark ¡ All rights reserved ISSN 0905-7161 Novel development Displacement of the incisive foramen in conjunction with implant placement in the anterior maxilla without jeopardizing vitality of nasopalatine nerve and vessels: a novel surgical approach Artzi Z, Nemcovsky CE, Bitlitum I, Segal P. Displacement of the incisive Zvi Artzi 1 , foramen in conjunction with implant placement in the anterior maxilla Carlos E. Nemcovsky 1 , without jeopardizing vitality of nasopalatine nerve and vessels: Ilan Bitlitum 1 , Pnina Segal 2 a novel surgical approach. Clin Oral Impl Res 2000: 11: 505–510. C Munksgaard 2000. 1 Department of Periodontology and 2 Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel Accurate implant placement in the anterior maxilla is essential in achiev- ing optimal prosthetic rehabilitation with proper function and acceptable esthetic and phonetic demands. One of the preferable prosthetic solutions Key words: bone transplantation – to restore a missing maxillary incisor in young adults is by an implant- incisive canal – intramembranous bone – supported crown. Bone resorption together with an enlarged incisive for- symphyseal bone – cortico-cancellous amen, challenge proper implant placement. A simultaneous procedure block – autograft where the implant osteotomy site penetrated the incisive canal is pre- sented. A configurated cortico-cancellous block graft core was adjusted to Dr Zvi Artzi, Department of fit the foramen while its soft tissue content was pushed back posteriorly Periodontology, The Maurice and but not removed. This procedure was followed by an immediate implant Gabriela Goldschleger, School of Dental placement. Re-entry at 9 months revealed solid bone support embracing Medicine, Tel Aviv University,Tel Aviv, Israel. Fax: 972 3 6409250 the implant body. Although the size of the incisive foramen diminished significantly, the nasopalatine branches were still evident. No compli- Accepted for publication 23 August 1999 cations and/or loss of sensation were observed. Implant reconstruction in the anterior maxilla is always challenging. Esthetic, phonetic and func- tional demands dictate meticulous, accurate plan- ning of the osteotomy site and subsequent ideal positioning of the titanium fixtures (Mecall & Ro- senfeld 1991). The high resorption rate of the pre- maxilla in the post extraction phase (Lam 1960; Sobolik 1960; Atwood 1962; Carlsson et al. 1967; Pietrokovski 1975; Jahangiri et al. 1998), as well as frequent instances of an enlarged incisive foramen could jeopardize the surgical osteotomy prepara- tion. Proximity of the incisive canal to the location of the future osteotomy, according to the surgical 505 template, advocates augmenting the area prior to or together with implant placement. Traditional regenerative procedures, using auto- logous bone chips or a mixture of demineralized freeze-dried bone (DFDB) and tricalcium phos- phate (TCP), have been reported (Rosenquist & Nystrom 1992; Scher 1994), where a meticulous curettage of the soft tissue contents was carried out. The aim of this case report was to evaluate whether bone augmentation of an anatomical space, such as an enlarged incisive foramen, is achievable regardless of the presence of the naso- palatine nerve and vessels. A new approach using