Implant in Incisive Foramen?

Dr. W. asks:
I have a female patient with severe maxillary anterior atrophy and she wants an overdenture. She has 3 remaining maxillary molars which will help to support the distribution of occlusal forces. She does not want any bone grafts. I am considering a treatment plan where I place 2 short implants in the #7 and 10 areas [maxillary right lateral incisor and left lateral incisor; 12, 22], plus 1 implant in the incisive foramen. I saw a presentation on placing implants in the incisive foramen technique at the AAID [American Academy of Implant Dentistry] 2 years ago. Have any of you done this and is there an adequate pool of literature to support the use of this procedure?

11 thoughts on “Implant in Incisive Foramen?

  1. Placing an implant in the incisive foramina, regardless of your ability to obtain osseointegration, will likely make fabrication of a well contoured pre-maxillary surface on the overdenture very difficult.
    There will need to be a bump where an attachment would reside that will be lingual to the teeth, even if you are “fortunate” enough to have significant pre-existing resorption that in the #7 or #10 position would create adequate space for attachment components.

  2. Dr W
    You talk about a treatment plan with three implants, but you do not mention how you are restoring them.
    Please remember this is a prosthetic discipline first.
    Think about what kind of prosthesis you would be fabricating, and then where, how, and how many implants you need to acomplish this. If you plan the surgical aspect first, you are taking a risk that the resulting prosthesis might be a problem.

  3. Dr W
    I should have elaborated a little more.
    Implant placement inthe anterior maxilla will have trajectories and angulations that would be difficult to use for an overdenture. Most maxillary overdentures for that reason rely on bilateral implants in the posterior region ( either individual attachments or bilateral bars). Some practitioners are placing six minis anterior to the sinuses for overdenture retention and seem to be getting away with it.
    I realize you did say the plan was an overdenture, I just expected more details.
    Thanks,

  4. Remember, you are the doctor not the patient. If a bone graft is needed then it is needed. If you do not do things right you are asking for headaches and potential lawsuits. That being said, If she just wants an overdenture that is not palateless then you should be fine with two implants in the 7&10 area and skip the third implant. From what I have seen three implants can create a tripod effect on the middle implant and, if it is against natural lower dentition especially, can cause problems with failure of this implant over time. If a palateless overdenture is desired, then you need to graft and place at least 4 implants. Good luck or good lawyer.

  5. Most interesting! Why anybody would even consider
    placing an implant in THAT area is beyond me. Then again, everybody is entitled to his or her own opinion.

    The nasopalatine foramen is where the nasopalatine nerve and blood vessels make their exit to the palate.By nature, it is protected by a fibrous connective tissue pad, to keep it from being irritated
    It is for this very reason that the denture base be relieved to avoid pressure to the nerve and blood vessels.

    Complications associated with implant placement in this area, will not be limited to peri implantitis. Possibility of developing paresthesia, permanent nerve damage or even cavernous sinus thrombosis to the extreme, exist and should be avoided.

    I would say, it is simply cruising for trouble. A big one at that!

    Just a suggestion, why not evaluate the basic morphology of the maxilla and find out if you can harness the bulk of the canine prominences without sacrificing the stability of your prosthesis? This way
    support and distribution of masticatory forces is
    “equilibrated.”

    My two cents…

  6. Almost ALL the implants I have placed in the maxilla and used for overdenture retention have failed ! The bone in the maxilla is simply too weak. All implants in the maxilla should be SPLINTED . So either a bar overdenture or a hybrid . Anything else will fail . It’s just a matter of time . this will only work in the mandilble where the bone in the anterior is a completely different animal. So if you want to place an implant in the incisive foramen or not , make sure you will have enough space for the splinted bar and enough space for a denture/ partial .

  7. Dr. W,

    An implant can be placed in the Nasopalatine canal. Here are a couple of articles. I have a case we are restoring now with an implant in the Nasopalatine canal. One of the articles below discusses patient satisfaction with restorations including implants in the canal. I think it’s all about patient/dentist communication. Placing an implant in the canal is much less traumatic than large scale grafting, but make sure they understand what the trade off is. I’ve placed implants in the canal half a dozen times and have not had any patients with complications or complaints.

    Implant Dentistry:
    December 2009 – Volume 18 – Issue 6 – pp 473-479
    doi: 10.1097/ID.0b013e3181bd0c7c
    Clinical Science and Technology

    Int J Oral Maxillofac Implants 24(5):936-42 (2009)

  8. Thanks to the one who responded who has done this procedure multiple times with success and no complications. I saw the presentation at the AAID and understand that it is not without some risk, but that the risk involved is not great. Certainly being fearful of a legal event keeps many from becoming implalntologists and that same fear keeps many implantolotists from offering some services that actually can work well. Its good when a question is asked and one can get an answer from experts on this forum. I’ve completed the AAID MaxiCourse, Misch Implant Institute course, done implants for 20 years but never done an incisal foramen implant due to no need by one of my patients. Now comes the need and to have a place to ask intelligent questions is welcomed. One dentist asked about prosthetic treatment plan. I plan a partial denture design overdenture. Crowns on the remaining molars, #2,3 and 14. Two locator attachments on an overdenture bar between 7-8 and 9-10. Clasps will form the retention in the posterior segments of the overdenture as in a traditional RPD. The premaxilla is very artophic and will allow a bar and Locators with no space issues. I welcome your comments, thanks to all.

  9. Placement into the incisive canal is a treatment option. See “Dental Implant Prosthetics” Carl Misch, Elsevier & Mosby, 2005 page 293

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