Management of the Canalis Sinuosus (CS) in Anterior Maxillary Implantology: A Minimally Invasive Case Report

Abstract

Background: The lack of knowledge on the existence of Canalis Sinuosus (CS) has  shown  that many  cases of implant failure in the anterior maxillary region  still occur, in which patients and  implantologists end  up reporting  more pronounced bleeding during surgery, postoperative pain that does not go away  with analgesics, and also  paresthesia.  Aims: We present a case report demonstrating an innovative surgical technique for managing the Canalis Sinuosus (CS) during dental implant placement in the anterior maxilla, focusing on minimizing  complications through  a minimally invasive  approach.   Presentation of the Case: A 55-year-old female with a mobile maxillary left lateral incisor and  radiographic evidence of CS underwent extraction,  curettage, anti-microbial photodynamic therapy  (aPDT), and immediate implant placement using  bone  expanders.  Bone reconstruction was performed with xenogeneic biomaterial, L-PRF,  I-PRF,  and  a collagen membrane.  Discussion: Postoperative CBCT scans at eight months showed the CS in close proximity to the implant, but without encroachment, and the patient reported no sensory changes or pain.  Successful osseointegration allowed for prosthetic rehabilitation. Conclusion: This case underscores that  a thorough understanding of CS anatomy and minimally invasive techniques, like bone expanders, can facilitate successful implant placement in the  anterior  maxilla,  even  with anatomical variations, minimizing complications and enhancing patient satisfaction. No adverse events in the transoperative period were observed. There was no excessive bleeding, pain or paresthesia in the postoperative period either.  After eight months of surgery, the reopening and provisional prosthetic procedures were performed and no abnormal symptoms were observed during the soft tissue healing period.  With the prostheses finished and functioning, the patients were highly satisfied in terms  of final aesthetic outcomes. Conclusion: This report highlights the importance of considering CS anatomy in surgical planning and suggests that minimally invasive techniques can improve patient outcomes in complex cases. Further studies are needed to validate the long-term efficacy of this technique in a larger patient population.