Fixed Rehabilitation of Atrophic Maxilla with An Implant in the Nasopalatine Canal

Case report: A 48-year-old male patient went to our clinic with the purpose of fixed implant rehabilitation of the upper jaw. The periodontal diagnosis indicated the presence of severe generalized chronic periodontitis, with great involvement of several teeth, including all upper. Radiographic evaluation showed reduced bone quantity, with great pneumatization of the maxillary sinuses. Because it was an extreme case in terms of available bone, we decided to place five implants, with the placement of one implant on the nasopalatine canal. The other implants were placed in the remaining maxillary bone. During osseointegration period, the patient used a removable prosthesis. After 3 months of osseointegration, second surgical stage was performed and a metal-acrylic hybrid fixed prosthesis was fabricated. Discussion: Although the implants were placed in a palatal position, the patient didn't demonstrate problems with speech. In this clinical case, the nasopalatine neurovascular bundle was removed and implant site preparation was then performed. However, the patient didn't refer any sensory loss. In the literature, there are described some cases where sensory loss was refered but was trasitional and minimal. Conclusions: According to some studies, the placement of implants in the nasopalatine canal can offer a viable treatment approach for the rehabilitation of the severily atrophic maxilla, with great satisfaction of patients. The described procedure was successful, returning the patient's confidence in his smile. Keywords: implants, nasopalatine canal, fixed rehabilitation