Nasal Cavity Perforation by Palatal Implants:

Purpose: Lateral cephalometric films were examined for their validity as a tool for the postoperative evaluation of palatal implant placement. Materials and Methods: Cephalometric and histometric data of 20 partially edentulous human cadaveric maxillae were compared. Lateral cephalograms of the specimens were made, and the palatal complex was pencil traced. In addition, low-dose dental computerized tomography (CT) scans were obtained from every specimen. Based on the CT data, palatal implants (Orthosystem; Institut Straumann, Waldenburg, Switzerland) were placed. Postimplantation, another lateral cephalometric film was recorded. The specimens were prepared for histologic examination. The preoperative tracings were superimposed on the postoperative cephalometric films. Results: Of 20 implants placed, 12 were 4 mm long and 8 were 6 mm long. The distance between the cranial end of the implants and the nasal floor on microscopy ranged from 0.3 to 9.3 mm. Perforation of the nasal floor was absent throughout on intraoperative probing, while 2 implants projected beyond the nasal floor on histologic analysis of the specimens. An analysis of the superimposed pre- and postoperative cephalograms showed 5 implants projecting beyond the nasal floor. Histologically, only 1 of these projecting implants had actually caused perforation of the palatal complex. A comparison between the histometric and the cephalometric data showed that cephalometry, on average, imaged the palatal complex 0.8 mm below the actual anatomic site. Discussion and Conclusions: Twenty percent of palatal implants projecting beyond the nasal floor were false-positive records on the postoperative lateral cephalograms. Despite CT scans, 10% of the implants placed caused fenestration of the nasal cavity by histologic evidence. If the palatal complex was perforated, intraoperative probing with a periodontal probe did not confirm the perforation. Bone perforations up to 1.3 mm did not necessarily result in frank perforation of the nasal mucosa. Two-dimensional images could not be related to actual penetrations into the nasal cavity.