Morphometric Analysis of the Incisive (Nasopalatine) Canal and Foramen: Clinical Implications for Anterior Maxillary Surgery

Background and aim: The incisive (nasopalatine) canal is an important anatomical structure of the anterior maxilla. It holds significance for surgeries and implant placement in the central incisor region. The size, shape, and relation with surrounding bones may vary by age, gender, and ethnicity. Standard radiographs used in dentistry often miss these variations, while cone beam computed tomography (CBCT) allows a precise evaluation in sagittal and axial views. This study aimed to analyze anatomical variations of the incisive canal and surrounding structures, such as canal length, shape, diameter, and bone thickness in the Pakistani subpopulation using CBCT, and compare them across age and gender. Methods: A retrospective cross-sectional study was conducted on 121 high-resolution CBCT scans taken from the Oral Radiology Department, the University of Lahore, from 2021 to 2023. Measurements were done in Planmeca Romexis software (Helsinki, Finland: Planmeca Oy), and statistical analysis was performed using SPSS version 25 (Armonk, NY: IBM Corp.) using t-tests, ANOVA, and nonparametric tests where appropriate. Results: The mean age was 34.61±15.38 years. Males had significantly longer incisive canals, thicker palatal bone, and longer incisor roots (p<0.05). Posterior bone width and the distance from incisive foramen to alveolar crest were also greater in males, the latter being marginally significant. Anterior bone width decreased considerably in older age groups, especially above 60 years (p=0.010), while incisor root width showed no gender difference. Hourglass was the most common canal shape (43%), and round foramen shape was slightly more common than oval. No significant differences in shape were seen by age groups and gender. Conclusion: This study shows key anatomical differences in the Pakistani subpopulation. Gender and age affected many linear measurements, while canal and foramen shapes were fairly consistent. The hourglass configuration was the predominant shape of the incisive canal, and the round foramen appeared slightly more frequently than the oval type. These research findings will be useful for implant planning and surgical procedures involving the anterior maxilla.