How to have an anterior implant placed when the incisive foramen is in the way?

For those who don't know the incisive foramen is a hole in the center of the anterior maxilla that houses a vascular and nerve bundle behind or sometimes between the maxillary central incisors. When placing an implant to replace a central incisors most surgeon will review a cone beam scan in order to locate this anatomical structure.

Most implant surgeons I know agree that placing an implant in contact with this  with the vital tissue inside the incisive foramen will likely compromise the success of the implant. I went to an interesting presentation by Dr. Edgard Elchaar, a Manhattan periodontist who is in charge of the post graduate training for those studying to be periodontists at NYU College of Dentistry. He showed a case where he place two fairly robust implants in position #8 and #9 ( replacing the right and left central incisor) and when I asked him about the incisive foramen he explained that he relocated it. I asked how and he said he removed some of the tissue in the foramen and replaced it with an allograft (human cadaver bone graft). He explained that he does this fairly routinely and hasn't noticed any real complications. Once the grafting has been placed he can feel confident that as long as the implants are placed in contact with the grafting material and not soft tissue in the incisive foramen.

Although he explained that they have been teaching this at NYU for a number of years, it was news to me. In the past I have chosen to opt for a three unit bridge instead of an anterior implant if a scan shows the incisive foramen may be in the way. I am interested if any of my dentist readers have had any experience with their own patients who have had their incisive foramen relocated? Please feel free to comment.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/03/how-to-have-anterior-implant-placed.html - http://lspindelnycdds.blogspot.com/

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