Influence of Implant Diameter and Taper on Virtual Implant Placement in the Maxillary Central Incisor Position: A CBCT Analysis

This study aimed to assess the influence of implant diameter and taper on the proximity of virtually planned maxillary central incisor implants to the nasopalatine canal and adjacent anatomical structures.Virtual implant planning was performed in the maxillary central incisor position. The distance between the implant and the incisive canal (IC) and the thickness of the surrounding buccal and palatal bone walls were measured. Implants were categorized as having an exposed implant surface, thin bone, or moderate/thick bone. Measurements were repeated for regular-/narrow-diameter and parallel/tapered implants.A total of 60 patients were included, and 240 implants (60 of each type: 3.3-bone level [BL], 3.3-bone level tapered [BLT], 4.1-BL, and 4.1-BLT) were planned. The percentages of implants with between 0 and 0.5 mm of remaining bone in the coronal aspect of the IC were 31.6% for 4.1-BL/BLT and 6.6% for 3.3-BL/BLT (P < .001). The percentage of implants with IC exposure was 13.3% for 4.1-BL/BLT and 6.6% for 3.3-BL/BLT (P < .001). The frequency of sites that required bone augmentation at the coronal facial aspect (< 1 mm) was 52.6% and 33.9% for 4.1-BL/BLT and 3.3-BL/BLT, respectively. At the apical portion, the percentages of sites requiring bone augmentation at the facial aspect were 59.9%, 49.9%, 31.6%, and 23.3% for 4.1-BL, 3.3-BL, 4.1-BLT, and 3.3-BLT, respectively (P < .001).The proximity of the nasopalatine canal is often < 0.5 mm from regular-diameter virtually planned implants at the most coronal aspect in the maxillary central incisor position. In these situations, the selection of narrowdiameter implants significantly lowers the incidence of implant exposure and the need for additional management of the nasopalatine canal and also results in greater residual buccal and lingual bone thicknesses surrounding the implant. As expected, tapered implants reduced the risk of implant exposure through the buccal cortex at the apical aspect.