Interruption of canalis sinuosus by dental implant placement: report of two cases

Case Report: The Canalis Sinuosus (CS) represents a critical anatomical consideration in anterior maxillary implantation, with its perforation potentially leading to either neuropathic complications or significant hemorrhage. This report details two clinically distinct cases of CS-related injuries during upper incisor implant placement. In the first case, a 60-year-old male developed persistent neuropathic pain following terminal CS branch perforation, with symptoms enduring at 1-year follow-up despite implant retention. The second case involved a 35-year-old female who experienced 5-day postoperative bleeding from accessory canal (0.9 mm diameter) disruption, successfully managed through conservative measures. These outcomes underscore three critical findings: first, accessory canals pose substantial hemorrhage risks even with proper implant positioning; second, injuries of terminal branch CS may necessitate extended pain management protocols; and third, cone beam computed tomography evaluation should be considered mandatory for anterior maxillary implant planning. As the first comparative analysis of neurological versus vascular CS complications, this report provides clinicians with clear guidelines for complication prevention and management, while highlighting underrecognized anatomical risks in implant dentistry.