{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T23:42:41Z","timestamp":1782776561830,"version":"3.54.5"},"reference-count":16,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T00:00:00Z","timestamp":1716336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2025,6]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>While the nasal fossa and nasopalatine canal are recognized limitations for immediate implants in esthetic areas, the canalis sinuosus (CS) and its branches have been largely overlooked. Neglecting this anatomy can lead to sensory issues, pain, and implant failure underscores the necessity of meticulous pre\u2010surgical assessment and planning to mitigate risks and ensure implant success. This case highlights the need for comprehensive pre\u2010surgical evaluation and precise planning to minimize these complications and ensure successful implant outcomes in this scenario.<\/jats:p><\/jats:sec>Methods and Results<\/jats:title>A 41\u2010year\u2010old woman with a history of root perforation and external root resorption was referred for dental implant placement. Following clinical evaluation and computed tomography, the presence of an accessory canal of the CS was identified. After meticulous planning to avoid implant contact with this structure, ridge preservation was performed. After 6 months, the implant was successfully placed following guided osteotomy. The case demonstrates clinical and radiographic stability after 36 months of follow\u2010up.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The correct diagnosis and planning, within a multidisciplinary team, can lead to successful implant placement in a challenging site with an anatomical variation. This study, to our knowledge, represents the first to propose an alternative treatment approach in the presence of CS in an esthetic region.<\/jats:p><\/jats:sec>Key points<\/jats:title>Why is this case new information?<\/jats:bold><\/jats:p>\nThis case emphasizes the importance of thorough pre\u2010surgical evaluation to mitigate potential complications related to the CS. It is the first, to our knowledge, to propose an alternative treatment approach in the presence of this anatomical variation in an esthetic region.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p>What are the keys to successful management in this case?<\/jats:bold><\/jats:p>\nComprehensive pre\u2010surgical evaluation, precise planning with detailed CBCT assessment to identify the CS, careful consideration of its anatomy during surgical intervention, knowledge of the limitations of tissue reconstructions, and precise clinical strategies to minimize associated complications.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p>What are the primary limitations to success in this case?<\/jats:bold><\/jats:p>\nThe need to position the implant with a safety margin from the CS led to implant positioning resulting in fenestration of the buccal bone plate, preventing its reconstruction due to the bone envelope's design, resulting in a discrepant gingival margin compared to the contralateral tooth, which did not allow for further crown lengthening due to a rather short root.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/cap.10294","type":"journal-article","created":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T05:58:55Z","timestamp":1716357535000},"page":"111-117","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A 3\u2010year follow\u2010up of implant placement in proximity to canalis sinuosus: Case study"],"prefix":"10.1002","volume":"15","author":[{"given":"C\u00e1ssio Cardona","family":"Orth","sequence":"first","affiliation":[{"name":"Department of Periodontology Implanteperio Institute Sao Paulo Brazil"},{"name":"Orth Clinic (Cl\u00ednica Orth) Montenegro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celso","family":"Orth","sequence":"additional","affiliation":[{"name":"Orth Clinic (Cl\u00ednica Orth) Montenegro 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