Evaluation of Sagittal Root Positions and Bone Perforation in Anterior Teeth Using Cone Beam Computed Tomography: An Observational Study

Abstract

CBCT and virtual implant helps the clinician in assessing the implant positioning with nearby vital structures and in planning the implant surgical procedures. Thus, the current study aims to evaluate the anterior sagittal root position and assess labial bone perforations in CBCT images. This study was carried out using CBCT scans of 140 samples involving 1338 teeth. The DICOM files were imported into Care stream 3D Imaging software for analysis. All measurements were made in the appropriate section slice of 200 micro thickness in a darkened room. A standardized orientation was established by two examiners. The sagittal root positions (SRP) were assessed in maxillary and mandibular anterior teeth.LabialBone perforation (LBP) was assessed usingtapered implants in the virtual implant software. Overall, Class I SRP was highest (81.48 % & 38.49%) in both sextants. SRP class I was most prevalent in canine teeth in both arches (87.96% and 56.45%), followed by incisors in other types in maxillary arch. In mandibular arch, both incisors were in Class IV and I. The overall LBP was 4.26% and more likely in the mandibular arch (5.64%) than in the maxillary arch (2.8%). The mandibular central incisors showed the highest rate of perforation (8.5 – 11.93 %). The SRP and LBP did not show a statistically significant difference between right and left sides in both arches. The correlation coefficient between SRP and LBP showed a statistically significant results (p<0.01).Class I SRP was the most prevalent in maxillary and mandibular arches. Significantly more number of perforations occurred with mandibular anterior teeth and in Class IV SRP types (approx. 10-30 %) suggesting implant placement requires careful presurgical planning and regenerative approaches or delayed implant placement may be considered.

Evaluation of sagittal root position and labial alveolar bone concavity in the maxillary anterior tooth area for immediate implant placement

“…28 The results of this study revealed that the frequency of Class I SRP was higher than those of other classes, and Class III SRP had the lowest frequency. The results are in line with those reported by Kan et al, 9 Petaibunlue et al, 1 and Medikeri et al 29 who indicated that the frequency of Class I SRP was the highest (81.1%, 85.1%, and 81.48%, respectively) and the frequency of SRP Class III was the lowest (0.7%, 0.0%, and 1.08%, respectively; Table 5). In this study, the frequency of Class I SRP was higher than that reported in the three previous studies.…”

“…A previous study reported a significant correlation between the SRP and labial bone perforation in the maxilla. 29 The SRP within the alveolar bone provides useful information to prevent labial bone perforation. Considering these factors, we evaluated the SRP and labial alveolar bone concavity in the maxillary anterior tooth area.…”

Assessment of sagittal root position, alveolar bone concavity, and labial bone perforation in the mandibular anterior tooth region for immediate implant placement

“…In virtual immediate implant placement, a parallel implant was selected to replace the investigated tooth root, and the diameter of dental implants was calculated using generally used values for anterior mandibular teeth: 4.3 mm for central incisors, 3.3 mm for lateral incisors, and 4.3 mm for canines as well as the length according to the available bone in the particular case; dental implant should be parallel to the long axis of the alveolar bone buccolingually. 7 , 10 , 16 …”

“…indicated that in the mandibular teeth, the frequency distribution of Class I SRP was the highest compared with the other classes. 10 To obtain reliable information and evaluate SRP, alveolar bone concavity, and labial bone perforation (LBP) with accurate radiographic interpretation, the American Academy of Oral and Maxillofacial Radiology recommends cone-beam computed tomography (CBCT). 11 , 12 CBCT can also be used to evaluate patient anatomy.…”

“… 11 , 13 Therefore, evaluation of the alveolar bone using CBCT can determine whether immediate implant placement is feasible; that is, whether the available alveolar bone can provide sufficient primary stability during immediate implant placement. 10 , 14 …”