Comprehensive analysis of the maxillary esthetic zone for immediate implant placement using cone beam computed tomography: A study of 352 maxillary images

Statement of problem. Previous studies have examined the maxillary esthetic zone for immediate implant placement, but these studies had small sample sizes and did not investigate multiple parameters. Purpose. The purpose of this cross-sectional study was to use cone beam computed tomography (CBCT) to evaluate the sagittal root position (SRP), alveolar bone concavity, labial bone perforation (LBP), and tooth-ridge angle in the maxillary anterior teeth region. Material and methods. A total of 352 CBCT images of patients (180 men and 172 women) who visited the dental hospital between 2018 and 2023 were analyzed. The sample included 2112 anterior maxillary teeth. SRP, alveolar bone concavity, tooth ridge angle, and LBP were assessed using virtual implant simulation. The data were analyzed by using chi-squared and kappa tests to analyze distributions and agreement, respectively, dependent and independent t-tests to assess sex and tooth-specific differences, and the Spearman correlation test to explore potential correlations (alpha<.05). Results. The CBCT images revealed that the majority of SRP were in Class I (85.4%), with smaller percentages in Class II (12.5%) and Class IV (2.3%); Class III was the least common (1%). The canine exhibited the most significant alveolar bone concavity angle average (149.14 +/- 6.35 degrees), followed by the lateral incisor (142.32 +/- 8.7 degrees). The canines had the highest occurrence of LBP (63.1%) ( P<.01). Women had a higher frequency of labial bone perforation and deeper alveolar bone concavities than men ( P<.01). Conclusions. The findings of this study indicate that careful assessment and planning are necessary for immediate implant placement in the maxillary anterior region. The significant occurrence of LBP highlights the importance of thorough planning and evaluation to avoid surgical mishaps and complications which may necessitate bone grafting and result in added costs and time. Special attention should be given to women and the canine area.