CBCT-based morphometric assessment of the Mandibular second premolar region: implications for implant placement and perforation prevention
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Abstract
Objective: To study the mandibular second premolar relation to alveolar bone and provide clinical guidelines for implant fixtures to prevent buccal and lingual perforations.
Methods: This cross-sectional analytical study evaluated Cone-Beam Computed Tomography (CBCT) records from Jinnah MRI, University of Lahore, and Fatima Memorial Hospital. CBCT scans (n=164) were selected via purposive sampling per defined inclusion and exclusion criteria. The scans were used to measure alveolar process height and width, basal bone width, and the angles between the long axes of the alveolar and basal bones in the mandibular second premolar region. Measurements were performed using the Ginifab web-based application. Ethical approval was granted by the Institutional Review Board of CMH Lahore Medical College.
Results: Measurements of mandibular second premolars revealed that the alveolar process height (EF) and width (AB) and basal bone width (CD) were 20.3±1.1 mm, 52.2 (49.3–53.7) mm, and 53.0 (50.2–54.5) mm for females, and 20.8±1.2 mm, 53.1 (51.8–55.0) mm, and 54.0 (52.8–55.8) mm for males. Age distributions were similar (females: median 32.5 years; males: median 33.0 years, p=0.151). Males showed significantly greater crest distance (20.8±1.2 vs. 20.3±1.1 mm; p=0.013) and wider alveolar processes (53.1 vs. 52.2 mm; p=0.003) and basal bones (54.0 vs. 53.0 mm; p=0.006). No gender differences in tooth-to-bone angles were observed. Oblique morphology predominated (70.1%, p=0.865), thus ultimately informing implant placement strategies.
Conclusion: The proposed classification guides mandibular second premolar implant selection and design. The oblique type may pose the highest risk of buccal perforation according to this study.
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