Analysis of the dimensions of the labial bone wall in the anterior maxilla: a cone-beam computed tomography studyby Hani El Nahass, Suzy N. Naiem

Clinical Oral Implants Research


Oral Surgery


Hani El Nahass

Suzy N. Naiem

Analysis of the dimensions of the labial bone wall in the anterior maxilla: a cone-beam computed tomography study

Authors’ affiliations:

Hani El Nahass, Department of Oral Medicine,

Periodontology Cairo University, Cairo, Egypt

Suzy N. Naiem, Private Clinic (Nahass Dental

Clinic), Cairo, Egypt

Corresponding author:

Dr. Hani El Nahass, BDS, MSc, PhD

Department of Oral Medicine and Periodontology

Cairo University, 28 Street 263 Maadi-Cairo, Egypt

Tel: +00201002659854 e-mail:


Background: Immediate implant placement in extraction socket does not appear to prevent the resorption of the labial wall. It has been recommended that a minimal thickness of 1–2 mm of buccal bone should be available to preclude the resorption of the facial vertical dimension of the socket wall.

Objective: The aim was to determine the dimension of the facial buccal plate of bone in the anterior esthetic zone at different levels and relate it to immediate implant placement.

Materials and methods: Seventy-three patients’ cone-beam tomographic scans were included in the study (42 female and 31 male, mean age 39.6 years). The images were acquired using

OnDemand software. The measurements taken included: 1. Distance between the CEJ and the alveolar crest. 2. The labial bone thickness at different levels in relation to alveolar crest: at 1, 2, and 4 mm

The results: The measurements demonstrated that the distance between the CEJ and the crest was 2.10  0.85 for the central and 2.09  0.72 for the lateral incisor. The measurement taken at M0 (crestal level) revealed that only 1% of the incisors showed a thick labial bone (1–2 mm) and 73% showed a thin bony wall (0.5–1 mm) and 25% showed very thin wall <0.5 mm. At the M1, 7% showed very thin bony wall and 86% showed a thin bony wall while only 6% exhibited a thick bony wall. The M2 showed only 1% of very thin bony wall, and about 85% showed a thin bony wall and 14% exhibited a thick bony level. The M4 demonstrated very thin bony wall and about 75% thin bony wall and 23% showed thick bony wall. Males showed statistically significantly higher mean distance between cemento–enamel junction and alveolar crest (CEJ-AC) than females at the central as well as lateral incisors. To obtain good results, meticulous preoperative analysis is recommended. Thus, to chose an adequate treatment approach, the utilization of CBCT is recommended.

Osseointegrated implants have been used with great success for many years (Blanes et al. 2007). The presence of sufficient amount of bone volume is the most important prerequisite. Moreover, there has been interest in placing dental implants into sockets immediately following the extraction of the tooth.

It has been suggested that the immediate placement of implants into extraction sockets may avoid the resorption process of the buccal bone plate and maintain the original shape of the alveolar ridge (Evans & Chen 2008). However, a series of researches conducted in dogs (Araujo & Lindhe 2005; Araujo et al. 2005) failed to support this hypothesis. The placement of an implant in a tooth extraction socket site failed to prevent remodeling that occurred, in particular, in the buccal plate of bone (Araujo & Lindhe 2005; Januario et al. 2011). To achieve superb esthetic success, it has been suggested to place the implant in an ideal three-dimensional position (Buser et al. 2004), in order to maintain the adequate buccal bone (Grunder et al. 2005; Ferrus et al. 2010) and tissue biotype (Chen et al. 2007). The data obtained from the diagnostic imaging are essential for correct implant placement. Therefore, an understanding of the anatomy of anterior region is mandatory. The thickness of the labial bony wall is of utmost importance to determine the most suitable treatment approach (Braut et al. 2011).


Accepted 5 December 2013

To cite this article:

El Nahass H, Naiem SN. Analysis of the Dimensions of the labial bone wall in the anterior maxilla: a cone-beam computed tomography study.

Clin. Oral Impl. Res. 00, 2014, 1–5 doi: 10.1111/clr.12332 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1

The maxillary anterior region has an esthetic importance in cases of immediate placement as the buccal bone should be at least 1–2 mm to preclude future bone resorption and to create adequate soft tissue support (Grunder et al. 2005).

Cone-beam computed tomography (CBCT) has been introduced to dentistry, and it has proven to be a versatile tool that has been successfully employed for various dental procedures that entail periodontal, endodontic, and implant-related study evaluation .

The measurement of buccal and lingual bone plate thickness using CBCT images has demonstrated good precision therefore can be used to accurately measure the facial bone thickness (Menezes & Janson 2010).

Due to the fact of naturally occurring biologic events, the thin facial bone wall is prone to resorption which can lead to fenestration and dehiscence following tooth extraction (Schropp et al. 2003).


The main purpose of this study was to investigate the bone thickness on buccal aspect of maxillary anterior using CBCT and measure the distance between the cemento–enamel junction (CEJ) and the alveolar bone crest.

The study evaluated the thickness of the buccal plate of bone at different levels that are clinically relevant. Additional purpose of this study was to investigate the differences between that could be seen between males and females.

Material and methods

This study included 73 patients’ cone-beam tomographic scans that were included in the study (42 female and 31 male, mean age 42.3 years).

Patients with periodontal disease or history of periodontal disease were excluded from this study. Patients with bone loss related to upper anterior area or with soft tissue recession were also excluded from the study.

Moreover, patients who were smokers were excluded. All patients were medically free with no history of chemotherapy nor radiotherapy.