Evaluation of Alveolar bone thickness in the maxillary anterior esthetic zone of six anterior teeth – A retrospective CBCT study

Evaluation of Alveolar bone thickness in the maxillary anterior esthetic zone of six anterior teeth – A retrospective CBCT study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Alveolar bone thickness in the maxillary anterior esthetic zone of six anterior teeth – A retrospective CBCT study Abdulmajeed Aljabr This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8992939/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background The maxillary anterior region represents a critical esthetic zone in which labial alveolar bone thickness (LABT) plays a decisive role. Therefore, accurate assessment of LABT is an essential diagnostic consideration in treatment planning. Given the documented ethnic and regional variations in alveolar bone morphology, evaluation of LABT across different geographical populations is warranted. Accordingly, the present study aimed to assess the LABT in the maxillary anterior region among individuals from the central province of Saudi Arabia Methods The aim of the present study was to assess the LABT of the six maxillary anterior teeth, with the objective of comparing the thickness at predetermined measurement points. Additionally, variations in LABT were evaluated with respect to side (right versus left), gender, and age. A total of 206 cone-beam computed tomography (CBCT) sagittal images were analyzed. Measurements were obtained at three standardized levels: Point A, extending from the facial plate at the level of the alveolar bone crest to the coronal third of the root; Point B, at the mid-root level; and Point C, at the apical third of the root. Statistical analysis was performed using SPSS software (version 26.0; IBM Corp., Armonk, NY, USA). A p-value of < 0.05 was considered statistically significant. Results The mean LBAT was less than 2 mm. The thickness was least at Point B (0.83 mm to 0.95 mm) and the greatest at Point C (1.22 to 1.55 mm). At Point A, the bony thickness was intermediate (0.92 to 1.33 mm), which was statistically significant ( p -value < 0.05). The comparison of the LBAT on the right and left sides and among age groups was not statistically significant. However, comparison among the gender showed statistical significance at Point A, for left canine, right and left canine both at Point B, and for Point C, in the left canine, ( p -value < 0.05). Conclusions LABT was less than the required bone thickness of 2 mm. The clinicians to be given due attention to this, while planning implant treatment, especially in female patients, where thickness of the bone is less than the male. labial bone buccal plate maxillary anterior teeth alveolar bone thickness CBCT Figures Figure 1 Background Implant planning in the anterior region requires a careful assessment of alveolar bone thickness. [1]. Changes in bone morphology such as reduced height, width, density, or LABT can lead to complications if they are not identified and managed at the appropriate time.[2] LABT in the maxillary anterior region plays a crucial role in both esthetics and function. In the anterior region, treatment planning is influenced not only by functional requirements but also by the patient’s esthetic expectations.[3]. Following tooth extraction and during the healing phase in the maxillary anterior area, the facial cortical bone undergoes greater resorption, making accurate diagnosis, timely intervention, and proper follow-up essential. [4]. The factors such as thin facial bone, complete absence of bone, or the presence of fenestrations and dehiscence must be carefully identified and addressed either before or during implant placement.[3] Additionally, soft tissue contours closely follow the underlying bone architecture, further highlighting the importance of assessing LABT. As a result, evaluating this parameter using CBCT has become a fundamental step in implant planning.[5]. Several studies have been conducted across different populations and anatomical regions to assess LABT. [6-10]. In the Kingdom of Saudi Arabia, multiple studies from various regions of the country have reported this parameter; [11-16]. However, their findings have shown variability based on factors such as gender, age, side (right or left), and the type of anterior tooth examined. A review of the available literature revealed a lack of studies focusing on the central province of Saudi Arabia. Therefore, the aim of the present study was to assess the labial alveolar bone thickness in the maxillary anterior region. The secondary objectives included comparing labial bone thickness across gender, between right and left sides, and among selected age groups. Materials and Methods 2.1 Study Design- This is a retrospective study Sample size — This study was undertaken at college of dentistry, Majmaah university, central province KSA. For the study, CBCT images of patients who attended a university dental clinic between December 2024, and June 2025 were selected. A total of 384 CBCT scans were obtained from the database at the Radiology Department, college of Dentistry, Majmaah University, Kingdom of Saudi Arabia. Sample size calculation —Assuming means mid-buccal bone thickness was 0.83 and apical bone thickness was 1.06, standard deviation 0.49 with 80% power, 5% level of significance, and 95% confidence level, the required sample size was, 206. (According to the World Health Organization Sample Size calculator (Lun & Chiam, National University of Singapore, software version) was used for the sample size calculation. [17] Inclusion and exclusion criteria: Inclusion criteria: Saudi patients, age ranged between 18 to 65 years. Non-smokers. Absence of any systemic disease. Periodontal health—absence of any signs of periodontal disease. Presence of normal occlusion. The presence of all six maxillary anterior teeth (including canine). Exclusion criteria : Poor image quality of CBCT scan. Images from patients with systemic or pathological dentoalveolar conditions (e.g., cyst) that might cause abnormal bone remodeling. Any history or current periapical lesion. Presence of inflammatory processes at the apical level. Patient with a previous history of road traffic accidents (RTA). Cancer subjects. History of radiation or chemotherapy. Osteoporosis conditions. Tooth malalignment. All 384 patient records were searched according to these inclusion and exclusion criteria, and the final required number of CBCT scan (206) was selected. Radiographic Image Analysis: Detail of CBCT All the CBCT images selected for the study were exposed from the same machine. (Orthophos (Sirona Dental Systems, Bensheim, Germany). Imaging parameters used were 85 kV, 6 mA, 14.1 s exposure time, 0.2 mm voxel size, and 80 × 40 mm field of view. Imaging parameters were determined according to the “as low as reasonably achievable” (ALARA) principle. The images were constructed and analyzed using Horos 3.0 software (Horos Project, Annapolis, MD, USA). Scan Measurements Inter examiner calibration. Measurements on the CBCT scans were analyzed by two independently trained faculty. The right-side canine (RCA), right-side lateral incisor (RL), right-side central incisor (RC), left-side canine (LCA), left-side lateral incisor (LL), and left-side central incisor (LC) were included in the analysis. Inter examiner calibration difference was assessed. Initially, two examiners (AM,Am2 ) assessed 20 CBCT images. The weighted mean kappa score was 0.92. Further, to ensure correct measurement, all measurements were performed twice by one observer, and the averages were submitted to statistical analysis. Secondly, only three CBCT images were measured at one time, and after every three CBCT measurements, a break was taken to avoid eye fatigue of the observer. Repeated measurements of reliability between investigators were assessed to measure their degree of agreement. For this, the CBCT images were examined one week apart (every 5th CBCT was re-examined by the examiners to rule out intra- and inter-examiner variability). Intraclass correlation coefficients were calculated to assess outcome reproducibility and consistency between all repeated measures. Data Collection Alveolar Bone Thickness Measurement For the measurement of facial plate thickness of the alveolar bone, sagittal CBCT images of each tooth were selected. The sagittal section was made at the middle of each tooth by applying the cursor in the midline that bisects the tooth into equal halves. Reference points were used to measure alveolar bone thicknesses at three locations using a digital caliper: Point A from the facial plate at the level of the bone crest to the coronal root third, Point B to the mid root surface, and Point C to the apical third. All measurements were taken in millimeters (mm). To set fixed reference points for each tooth in the sagittal view, the cursor was placed at the tooth’s midline, and in the sagittal view, the tooth root was divided equally into cervical, middle, and apical thirds. Reference points were set at the midpoint of each third, while the cementoenamel junction (CEJ) was set as a fixed reference point for measuring crest height. Crest height (Point D) was measured as the distance from the CEJ to the alveolar bone crest. This was done by using the same sagittal view as that used for measuring thicknesses and the same digital caliper as mentioned above. The built-in digital caliper was used for direct bone measurements on the CBCT images. All images were viewed on the same monitor and under the same lighting conditions (Figure 1). Data Analysis All the analysis was done using SPSS version 31. A p -value of <0.05 was considered statistically significant. Buccal bone thickness was measured with descriptive analysis using mean ± standard deviation (SD) and median (min-max). Comparison of variable were the gender and age groups was done using an independent sample t -test. A comparison of variables between the right and the left side was done using paired t -test. Consent to participate declaration - This study used anonymized retrospective data; therefore, individual informed consent was not required as approved by the Institutional Review Board. Ethics declaration : The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of [IRB Majmaah university # 10234/2025].” Results To assess the outcome reproducibility and consistency between all repeated measures, intraclass correlation coefficients were calculated which ranged from 0.86–0.92 Demographic Data A Total of 206 CBCT scans were examined. Among that, 102 were males (54.83%). In our study, age group of subjects were divided into those below and above 30 years of age. There were 114 (61.29%) (below 30 years of age). Labial Alveolar Bone Thickness ( LABT) The bone thickness measured in all the teeth, at any given point (Point A, Point B, and Point C) showed following distribution. In only the canine, 4% of teeth measurement of bone thickness equal to more than 2 mm. 18% of lateral incisor, 6 % canine and 4% of central incisors measurement was between 1.5 to 2 mm. 82% of lateral incisor, 90% of canine and 96% central incisor, it was less than 1.5 mm (Table 1) Table 1: The percentage and frequency distribution of the LABT. Bone thickness Teeth Central incisor (n%) Lateral incisor (n%) Canine (n%) 2 1 Nil 2 Comparison of LABT at Different Points The Bone thickness was measured at six anterior teeth, at three points A, B, and C. The thickness was at least at Point B (0.83 mm to 0.95 mm) and the greatest at Point C (1.22 to 1.55 mm). At Point A, the bony thickness was intermediate (0.92 to 1.33 mm). This difference was found to be statistically significant ( p -value <0.05). However, the comparison among the teeth was not statistically significant ( p -value ≥ 0.05) (Table 2). Table 2: A Comparison of the labial bone thickness among maxillary anterior teeth . Right Left Point Tooth Mean SD ± mm Mean SD ± mm p -Value Canine 1.32 0.30 1.33 0.34 0.456 A Lateral 1.06 0.27 1.04 0.31 0.977 Central 0.96 0.20 0.92 0.20 0.033 Canine 0.83 0.26 0.83 0.26 0.942 B Lateral 0.84 0.41 0.83 0.33 0.813 Central 0.95 0.28 0.92 0.26 0.865 Canine 1.55 0.47 1.47 0.48 0.121 C Lateral 1.40 0.73 1.33 0.73 0.187 Central 1.22 0.49 1.31 0.52 0.246 Comparison of LABT—Right and Left Sides The comparison of the LABT on the right and left sides at any given point (Point A, B, or C) was not statistically significant between the six teeth measured (canine, lateral, and central incisor). (Table 2) C omparison of LABT by Gender The comparison of LABT for all six teeth between males and females showed statistical significance at Point A, for left canine ( p -value ≥ 0.05), right and left canine both at Point B, and for Point C, in the left canine, which was statistically significant difference ( p -value < 0.05) (Table 3) Table 3 : C omparison of Bone Thickness by Gender Sex Points Male Females Mean SD Mean SD P value A R. Canine 1.32 0.26 1.30 0.29 0.843 R. Lateral 1.06 0.24 1.04 0.26 0.754 R. Central 1.23 0.20 1.21 0.27 0.832 L. Central 1. 21 0.28 1.19 0.26 0.932 L. Lateral 0.97 0.35 1.01 0.28 0.284 L. Canine 1.45 0.58 1. 27 0.34 0.013 B R. Canine 1. 18 0.24 0.97 0.30 0.036 R. lateral 0.85 0.50 0.84 0.42 0.823 R. Central 1.01 0.34 1. 03 0.31 0.217 L. Central 1.03 0.26 1.05 0.43 0.136 L. Lateral 0.92 0.32 0.89 0.26 0.557 L. Canine 1.23 0.35 1.04 0.53 0.016 C R. Canine 1.34 0.32 1.31 0.28 0.834 R. Lateral 1.01 0.20 1.03 0.24 0.682 R. Central 1. 25 0.28 1.23 0.34 0.481 L. Central 1.24 0.32 1.21 0.27 0.824 L. Lateral 1.04 0.23 1.01 0.32 0.944 L. Canine 1.37 0.34 1.18 0.23 0.036 Comparison of LABT among Different Age Groups The comparison of the LABT at different given points compared between the two age groups (below and above 30 years) showed no statistically significant difference ( p -value ≥ 0.05). Discussion The LABT measurement for maxillary anterior teeth has important clinical implications. Thin buccal plate less than 1 mm pose challenge to Immediate Implant Placement with greater risk of post-extraction resorption and soft tissue recession.[18]. In such cases planned bone and soft tissue augmentation may be required, since it forms the major esthetic zone. In addition to this, Orthodontic Tooth Movement, done in the presence of thin cortical bone thickness, may also increase the risk of dehiscence and fenestration during labial movement.[19]. With both functional and esthetic importance of this critical anterior zone, these study findings are considered to be helpful for the clinician to plan the well-designed treatment plan avoiding complications. The present study evaluated LABT of the six maxillary anterior teeth at three standardized levels (Point A, B, and C) in a Saudi population. The findings demonstrated that bone thickness was thinnest at Point B (0.83–0.95 mm), thickest at Point C (1.22–1.55 mm), and intermediate at Point A (0.92–1.33 mm), with statistically significant differences between measurement levels (p < 0.05). However, no statistically significant differences were observed among individual teeth, between right and left sides, or between age groups (<30 and ≥30 years). Gender differences were observed at specific points, particularly involving the canine region. Thus, Null hypothesis proposed at the beginning of the study was rejected. In our study, the mid-root region (Point B) demonstrated the least bone thickness. This finding aligns with some of previous studies. Fuentes ( 2015). reported that the facial bone in the maxillary anterior region is frequently <1 mm in thickness, particularly at the mid-root level, which is consistent with our range (0.83–0.95 mm). [20]. Similarly, Huynh-Ba G et al. (2010) also observed thin cortical bone thickness (<1 mm).[21]. Aljabr et al ( 2023) study done in the eastern province of KSA almost showed similar result, asserting the reported values can be considered for overall Saudi population.[16] We have observed a progressive increase in thickness as the bone moves from coronal to apical level, with the exception of the mid root region. There was relatively increase in thickness at the apical third or Point C. This finding agrees with the findings of Zekry A et al. (2014), who reported that buccal bone thickness tends to increase apically due to the anatomical contour of the alveolar process.[22]. This anatomical pattern has clinical implications, particularly in immediate implant placement, where thin crestal and mid-root bone may predispose to post-extraction resorption. Anatomically, central incisors are often reported to have thinner buccal plates compared to canines, however in our study, we did not find any statistically significant differences among the six anterior teeth. A previously reported studies conducted by Almahdi et al ( 2021) and Aljabr et al ( 2023) reported minimal differences among selected maxillary anterior teeth which support the present findings.[16]. In contrast, a study by Nowzari H et al. (2012), who found thinner cortical bone thickness in the central incisor compared to the canine and showed significant inter-tooth variation in a North American cohort. [23]. Regional variations is the possibility for this difference observed. Differences in the bone morphology between ethnic population, explains the contrast report between Middle Eastern and Western populations. The absence of significant differences between right and left sides in the current study is consistent with the bilateral symmetry described in previous few studies. Studies carried out Saudi population by Sheerah et al ( 2019) and Aljabr et al (2023) is also reported similar report with no difference between the right and left side.[24,16] This bilateral consistency reinforces the reliability of unilateral assessments in clinical decision-making when contralateral anatomy is intact. In most of the studies, regarding the gender differences, it was concluded that, males demonstrated thicker bone compared to females. In the present study too we observed, if not for all the teeth and at all points, but at specific measurement points, particularly involving the canine region, ales demonstrated significantly greater bone thickness at certain levels . This finding agrees with Januário AL et al. (2011), who reported that males tend to have thicker buccal cortical plates than females,[25] Similarly, Alqahtani ND et al. (2020),[26] and Aljabr et al ( 2023) [16]studies also reported, male patients exhibiting greater facial bone thickness in the maxillary anterior region compared to females. These gender-related differences may be attributed to hormonal influences, overall craniofacial dimensions, and functional loading. These patterns are also likely to be due to differences in skeletal morphology and bone density. Translating these findings to the clinical assessment, points out that, females may have increase susceptibility to post-extraction ridge resorption and aesthetic compromise, especially in the anterior maxilla. Therefore, gender-specific risk assessment may be beneficial during implant treatment planning. In the preset study the absence of statistically significant differences between age groups (<30 and ≥30 years) suggests relative stability of buccal bone thickness in early to middle adulthood. These findings are similar to the reports of Monje A et al. (2018), who reported that significant alveolar bone dimensional changes are more strongly associated with tooth loss and periodontal disease rather than chronological age alone.[28] The relatively young age distribution in the present sample may explain the lack of significant age-related variation. In contrast, some studies have documented age-related thinning of the alveolar cortical bone, particularly in individuals beyond the fifth decade of life. A systematic review of reported that, patients over 50 years exhibited thinner facial alveolar bone and increased CEJ-bone crest distances compared to younger cohorts [9] .Additionally few other studies demonstrated a clear decline in cortical bone thickness with advancing age, with progressive thinning of the cortical plates (Zhou et al., et al. ( 2026)[28] and Srebrzyńska-Witek et al ( 2018). [29] Strength of the study is that it provided the important parameter of LABT in the anterior region, which is a functional and esthetic requirement in immediate implant placement.It also explains that probable need for bone augmentation in this area. Ther ae are limitations. Some of the differences observed between our study and previous studies may be related to the sample size, age group differences, and genetic components. Some of the previous studies concluded with the difference in the cortical bone thickness between different arch and face form, which we have not considered in our study. Further, inclination of the tooth in the arch, the tooth form, root form, and other morphological features also influence the bone thickness. Future studies can include the following additional considerations, which may provide better clarity in the outcome. and data collection and the permission to acknowledge was taken from the individual . Conclusion Within the limitations of this study, no statistically significant differences were observed among the six maxillary anterior teeth with respect to LABT. However, significant variations were identified at different measurement levels within certain teeth. Additionally, gender-related differences at specific levels underscore the need to consider anatomical variability during treatment planning, particularly in female patients. The majority of sites exhibited a LABT of less than 2 mm, with only a limited number demonstrating a thickness greater than 2 mm. These findings emphasize the importance of thorough preoperative evaluation and individualized treatment planning. Careful consideration of ridge preservation or ridge augmentation procedures, when indicated, may be essential to achieve optimal functional and esthetic outcomes. Abbreviations CBCT-Cone Beam Computed Tomography LABT – Labial alveolar bone thickness CEJ- Cemento enamel junction right-side canine (RCA), right-side lateral incisor (RL), right-side central incisor (RC), left-side canine (LCA), left-side lateral incisor (LL), left-side central incisor (LC) Declarations Ethics approval and consent to participate The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of [IRB Majmaah university # 10234 /2025 Consent for publication This study used anonymized retrospective data; therefore, individual informed consent was not required as approved by the Institutional Review Board. Consent for publication was thus obtained from the IRB. Availability of data and materials- The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests – "The authors declare that they have no competing interests" Funding : This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions: Author Is solely responsible for all the activities involved in this research and publications, except for the data collection ( it was combined and done by two examiners) Acknowledgements: Author acknowledges the help of Dr Abdullah A. Aljabr, Department of Medical Education , College of Dentistry , Majmaah University , AL-Majmaah 11952 , Saudi Arabia , for assessing the measurements References Al‐Haj Husain A, Stadlinger B, Özcan M, Schönegg D, Winklhofer S, Al‐Haj Husain N, Piccirelli M, Valdec S. Buccal bone thickness assessment for immediate anterior dental implant planning: a pilot study comparing cone‐beam computed tomography and 3D double‐echo steady‐state MRI. Clinical Implant Dentistry and Related Research. 2023 ;25(1):35-45. Farahamnd A, Sarlati F, Eslami S, Ghassemian M, Youssefi N, Esfahani BJ. Evaluation of impacting factors on facial bone thickness in the anterior maxillary region. Journal of Craniofacial Surgery. 2017 ;28(3):700-5. Bidra AS, Chapokas AR. Treatment planning challenges in the maxillary anterior region consequent to severe loss of buccal bone. Journal of Esthetic and Restorative Dentistry. 2011 ;23(6):354-60. Iyer J, Hariharan A, Cao UM, Tran SD. Acquired facial, maxillofacial, and oral asymmetries—a review highlighting diagnosis and management. Symmetry. 2021 ;13(9):1661. Cui X, Reason T, Pardi V, Wu Q, Martinez Luna AA. CBCT analysis of crestal soft tissue thickness before implant placement and its relationship with cortical bone thickness. BMC Oral Health. 2022 ;22(1):593. Tsigarida, A.; Toscano, J.; de Brito Bezerra, B.; Geminiani, A.; Barmak, A.B.; Caton, J.; Papaspyridakos, P.; Chochlidakis, K. Buccal bone thickness of maxillary anterior teeth: A systematic review and meta-analysis. J. Clin. Periodontol. 2020, 47, 1326–1343. Ramanauskaite, A.; Becker, K.; Kassira, H.C.; Becker, J.; Sader, R.; Schwarz, F. The dimensions of the facial alveolar bone at tooth sites with local pathologies: A retrospective cone-beam CT analysis. Clin. Oral Investig. 2020, 24, 1551–1560. Botelho, S.V.; Perussolo, J.; Misawa, M.Y.; Zadeh, H.H.; Araújo, M.G. The Basal Bone and Alveolar Process in the Maxillary Anterior Region in Humans: A Cone Beam Computed Tomographic Study. Int. J. Periodontics Restor. Dent. 2020, 40, 907–914. Rojo-Sanchis, J.; Soto-Peñaloza, D.; Peñarrocha-Oltra, D.; Peñarrocha-Diago, M.; Viña-Almunia, J. Facial alveolar bone thickness and modifying factors of anterior maxillary teeth: A systematic review and meta-analysis of cone-beam computed tomography studies. BMC Oral Health 2021, 21, 143. Almahdi, R.A.; Alasqah, M. Assessment of buccal bone thickness in the maxillary and mandibular canine using cone-beam computed tomography. Int. J. Med. Dent. 2021, 25, 331–338. Alqhtani, N.R.; Alenazi, A.; Alqahtani, A.S.; Gufran, K.; Robaian, A.; Alqahtani, A.M.; Aldossary, S.F.; Aldossry, M.F. Labial alveolar bone thickness and its correlation with buccolingual maxillary incisors angulation: A CBCT based study. Eur. Rev. Med. Pharmacol. Sci. 2022, 26, 4625–4633. Othman, B.; Khalifa, H.; Afandi, A.; Alshehri, N.A.; Sait, A.; Abdoun, S.; Zahid, T. Measuring the Facial Plate of Bone in the Upper Anterior Teeth Utilizing Cone Beam Computed Tomography at King Abdulaziz University, Jeddah, Saudi Arabia. Cureus 2022, 14, e29453.1–e29453.21. Sheerah, H.; Othman, B.; Jaafar, A.; Alsharif, A. Alveolar bone plate measurements of maxillary anterior teeth: A retrospective Cone Beam Computed Tomography study, AlMadianh, Saudi Arabia. Saudi Dent. J. 2019, 31, 437–444. Alsaffar, Z.J.; Shafshak, S.M.; Shokry, S. Assessment of labial and palatal alveolar bone thickness and height in maxillary anterior teeth in saudi population using cone beam computed tomography (CBCT). Int. J. Contemp. Dent. 2016, 7, 1–6. Alkazman, F.H.; Abouelkheir, H.M.; Almashat, H.; Alfahadi, H.R. Assessment of the distribution of facial root fenestration in maxillary anterior teeth in Saudi sub-population using cone-beam computed tomography: Retrospective study. Saudi Endod. J. 2021, 11, 73–79. Aljabr, A.A.; Almas, K.; Aljofi, F.E.; Aljabr, A.A.; Alzaben, B.; Alqanas, S. A CBCT Study of Labial Alveolar Bone Thickness in the Maxillary Anterior Region in a Teaching Hospital Population in the Eastern Province of Saudi Arabia. Biomedicines 2023, 11, 1571. Sample Size Calculations—World Health Organization (WHO). Available online: https://cdn.who.int\T1\textgreater{}sample_ size_calculator_survey (accessed on 1 January 2025). Khoury J, Ghosn N, Mokbel N, Naaman N. Buccal bone thickness overlying maxillary anterior teeth: a clinical and radiographic prospective human study. Implant dentistry. 2016 ;25(4):525-31. Antoun JS, Mei L, Gibbs K, Farella M. Effect of orthodontic treatment on the periodontal tissues. Periodontology 2000. 2017 ;74(1):140-57. Fuentes R, Flores T, Navarro P, Salamanca C, Beltrán V, Borie E. Assessment of buccal bone thickness of aesthetic maxillary region: a cone-beam computed tomography study. Journal of periodontal & implant science. 2015 ;45(5):162-8. Huynh‐Ba G, Pjetursson BE, Sanz M, Cecchinato D, Ferrus J, Lindhe J, Lang NP. Analysis of the socket bone wall dimensions in the upper maxilla in relation to immediate implant placement. Clinical oral implants research. 2010 ;21(1):37-42. Zekry A, Wang R, Chau AC, Lang NP. Facial alveolar bone wall width–a cone‐beam computed tomography study in A sians. Clinical oral implants research. 2014 ;25(2):194-206. Nowzari H, Molayem S, Chiu CH, Rich SK. Cone beam computed tomographic measurement of maxillary central incisors to determine prevalence of facial alveolar bone width≥ 2 mm. Clinical implant dentistry and related research. 2012 ;14(4):595-602. Sheerah H, Othman B, Jaafar A, Alsharif A. Alveolar bone plate measurements of maxillary anterior teeth: A retrospective Cone Beam Computed Tomography study, AlMadianh, Saudi Arabia. The Saudi dental journal. 2019 ;31(4):437-44. Januário AL, Duarte WR, Barriviera M, Mesti JC, Araújo MG, Lindhe J. Dimension of the facial bone wall in the anterior maxilla: a cone‐beam computed tomography study. Clinical oral implants research. 2011 ;22(10):1168-71. Alqhtani NR, Alenazi A, Alqahtani AS, Gufran K, Robaian A, Alqahtani AM, Aldossary SF, Aldossry MF. Labial alveolar bone thickness and its correlation with buccolingual maxillary incisors angulation: a CBCT based study. European Review for Medical & Pharmacological Sciences. 2022 ;26(13).4625-4633. Monje A, Chappuis V, Monje F, Muñoz F, Wang HL, Urban IA, Buser D. The Critical Peri-implant Buccal Bone Wall Thickness Revisited: An Experimental Study in the Beagle Dog. International Journal of Oral & Maxillofacial Implants. 2019 ;34(6).1328-1336. Zhou, Y., Yang, J., Le, K. et al. Alveolar bone heterogeneity during aging: a cone-beam CT based assessment of alveolar bone in tooth loss patients. BMC Oral Health 26 , 30 (2026). Srebrzyńska-Witek, A., Koszowski, R. & Różyło-Kalinowska, I. Relationship between anterior mandibular bone thickness and the angulation of incisors and canines—a CBCT study. Clin Oral Invest 2018 ; 22 , 1567–1578 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 May, 2026 Reviews received at journal 23 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers agreed at journal 14 Apr, 2026 Reviews received at journal 14 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers invited by journal 06 Apr, 2026 Editor assigned by journal 31 Mar, 2026 Editor invited by journal 10 Mar, 2026 Submission checks completed at journal 09 Mar, 2026 First submitted to journal 09 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8992939","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619390336,"identity":"a91cdf73-6287-43e2-ba95-3f493d46b1d8","order_by":0,"name":"Abdulmajeed Aljabr","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYHCCBGYGBhswS4IULWmkaWEAajlMghb+BoaHnwv3nI82OMB88DYPQ508QS0SBxiSpWc8u5274QBbsjUPw2HDBoJ6DjAkSPMcAGnhMZPmYTjASFCLPNCW3zwHzgG18H8DaqmzJ6jF4ABDGtCWAyBb2IBamBMJajE8zJBmPeNAcu7Mw2zGlnMMDicT1CJ3vCf5dsEBu9y+480Pb7ypqLMlqIWBmScBygC7k6B6EGA/QJSyUTAKRsEoGMEAALtcOrYEmJOeAAAAAElFTkSuQmCC","orcid":"","institution":"Majmaah University","correspondingAuthor":true,"prefix":"","firstName":"Abdulmajeed","middleName":"","lastName":"Aljabr","suffix":""}],"badges":[],"createdAt":"2026-02-28 07:54:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8992939/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8992939/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106702827,"identity":"682653af-1364-4fc1-bd0a-d65c9bd7d403","added_by":"auto","created_at":"2026-04-12 07:36:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109070,"visible":true,"origin":"","legend":"\u003cp\u003eCortical bone thickness measurement.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8992939/v1/6a32817dbbe1b2a5499c8d19.png"},{"id":106728183,"identity":"858d75c1-f125-4170-ac80-ad7798156dab","added_by":"auto","created_at":"2026-04-12 18:42:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1022906,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8992939/v1/e6ce6a8c-59e1-4980-b173-38d5b0284277.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Alveolar bone thickness in the maxillary anterior esthetic zone of six anterior teeth – A retrospective CBCT study","fulltext":[{"header":"Background","content":"\u003cp\u003eImplant planning in the anterior region requires a careful assessment of alveolar bone thickness. [1]. \u0026nbsp;Changes in bone morphology such as reduced height, width, density, or LABT can lead to complications if they are not identified and managed at the appropriate time.[2] LABT in the maxillary anterior region plays a crucial role in both esthetics and function. In the anterior region, treatment planning is influenced not only by functional requirements but also by the patient\u0026rsquo;s esthetic expectations.[3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollowing tooth extraction and during the healing phase in the maxillary anterior area, the facial cortical bone undergoes greater resorption, making accurate diagnosis, timely intervention, and proper follow-up essential. [4]. The factors such as thin facial bone, complete absence of bone, or the presence of fenestrations and dehiscence must be carefully identified and addressed either before or during implant placement.[3] Additionally, soft tissue contours closely follow the underlying bone architecture, further highlighting the importance of assessing LABT. As a result, evaluating this parameter using CBCT has become a fundamental step in implant planning.[5].\u003c/p\u003e\n\u003cp\u003eSeveral studies have been conducted across different populations and anatomical regions to assess LABT. [6-10]. In the Kingdom of Saudi Arabia, multiple studies from various regions of the country have reported this parameter; [11-16]. However, their findings have shown variability based on factors such as gender, age, side (right or left), and the type of anterior tooth examined. A review of the available literature revealed a lack of studies focusing on the central province of Saudi Arabia.\u003c/p\u003e\n\u003cp\u003eTherefore, the aim of the present study was to assess the labial alveolar bone thickness in the maxillary anterior region. The secondary objectives included comparing labial bone thickness across gender, between right and left sides, and among selected age groups.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study Design-\u0026nbsp;\u003c/strong\u003eThis is \u0026nbsp;a retrospective study\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u0026mdash; This study was undertaken at college of dentistry, Majmaah university, central province KSA. For the study, CBCT images of patients who attended a university dental clinic between December 2024, and June 2025 were selected. A total of 384 CBCT scans were obtained from the database at the Radiology Department, college of Dentistry, Majmaah University, Kingdom of Saudi Arabia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size calculation\u003c/strong\u003e\u0026mdash;Assuming means mid-buccal bone thickness was 0.83 and apical bone thickness was 1.06, standard deviation 0.49 with 80% power, 5% level of significance, and 95% confidence level, the required sample size was, 206. (According to the World Health Organization Sample Size calculator (Lun \u0026amp; Chiam, National University of Singapore, software version) was used for the sample size calculation. [17]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003col style=\"list-style-type: lower-alpha;\"\u003e\n \u003cli\u003eSaudi patients, age ranged between 18 to 65 years.\u003c/li\u003e\n \u003cli\u003eNon-smokers.\u003c/li\u003e\n \u003cli\u003eAbsence of any systemic disease.\u003c/li\u003e\n \u003cli\u003ePeriodontal health\u0026mdash;absence of any signs of periodontal disease.\u003c/li\u003e\n \u003cli\u003ePresence of normal occlusion.\u003c/li\u003e\n \u003cli\u003eThe presence of all six maxillary anterior teeth (including canine).\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e:\u003c/p\u003e\n\u003col style=\"list-style-type: lower-alpha;\"\u003e\n \u003cli\u003ePoor image quality of CBCT scan.\u003c/li\u003e\n \u003cli\u003eImages from patients with systemic or pathological dentoalveolar conditions (e.g., cyst) that might cause abnormal bone remodeling.\u003c/li\u003e\n \u003cli\u003eAny history or current periapical lesion.\u003c/li\u003e\n \u003cli\u003ePresence of inflammatory processes at the apical level.\u003c/li\u003e\n \u003cli\u003ePatient with a previous history of road traffic accidents (RTA).\u003c/li\u003e\n \u003cli\u003eCancer subjects.\u003c/li\u003e\n \u003cli\u003eHistory of radiation or chemotherapy.\u003c/li\u003e\n \u003cli\u003eOsteoporosis conditions.\u003c/li\u003e\n \u003cli\u003eTooth malalignment.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAll 384 patient records were searched according to these inclusion and exclusion criteria, and the final required number of CBCT scan (206) \u0026nbsp;was selected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiographic Image Analysis: Detail of CBCT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the CBCT images selected for the study were exposed from the same machine. (Orthophos (Sirona Dental Systems, Bensheim, Germany). Imaging parameters used were 85 kV, 6 mA, 14.1 s exposure time, 0.2 mm voxel size, and 80 \u003cem\u003e\u0026times;\u0026nbsp;\u003c/em\u003e40 mm field of view. Imaging parameters were determined according to the \u0026ldquo;as low as reasonably achievable\u0026rdquo; (ALARA) principle. The images were constructed and analyzed using Horos 3.0 software (Horos Project, Annapolis, MD, USA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScan Measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInter examiner calibration.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMeasurements on the CBCT scans were analyzed by two independently trained faculty. The right-side canine (RCA), right-side lateral incisor (RL), right-side central incisor (RC), left-side canine (LCA), left-side lateral incisor (LL), and left-side central incisor (LC) were included in the analysis. Inter examiner calibration difference was assessed. Initially, two examiners (AM,Am2 ) assessed 20 CBCT images. The weighted mean kappa score was 0.92. Further, to ensure correct measurement, all measurements were performed twice by one observer, and the averages were submitted to statistical analysis. Secondly, only three CBCT images were measured at one time, and after every three CBCT measurements, a break was taken to avoid eye fatigue of the observer. Repeated measurements of reliability between investigators were assessed to measure their degree of agreement. For this, the CBCT images were examined one week apart (every 5th CBCT was re-examined by the examiners to rule out intra- and inter-examiner variability). Intraclass correlation coefficients were calculated to assess outcome reproducibility and consistency between all repeated measures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlveolar Bone Thickness Measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the measurement of facial plate thickness of the alveolar bone, sagittal CBCT images of each tooth were selected. The sagittal section was made at the middle of each tooth by applying the cursor in the midline that bisects the tooth into equal halves. Reference points were used to measure alveolar bone thicknesses at three locations using a digital caliper: Point A from the facial plate at the level of the bone crest to the coronal root third, Point B to the mid root surface, and Point C to the apical third. All measurements were taken in millimeters (mm). To set fixed reference points for each tooth in the sagittal view, the cursor was placed at the tooth\u0026rsquo;s midline, and in the sagittal view, the tooth root was divided equally into cervical, middle, and apical thirds. Reference points were set at the midpoint of each third, while the cementoenamel junction (CEJ) was set as a fixed reference point for measuring crest height. Crest height (Point D) was measured as the distance from the CEJ to the alveolar bone crest. This was done by using the same sagittal view as that used for measuring thicknesses and the same digital caliper as mentioned above. The built-in digital caliper was used for direct bone measurements on the CBCT images. All images were viewed on the same monitor and under the same lighting conditions (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the analysis was done using SPSS version 31. A \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;0.05 was considered statistically significant. Buccal bone thickness was measured with descriptive analysis using mean \u003cem\u003e\u0026plusmn;\u0026nbsp;\u003c/em\u003estandard deviation (SD) and median (min-max). Comparison of variable were the gender and age groups was done using an independent sample \u003cem\u003et\u003c/em\u003e-test. A comparison of variables between the right and the left side was done using paired \u003cem\u003et\u003c/em\u003e-test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate declaration\u003c/strong\u003e - This study used anonymized retrospective data; therefore, individual informed consent was not required as approved by the Institutional Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e : The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of [IRB Majmaah university \u0026nbsp;# 10234/2025].\u0026rdquo;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTo assess the outcome reproducibility and consistency between all repeated measures, intraclass correlation coefficients were calculated which ranged from 0.86\u0026ndash;0.92\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA Total of 206 CBCT scans were examined. Among that, 102 were males (54.83%). In our study, age group of subjects were divided into those below and above 30 years of age. There were 114 (61.29%) (below 30 years of age).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLabial Alveolar Bone Thickness ( LABT)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe bone thickness measured in all the teeth, at any given point (Point A, Point B, and Point C) showed following distribution. In only the canine, 4% of teeth measurement of bone thickness equal to more than 2 mm. \u0026nbsp;18% of lateral incisor, 6 % canine and 4% of central incisors measurement was between 1.5 to 2 mm. 82% of lateral incisor, 90% of canine and 96% central incisor, it was less than 1.5 mm (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: The percentage and frequency distribution of the LABT.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBone thickness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTeeth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCentral incisor (n%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLateral incisor (n%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCanine (n%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026lt;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.5 to 2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026gt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Nil\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of LABT at Different Points\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The Bone thickness was measured at six anterior teeth, at three points A, B, and C. The thickness was at least at Point B (0.83 mm to 0.95 mm) and the greatest at Point C (1.22 to 1.55 mm). At Point A, the bony thickness was intermediate (0.92 to 1.33 mm). This difference was found to be statistically significant (\u003cem\u003ep\u003c/em\u003e-value \u0026lt;0.05). \u0026nbsp;However, the comparison among the teeth was not statistically significant (\u003cem\u003ep\u003c/em\u003e-value \u003cem\u003e\u0026ge;\u0026nbsp;\u003c/em\u003e0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: A Comparison of the labial bone thickness among maxillary anterior teeth\u003c/strong\u003e.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Right \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTooth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026plusmn;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003emm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026plusmn;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003emm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCanine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eLateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCanine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eLateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCanine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eLateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of LABT\u0026mdash;Right and Left Sides\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe comparison of the LABT on the right and left sides at any given point (Point A, B, or C) was not statistically significant between the six teeth measured (canine, lateral, and central incisor). (Table 2)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eC\u003c/em\u003eomparison of LABT by Gender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe comparison of LABT for all six teeth between males and females showed \u0026nbsp; statistical significance at Point A, for left canine \u0026nbsp;(\u003cem\u003ep\u003c/em\u003e-value \u003cem\u003e\u0026ge;\u0026nbsp;\u003c/em\u003e0.05), right and left canine both at Point B, and for Point C, in the left canine, which was \u0026nbsp;statistically significant difference (\u003cem\u003ep\u003c/em\u003e-value \u0026lt; 0.05) (Table 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 3 : \u003cem\u003eC\u003c/em\u003eomparison of Bone Thickness by Gender\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"20\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePoints\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Females\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eP value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Canine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Lateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Central\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Central\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Lateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Canine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Canine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. lateral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Central\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. 03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Central\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Lateral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Canine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Canine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Lateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eR. Central\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Central\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Lateral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eL. Canine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.37\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of LABT among Different Age Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe comparison of the LABT at different given points compared between the two age groups (below and above 30 years) showed no statistically significant difference (\u003cem\u003ep\u003c/em\u003e-value \u003cem\u003e\u0026ge;\u0026nbsp;\u003c/em\u003e0.05).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe LABT measurement for maxillary anterior teeth \u0026nbsp;has important clinical implications. Thin buccal plate less than 1 mm pose challenge to Immediate Implant Placement \u0026nbsp;with greater risk of post-extraction resorption and soft tissue recession.[18]. In such cases planned bone and soft tissue augmentation may be required, since it forms the major esthetic zone. In addition to this, Orthodontic Tooth Movement, done in the presence of thin cortical bone thickness, may also \u0026nbsp;increase the risk of dehiscence and fenestration during labial movement.[19]. With both functional and esthetic importance of this critical anterior zone, these study findings are considered to be helpful for the clinician to plan the well-designed treatment plan avoiding complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe present study evaluated LABT of the six maxillary anterior teeth at three standardized levels (Point A, B, and C) in a Saudi population. The findings demonstrated that bone thickness was thinnest at Point B (0.83\u0026ndash;0.95 mm), thickest at Point C (1.22\u0026ndash;1.55 mm), and intermediate at Point A (0.92\u0026ndash;1.33 mm), with statistically significant differences between measurement levels (p \u0026lt; 0.05). However, no statistically significant differences were observed among individual teeth, between right and left sides, or between age groups (\u0026lt;30 and \u0026ge;30 years). Gender differences were observed at specific points, particularly involving the canine region. Thus, Null hypothesis proposed at the beginning of the study was rejected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, \u0026nbsp;the mid-root region (Point B) demonstrated the least bone thickness. This finding aligns with some of previous studies. Fuentes ( 2015). reported that the facial bone in the maxillary anterior region is frequently \u0026lt;1 mm in thickness, particularly at the mid-root level, which is consistent with our range (0.83\u0026ndash;0.95 mm). [20]. Similarly, Huynh-Ba G et al. (2010) also observed thin cortical bone thickness (\u0026lt;1 mm).[21]. Aljabr et al ( 2023) study done in the eastern province of KSA almost showed similar result, asserting the reported values can be considered for overall Saudi population.[16] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe have observed a progressive increase in thickness as the bone moves from coronal to apical level, with the exception of the mid root region. There was relatively increase in thickness at the \u0026nbsp;apical third or \u0026nbsp;Point C. \u0026nbsp;This finding agrees with the findings of \u0026nbsp;Zekry A et al. (2014), who reported that buccal bone thickness tends to increase apically due to the anatomical contour of the alveolar process.[22]. This anatomical pattern has clinical implications, particularly in immediate implant placement, where thin crestal and mid-root bone may predispose to post-extraction resorption.\u003c/p\u003e\n\u003cp\u003eAnatomically, central incisors are often reported to have thinner buccal plates compared to canines, however in our study, we did not find any statistically significant differences among the six anterior teeth. A previously reported studies conducted by Almahdi et al ( 2021) and Aljabr et al ( 2023) \u0026nbsp;reported minimal differences among selected maxillary anterior teeth \u0026nbsp;which support the present findings.[16]. \u0026nbsp;In contrast, a study by Nowzari H et al. (2012), who found thinner cortical bone thickness in the central incisor compared to the canine and showed significant inter-tooth variation in a North American cohort. [23]. Regional variations is the possibility for this difference observed. Differences in the bone morphology between \u0026nbsp;ethnic population, explains the contrast report between Middle Eastern and Western populations.\u003c/p\u003e\n\u003cp\u003eThe absence of significant differences between right and left sides in the current study is consistent with the bilateral symmetry described in previous few studies. Studies carried out Saudi population by \u0026nbsp;Sheerah et al ( 2019) and Aljabr et al (2023) is also reported similar report with no difference between the right and left side.[24,16] This bilateral consistency reinforces the reliability of unilateral assessments in clinical decision-making when contralateral anatomy is intact.\u003c/p\u003e\n\u003cp\u003eIn most of the studies, regarding the gender differences, it was concluded that, males demonstrated thicker bone compared to females. In the present study too we observed, if not for all the teeth and at all points, but at specific measurement points, particularly involving the canine region, \u0026nbsp;ales demonstrated significantly greater bone thickness at certain levels . This finding agrees with Janu\u0026aacute;rio AL et al. (2011), who reported that males tend to have thicker buccal cortical plates than females,[25] Similarly, Alqahtani ND et al. (2020),[26] and Aljabr et al ( 2023) [16]studies also reported, male patients exhibiting greater facial bone thickness in the maxillary anterior region compared to females. These gender-related differences may be attributed to hormonal influences, overall craniofacial dimensions, and functional loading. These patterns are also likely to be due to differences in skeletal morphology and bone density. Translating these findings to the clinical assessment, \u0026nbsp;points out that, females may have increase susceptibility to post-extraction ridge resorption and aesthetic compromise, especially in the anterior maxilla. Therefore, gender-specific risk assessment may be beneficial during implant treatment planning.\u003c/p\u003e\n\u003cp\u003eIn the preset study the absence of statistically significant differences between age groups (\u0026lt;30 and \u0026ge;30 years) suggests relative stability of buccal bone thickness in early to middle adulthood. These findings are similar to the reports of Monje A et al. (2018), who reported that significant alveolar bone dimensional changes are more strongly associated with tooth loss and periodontal disease rather than chronological age alone.[28] The relatively young age distribution in the present sample may explain the lack of significant age-related variation.\u003cem\u003e\u0026nbsp;\u003c/em\u003eIn contrast, some studies have documented age-related thinning of the alveolar cortical bone, particularly in individuals beyond the fifth decade of life. A systematic review of reported that, patients over 50 years exhibited thinner facial alveolar bone and increased CEJ-bone crest distances compared to younger cohorts [9] .Additionally \u0026nbsp;few other studies \u0026nbsp;demonstrated a clear decline in cortical bone thickness with advancing age, with progressive thinning of the cortical plates (Zhou et al., et al. ( 2026)[28] and Srebrzyńska-Witek et al ( 2018). [29]\u003c/p\u003e\n\u003cp\u003eStrength of the study is that it provided the important parameter of LABT in the anterior region, which is a functional and esthetic requirement \u0026nbsp;in immediate implant placement.It also explains that probable need for bone augmentation in this area. Ther ae are limitations. Some of the differences observed between our study and previous studies may be related to the sample size, \u0026nbsp;age group differences, and genetic components. Some of the previous studies concluded with the difference in the cortical bone thickness between different arch and face form, which we have not considered in our study. Further, inclination of the tooth in the arch, the tooth form, root form, and other morphological features also influence the bone thickness. Future studies can include the following additional considerations, which may provide better clarity in the outcome.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eand data collection and the permission to acknowledge was taken from the \u0026nbsp; individual\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWithin the limitations of this study, no statistically significant differences were observed among the six maxillary anterior teeth with respect to LABT. However, significant variations were identified at different measurement levels within certain teeth. Additionally, gender-related differences at specific levels underscore the need to consider anatomical variability during treatment planning, particularly in female patients. The majority of sites exhibited a LABT of less than 2 mm, with only a limited number demonstrating a thickness greater than 2 mm. These findings emphasize the importance of thorough preoperative evaluation and individualized treatment planning. Careful consideration of ridge preservation or ridge augmentation procedures, when indicated, may be essential to achieve optimal functional and esthetic outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col start=\"1\" type=\"a\" style=\"list-style-type: lower-alpha;\"\u003e\n \u003cli\u003eCBCT-Cone Beam Computed Tomography\u003c/li\u003e\n \u003cli\u003eLABT \u0026ndash; Labial alveolar bone thickness\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCEJ- Cemento enamel junction\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eright-side canine (RCA),\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;right-side lateral incisor (RL),\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eright-side central incisor (RC),\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eleft-side canine (LCA),\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eleft-side lateral incisor (LL),\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eleft-side central incisor (LC) \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of [IRB Majmaah university \u0026nbsp;# 10234 /2025\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used anonymized retrospective data; therefore, individual informed consent was not required as approved by the Institutional Review Board. Consent for publication was thus obtained from the IRB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials-\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Competing Interests \u0026ndash;\u0026nbsp;\u003c/strong\u003e\u0026quot;The authors declare that they have no competing interests\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding :\u0026nbsp;\u003c/strong\u003eThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor Is solely responsible for all the activities involved in this research and publications, except for the data collection ( it was combined and done by two examiners)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor acknowledges the help of Dr Abdullah A. Aljabr, Department of Medical Education , College of Dentistry , Majmaah University , AL-Majmaah 11952 , Saudi Arabia , for assessing the measurements\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAl‐Haj Husain A, Stadlinger B, \u0026Ouml;zcan M, Sch\u0026ouml;negg D, Winklhofer S, Al‐Haj Husain N, Piccirelli M, Valdec S. Buccal bone thickness assessment for immediate anterior dental implant planning: a pilot study comparing cone‐beam computed tomography and 3D double‐echo steady‐state MRI. Clinical Implant Dentistry and Related Research. 2023 \u0026nbsp;;25(1):35-45.\u003c/li\u003e\n \u003cli\u003eFarahamnd A, Sarlati F, Eslami S, Ghassemian M, Youssefi N, Esfahani BJ. Evaluation of impacting factors on facial bone thickness in the anterior maxillary region. Journal of Craniofacial Surgery. 2017 ;28(3):700-5.\u003c/li\u003e\n \u003cli\u003eBidra AS, Chapokas AR. Treatment planning challenges in the maxillary anterior region consequent to severe loss of buccal bone. Journal of Esthetic and Restorative Dentistry. 2011 ;23(6):354-60.\u003c/li\u003e\n \u003cli\u003eIyer J, Hariharan A, Cao UM, Tran SD. Acquired facial, maxillofacial, and oral asymmetries\u0026mdash;a review highlighting diagnosis and management. Symmetry. 2021 ;13(9):1661.\u003c/li\u003e\n \u003cli\u003eCui X, Reason T, Pardi V, Wu Q, Martinez Luna AA. CBCT analysis of crestal soft tissue thickness before implant placement and its relationship with cortical bone thickness. BMC Oral Health. 2022 ;22(1):593.\u003c/li\u003e\n \u003cli\u003eTsigarida, A.; Toscano, J.; de Brito Bezerra, B.; Geminiani, A.; Barmak, A.B.; Caton, J.; Papaspyridakos, P.; Chochlidakis, K. Buccal bone thickness of maxillary anterior teeth: A systematic review and meta-analysis. J. Clin. Periodontol. 2020, 47, 1326\u0026ndash;1343.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRamanauskaite, A.; Becker, K.; Kassira, H.C.; Becker, J.; Sader, R.; Schwarz, F. The dimensions of the facial alveolar bone at tooth sites with local pathologies: A retrospective cone-beam CT analysis. Clin. Oral Investig. 2020, 24, 1551\u0026ndash;1560.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBotelho, S.V.; Perussolo, J.; Misawa, M.Y.; Zadeh, H.H.; Ara\u0026uacute;jo, M.G. The Basal Bone and Alveolar Process in the Maxillary Anterior Region in Humans: A Cone Beam Computed Tomographic Study. Int. J. Periodontics Restor. Dent. 2020, 40, 907\u0026ndash;914.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRojo-Sanchis, J.; Soto-Pe\u0026ntilde;aloza, D.; Pe\u0026ntilde;arrocha-Oltra, D.; Pe\u0026ntilde;arrocha-Diago, M.; Vi\u0026ntilde;a-Almunia, J. Facial alveolar bone thickness and modifying factors of anterior maxillary teeth: A systematic review and meta-analysis of cone-beam computed tomography studies. BMC Oral Health 2021, 21, 143.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAlmahdi, R.A.; Alasqah, M. Assessment of buccal bone thickness in the maxillary and mandibular canine using cone-beam computed tomography. Int. J. Med. Dent. 2021, 25, 331\u0026ndash;338.\u003c/li\u003e\n \u003cli\u003eAlqhtani, N.R.; Alenazi, A.; Alqahtani, A.S.; Gufran, K.; Robaian, A.; Alqahtani, A.M.; Aldossary, S.F.; Aldossry, M.F. Labial alveolar bone thickness and its correlation with buccolingual maxillary incisors angulation: A CBCT based study. Eur. Rev. Med. Pharmacol. Sci. 2022, 26, 4625\u0026ndash;4633.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOthman, B.; Khalifa, H.; Afandi, A.; Alshehri, N.A.; Sait, A.; Abdoun, S.; Zahid, T. Measuring the Facial Plate of Bone in the Upper Anterior Teeth Utilizing Cone Beam Computed Tomography at King Abdulaziz University, Jeddah, Saudi Arabia. Cureus 2022, 14, e29453.1\u0026ndash;e29453.21.\u003c/li\u003e\n \u003cli\u003eSheerah, H.; Othman, B.; Jaafar, A.; Alsharif, A. Alveolar bone plate measurements of maxillary anterior teeth: A retrospective Cone Beam Computed Tomography study, AlMadianh, Saudi Arabia. Saudi Dent. J. 2019, 31, 437\u0026ndash;444.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAlsaffar, Z.J.; Shafshak, S.M.; Shokry, S. Assessment of labial and palatal alveolar bone thickness and height in maxillary anterior teeth in saudi population using cone beam computed tomography (CBCT). Int. J. Contemp. Dent. 2016, 7, 1\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eAlkazman, F.H.; Abouelkheir, H.M.; Almashat, H.; Alfahadi, H.R. Assessment of the distribution of facial root fenestration in maxillary anterior teeth in Saudi sub-population using cone-beam computed tomography: Retrospective study. Saudi Endod. J. 2021, 11, 73\u0026ndash;79.\u003c/li\u003e\n \u003cli\u003eAljabr, A.A.; Almas, K.; Aljofi, F.E.; Aljabr, A.A.; Alzaben, B.; Alqanas, S. A CBCT Study of Labial Alveolar Bone Thickness in the Maxillary Anterior Region in a Teaching Hospital Population in the Eastern Province of Saudi Arabia. Biomedicines 2023, 11, 1571.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSample Size Calculations\u0026mdash;World Health Organization (WHO). Available online: https://cdn.who.int\\T1\\textgreater{}sample_ size_calculator_survey (accessed on 1 January 2025).\u003c/li\u003e\n \u003cli\u003eKhoury J, Ghosn N, Mokbel N, Naaman N. Buccal bone thickness overlying maxillary anterior teeth: a clinical and radiographic prospective human study. Implant dentistry. 2016 ;25(4):525-31.\u003c/li\u003e\n \u003cli\u003eAntoun JS, Mei L, Gibbs K, Farella M. Effect of orthodontic treatment on the periodontal tissues. Periodontology 2000. 2017 ;74(1):140-57.\u003c/li\u003e\n \u003cli\u003eFuentes R, Flores T, Navarro P, Salamanca C, Beltr\u0026aacute;n V, Borie E. Assessment of buccal bone thickness of aesthetic maxillary region: a cone-beam computed tomography study. Journal of periodontal \u0026amp; implant science. 2015 ;45(5):162-8.\u003c/li\u003e\n \u003cli\u003eHuynh‐Ba G, Pjetursson BE, Sanz M, Cecchinato D, Ferrus J, Lindhe J, Lang NP. Analysis of the socket bone wall dimensions in the upper maxilla in relation to immediate implant placement. Clinical oral implants research. 2010 ;21(1):37-42.\u003c/li\u003e\n \u003cli\u003eZekry A, Wang R, Chau AC, Lang NP. Facial alveolar bone wall width\u0026ndash;a cone‐beam computed tomography study in A sians. Clinical oral implants research. 2014 ;25(2):194-206.\u003c/li\u003e\n \u003cli\u003eNowzari H, Molayem S, Chiu CH, Rich SK. Cone beam computed tomographic measurement of maxillary central incisors to determine prevalence of facial alveolar bone width\u0026ge; 2 mm. Clinical implant dentistry and related research. 2012 ;14(4):595-602.\u003c/li\u003e\n \u003cli\u003eSheerah H, Othman B, Jaafar A, Alsharif A. Alveolar bone plate measurements of maxillary anterior teeth: A retrospective Cone Beam Computed Tomography study, AlMadianh, Saudi Arabia. The Saudi dental journal. 2019 ;31(4):437-44.\u003c/li\u003e\n \u003cli\u003eJanu\u0026aacute;rio AL, Duarte WR, Barriviera M, Mesti JC, Ara\u0026uacute;jo MG, Lindhe J. Dimension of the facial bone wall in the anterior maxilla: a cone‐beam computed tomography study. Clinical oral implants research. 2011 ;22(10):1168-71.\u003c/li\u003e\n \u003cli\u003eAlqhtani NR, Alenazi A, Alqahtani AS, Gufran K, Robaian A, Alqahtani AM, Aldossary SF, Aldossry MF. Labial alveolar bone thickness and its correlation with buccolingual maxillary incisors angulation: a CBCT based study. European Review for Medical \u0026amp; Pharmacological Sciences. 2022 ;26(13).4625-4633.\u003c/li\u003e\n \u003cli\u003eMonje A, Chappuis V, Monje F, Mu\u0026ntilde;oz F, Wang HL, Urban IA, Buser D. The Critical Peri-implant Buccal Bone Wall Thickness Revisited: An Experimental Study in the Beagle Dog. International Journal of Oral \u0026amp; Maxillofacial Implants. 2019 ;34(6).1328-1336.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZhou, Y., Yang, J., Le, K. \u003cem\u003eet al.\u003c/em\u003e Alveolar bone heterogeneity during aging: a cone-beam CT based assessment of alveolar bone in tooth loss patients. \u003cem\u003eBMC Oral Health\u003c/em\u003e \u003cstrong\u003e26\u003c/strong\u003e, 30 (2026).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSrebrzyńska-Witek, A., Koszowski, R. \u0026amp; R\u0026oacute;żyło-Kalinowska, I. Relationship between anterior mandibular bone thickness and the angulation of incisors and canines\u0026mdash;a CBCT study. \u003cem\u003eClin Oral Invest\u003c/em\u003e 2018 ; \u003cstrong\u003e22\u003c/strong\u003e, 1567\u0026ndash;1578\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"labial bone, buccal plate, maxillary anterior teeth, alveolar bone thickness, CBCT","lastPublishedDoi":"10.21203/rs.3.rs-8992939/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8992939/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe maxillary anterior region represents a critical esthetic zone in which labial alveolar bone thickness (LABT) plays a decisive role. Therefore, accurate assessment of LABT is an essential diagnostic consideration in treatment planning. Given the documented ethnic and regional variations in alveolar bone morphology, evaluation of LABT across different geographical populations is warranted. Accordingly, the present study aimed to assess the LABT in the maxillary anterior region among individuals from the central province of Saudi Arabia\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe aim of the present study was to assess the LABT of the six maxillary anterior teeth, with the objective of comparing the thickness at predetermined measurement points. Additionally, variations in LABT were evaluated with respect to side (right versus left), gender, and age. A total of 206 cone-beam computed tomography (CBCT) sagittal images were analyzed. Measurements were obtained at three standardized levels: Point A, extending from the facial plate at the level of the alveolar bone crest to the coronal third of the root; Point B, at the mid-root level; and Point C, at the apical third of the root. Statistical analysis was performed using SPSS software (version 26.0; IBM Corp., Armonk, NY, USA). A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean LBAT was less than 2 mm. The thickness was least at Point B (0.83 mm to 0.95 mm) and the greatest at Point C (1.22 to 1.55 mm). At Point A, the bony thickness was intermediate (0.92 to 1.33 mm), which was statistically significant (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The comparison of the LBAT on the right and left sides and among age groups was not statistically significant. However, comparison among the gender showed statistical significance at Point A, for left canine, right and left canine both at Point B, and for Point C, in the left canine, (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLABT was less than the required bone thickness of 2 mm. The clinicians to be given due attention to this, while planning implant treatment, especially in female patients, where thickness of the bone is less than the male.\u003c/p\u003e","manuscriptTitle":"Evaluation of Alveolar bone thickness in the maxillary anterior esthetic zone of six anterior teeth – A retrospective CBCT study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-12 07:36:25","doi":"10.21203/rs.3.rs-8992939/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-09T12:21:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T10:15:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217677192341264367408106353041060261825","date":"2026-04-23T09:21:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T19:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37917278556744693746040374353904626576","date":"2026-04-15T12:56:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223993124579574471674057705647259884145","date":"2026-04-15T06:22:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25005556479117712064076307893450852655","date":"2026-04-14T14:26:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-14T10:16:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242861257313670469957779355534051068017","date":"2026-04-06T06:16:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-06T05:48:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T09:41:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-10T09:17:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-09T21:03:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-03-09T16:29:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"079f696b-1ae2-4276-b33c-2bd503336f8d","owner":[],"postedDate":"April 12th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-09T12:21:59+00:00","index":78,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-12T07:36:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-12 07:36:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8992939","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8992939","identity":"rs-8992939","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}