Multifactorial analysis of the maxillary premolar area for immediate implant placement using cone beam computed tomography: A study of 333 maxillary images

Immediate implant placement in the maxillary premolar area is challenged by anatomic variations imposing risks such as perforation of the buccal bone and the maxillary sinus. Previous studies have addressed the potentially relevant factors individually; a study assessing all relevant variables comprehensively and with a large sample size is lacking. The purpose of this observational study was to analyze multiple anatomic considerations, including sagittal root position, alveolar bone concavity angle, buccal bone perforation, maxillary sinus floor root proximity, and maxillary sinus perforation in the maxillary premolar area, using cone beam computed tomography (CBCT) to inform, perceive, and simplify the placement of immediate implants. The analysis involved 333 CBCT images (189 of men, 144 of women). A total of 1332 first and second maxillary premolars were assessed for sagittal root position, alveolar bone concavity angle, buccal bone perforation, maxillary sinus floor root proximity, and maxillary sinus perforation. Chi-squared and kappa tests were used to analyze the distributions and agreement, respectively, while dependent and independent t tests were used to assess sex and tooth-specific differences. The Spearman correlation test was used to explore the potential correlations (α=.05) The majority of sagittal root position distribution was on the buccal side, ranging from 79.3% to 88.3%, while maxillary sinus floor root proximity showed a predominance of the T0 category (roots separated from the maxillary sinus floor), with noticeable sex disparities in the second right premolar (73% in men versus 50.7% in women; P