Morphological analysis of posterior mandibular lingual concavity and risk assessment for lingual plate perforation for standard implant placement

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Kavisara Sukumalchitkul
Kornkamol Kretapirom
Penporn Luangchana
Sirichai Kiattavorncharoen


Objectives: To determine the prevalence and dimensions of lingual concavity in the posterior mandibular area of the alveolar ridge with adequate dimensions for standard implant placement by cone-beam computed tomography and evaluate the risk of lingual plate perforation by virtual implant placement.

Materials and Methods: The 208 cross-sectional images (102 patients) of the second premolar and first molar area with adequate dimensions for standard implant placement in both dentate and edentulous condition were selected. The ridge morphology above the inferior alveolar canal 2 mm was classified into 3 types; concave, parallel, and undercut type. The undercut type were further measured by using the implant planning software (coDiagnostiX®) in following topics; vertical distance from the top of crest to the deepest point of lingual concavity (V), concavity depth (D) and concavity angle (θ). The 10 mm-length virtual implants were used to determine the risk of lingual plate perforation.

Results: The undercut type was found more than 30% in every tooth location (33.70% in second premolar and 42.30%in the first molar area). The highest prevalence of undercut type (50.9%) was found at the dentate first molar area. For the dimensional parameters of lingual concavity, there were no relationships between V, D, θ with age, gender, dentate status, and tooth type. The 7% of the virtual implants in the first molar area were found to be ≤ 1mm from the lingual plate which showed the statistically significant incidence of perforation (P<0.05).

Conclusions: The lingual concavity is commonly found in the posterior mandibular area. The risk of lingual plate perforation incidence was remarkable in the mandibular first molar area. Therefore, it is advisable to take the CBCT prior to the dental implant treatment in the posterior mandibular area especially on the first molar area, even in the case with adequate alveolar ridge dimension.


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Sukumalchitkul K, Kretapirom K, Luangchana P, Kiattavorncharoen S. Morphological analysis of posterior mandibular lingual concavity and risk assessment for lingual plate perforation for standard implant placement. M Dent J [Internet]. 2020 Nov. 13 [cited 2023 Dec. 8];40(3):267-76. Available from:
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