Cone beam computed tomography (CBCT) and virtual implant help clinicians assess implant positioning with nearby vital structures and plan implant surgical procedures. Thus, the current study aims to evaluate the anterior sagittal root position and assess labial bone perforations in CBCT images. This study was carried out using CBCT scans of 140 samples involving 1338 teeth. The Digital Imaging and Communications in Medicine (DICOM) files were imported into Carestream 3-dimensional imaging software for analysis. All measurements were made in the appropriate section slice of 200-μm thickness in a darkened room. A standardized orientation was established by 2 examiners. The sagittal root positions (SRPs) were assessed in maxillary and mandibular anterior teeth. Labial bone perforation (LBP) was assessed using tapered implants in the virtual implant software. Overall, Class I SRP was highest (81.48% and 38.49%, respectively) in both the sextants. The SRP for Class I was most prevalent in canine teeth in both arches (87.96% and 56.45%, respectively), followed by incisors in other types in the maxillary arch. In the mandibular arch, both incisors were in Class IV and I relationships. The overall LBP was 4.26% and was more likely in the mandibular arch (5.64%) than in the maxillary arch (2.8%). The mandibular central incisors showed the highest rate of perforation (8.5% to 11.93%). The SRP and LBP did not show a statistically significant difference between the right and left sides in both arches. The correlation coefficient between SRP and LBP showed a statistically significant result (P < .01). Class I SRP was the most prevalent in maxillary and mandibular arches. Significantly more perforations occurred with mandibular anterior teeth and in Class IV SRP types (approximately 10% to 30%), which suggests that implant placement requires careful presurgical planning and regenerative approaches or delayed implant placement may be considered.

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