Frequency of Buccal Bone Fenestration in Anterior maxilla: A Virtual Implant Placement Study

Objective: To determine the occurrence of buccal bone fenestration of the anterior maxilla and its relationship with the type of prosthesis (screw-retained or cement-retained) and the labial concavity angle (LCA) based on virtual placement of the implants. Methodology: A Cone-Beam Computed Tomography (CBCT)-based virtual implant simulation study was conducted over 6 months from May to October, 2025 at the Department of Periodontology, University Dental Hospital, University of Lahore. Two hundred anonymized CBCT images for patients over the age of 20 years were analyzed using BlueSky Plan software. Virtual placement of implants was done based on the type of prosthesis- screw retained and cement retained. Buccal bone thickness, presence of fenestration and LCA were documented. Data were analyzed based on the Mann Whitney U test and Fisher’s exact test with SPSS at a significance level of p value < 0.05. Results: The average age of patients was 39.7±10.9 years. The mean coronal bone-to-implant distance was significantly greater in cement-retained implants (2.33 ± 0.93 mm) compared with screw-retained implants (1.52 ± 0.48 mm) (p < 0.05). The distance b/w the bone and the implant significantly differed at the middle (1.61 ± 0.48 mm) and apical (1.40 ± 0.59 mm) levels for cement-retained implants as compared to screw-retained implants (1.03 ± 0.62 mm and 0.67 ± 0.88 mm, respectively; p < 0.05. The average LCA was 154.7° ± 7.1°. A statistically significant association between prosthesis type and fenestration was identified using Fisher’s exact test. In addition, the LCA showed a positive correlation, with significant differences observed between genders (p < 0.05). Conclusion:Screw-retained virtual implant positions demonstrated a higher likelihood of buccal bone fenestration compared to cement-retained positions. Labial concavity angle differed significantly between genders, suggesting anatomical variability may influence fenestration risk.