Morphological patterns of buccal bone plate in the maxillary esthetic zone: A cross-sectional study.

Background This cross-sectional study aimed to characterize buccal bone plate (BBP) morphological patterns in anterior maxillary teeth and to evaluate their association with other phenotypical and local anatomical characteristics.Methods Two examiners conducted a qualitative assessment of BBP morphological patterns using cone-beam computed tomography scans from healthy adults. Validated cases were employed to determine numerical thresholds for buccal bone thickness (BBT) for each BBP category at different apicocoronal levels. Periodontal phenotypical- and anatomical variables, including BBT, gingival thickness (GT), keratinized tissue width (KTW), supracrestal tissue height (STH), distance from the cementoenamel junction to the bone crest (CEJ-BC), sagittal root position (SRP), and tooth shape (TS), were documented through radiographic, clinical, and photographic evaluations.Results Four distinct BBP morphological patterns were identified and categorized as rectangular (39.2%), inverted triangular (23.6%), triangular (14.4%), or hourglass (22.8%). Significant variations in mean BBT values across the 4 BBP patterns were observed at different apicocoronal levels (p < 0.001). Associations were found between BBP morphological patterns and GT, SRP, and TS (p < 0.001). Multilevel logistic regression analysis showed that BBT, regardless of the vertical level, and GT at 2 mm apical to the gingival margin were key predictors of BBP shape. The inverted triangular pattern was linked to a thicker gingival phenotype and was mostly observed in lateral incisors.Conclusion Four BBP patterns were identified, and a novel classification system was devised. Associations between different categories and key phenotypic and anatomical variables, including BBT, GT, SRP, and TS, were observed. This classification can be used to aid diagnostic processes, and in the planning and execution of various treatments in the anterior maxilla, as well as in future research.Plain Language Summary The bone that supports the upper front teeth plays an important role in maintaining oral health and ensuring the success of dental treatments. Traditionally, this bone has been described using simple linear measurements. In the present study, we analyzed the entire bone plate and identified 4 distinct shapes: rectangular, inverted triangular, triangular, and hourglass. These shapes were linked to how thick the bone and gums were at different levels, and to the position and shape of the tooth. For example, the inverted triangular shape was seen more often in lateral incisors and was related to thicker gums. Understanding these patterns can help dentists plan treatments such as periodontal surgery and dental implants, and it also gives researchers a new tool for future studies.