Anterior Limit of the Mandibular Dentition as Evaluated by Cone-Beam CT

  • Sercan AkyalcinEmail author
  • Jeremy Scarpate
  • Jeryl English


One of the most common limiting factors in correcting dental and skeletal deformities is the limited ability to orthodontically move the teeth within the buccal and lingual cortical plates of the mandibular symphysis. In this chapter, we will define the anatomic characteristics of the mandibular symphysis area and review the relationships between mandibular incisors and their bony support. Since cephalometric radiographs overestimate the width of the buccal bone due to superimposition errors, a cone-beam computed tomography (CBCT) evaluation of the anterior mandibular dentition was presented in a group of individuals with varying growth patterns (hypodivergent, normodivergent, and hyperdivergent) and incisor inclinations (retroclined, upright, and proclined). Using the CBCT data, the relationship between mandibular incisors and their structural support was presented for each group of the mandibular incisors. Normative data and imaging methods presented in this chapter can be utilized to enhance the clinicians’ treatment planning strategies by providing a template on the limits of mandibular anterior teeth.


Anterior limit of mandibular dentition Facial medullary bone Alveolar width Symphysis width Cone-beam computed tomography 


  1. 1.
    Handelman CS. The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod. 1996;66:95–110.Google Scholar
  2. 2.
    Tweed C. The Frankfort-mandibular incisor angle in orthodontic diagnosis, treatment planning and prognosis. Angle Orthod. 1954;24:121–69.Google Scholar
  3. 3.
    Steiner CC. Cephalometrics in clinical practice. Angle Orthod. 1959;29:8–29.Google Scholar
  4. 4.
    Ricketts CM. Cephalometric synthesis. Am J Orthod. 1960;46:647–73.CrossRefGoogle Scholar
  5. 5.
    Baumrind S, Frantz R. The reliability of head film measurements. 1. Landmark identification. Am J Orthod. 1971a;60:111–27.CrossRefGoogle Scholar
  6. 6.
    Baumrind S, Frantz R. The reliability of head film measurement. 2. Conventional angular and linear measures. Am J Orthod. 1971b;60:505–17.CrossRefGoogle Scholar
  7. 7.
    Fuhrmann R. Three-dimensional interpretation of labiolingual bone width of the lower incisors. J Orofac Orthop. 1996;57:168–85.CrossRefGoogle Scholar
  8. 8.
    Nauert K, Berg R. Evaluation of labio-lingual bony support of lower incisors in orthodontically untreated adults with the help of computed tomography. J Orofac Orthop. 1999;60:321–34.CrossRefGoogle Scholar
  9. 9.
    Baumgartel S, Palomo JM, Palomo L, Hans MG. Reliability and accuracy of cone-beam computed tomography dental measurements. Am J Orthod Dentofac Orthop. 2009;136:19–28.CrossRefGoogle Scholar
  10. 10.
    Timock AM, Cook V, McDonald T, Leo MC, Crowe J, Benninger BL, Covell DA Jr. Accuracy and reliability of buccal bone height and thickness measurements from cone-beam computed tomography imaging. Am J Orthod Dentofac Orthop. 2011;140:734–44.CrossRefGoogle Scholar
  11. 11.
    Enlow DH, Hans MG. Essentials of facial growth. In: W. B. Saunders. Philadelphia, PA: Pennsylvania; 1996.Google Scholar
  12. 12.
    Buschang PH, LaPalme L, Tanquay R, Demirjian A. The technical reliability of superimposition on cranial base and mandibular structures. Eur J Orthod. 1986;8:152–6.CrossRefGoogle Scholar
  13. 13.
    Aki T, Nanda RS, Currier GF, Nanda SK. Assessment of symphysis morphology as a predictor of the direction of mandibular growth. Am J Orthod Dentofac Orthop. 1994;106:60–9.CrossRefGoogle Scholar
  14. 14.
    Gutermann C, Peltomaki T, Markic G, Hanggi M, Schaltzle M, Signorelli L, Patcas R. The inclination of mandibular incisors revisited. Angle Orthod. 2014;84:109–19.CrossRefGoogle Scholar
  15. 15.
    Gracco A, Luca L, Bongiorno MC, Siciliani G. Computed tomography evaluation of mandibular incisor bony support in untreated patients. Am J Orthod Dentofac Orthop. 2010;138:179–87.CrossRefGoogle Scholar
  16. 16.
    Tsunori M, Mashita M, Kazutaka K. Relationship between facial types and tooth and bone characteristics of the mandible obtained by CT scanning. Angle Orthod. 1998;68:557–62.PubMedGoogle Scholar
  17. 17.
    Swasty D, Lee J, Huang JC, Maki K, Gansky SA, Hatcher D, Miller AJ. Cross-sectional human mandibular morphology as assessed in vivo by cone-beam computed tomography in patients with different vertical facial dimensions. Am J Orthod Dentofac Orthop. 2011;139:e377–89.CrossRefGoogle Scholar
  18. 18.
    Yamada C, Kitai N, Kakimoto N, Murakami S, Furukawa S, Takada K. Spatial relationships between the mandibular central incisor and associated alveolar bone in adults with mandibular prognathism. Angle Orthod. 2007;77:766–72.CrossRefGoogle Scholar
  19. 19.
    Eroz UB, Ceylan I, Aydemir S. An investigation of mandibular morphology in subjects with different vertical facial patterns. Aust Orthod J. 2000;16:16–22.PubMedGoogle Scholar
  20. 20.
    Bjork A. Variations in the growth pattern of the human mandible: longitudinal radiographic study by the implant method. J Dent Res. 1963;42:400–11.CrossRefGoogle Scholar
  21. 21.
    Bjork A. Prediction of mandibular growth rotation. Am J Orthod. 1969;55:585–99.CrossRefGoogle Scholar
  22. 22.
    Enlow DH, Kuroda T, Lewis AB. Intrinsic craniofacial compensations. Angle Orthod. 1971;41:271–85.PubMedGoogle Scholar
  23. 23.
    Corelius M, Linder-Aronson S. The relationship between incisor inclination and various reference lines. Angle Orthod. 1976;46:111–7.PubMedGoogle Scholar
  24. 24.
    Bibby RE. Incisor relationship in different skeletofacial patterns. Angle Orthod. 1980;50:41–4.PubMedGoogle Scholar
  25. 25.
    Nielsen IL. Vertical malocclusions: etiology, development, diagnosis and some aspects of treatment. Angle Orthod. 1991;61:247–60.PubMedGoogle Scholar
  26. 26.
    Molina-Berlanga N, Llopis-Perez j F-MC, Puigdollers A. Lower incisor compensation and symphysis dimensions among class I and III malocclusion patients with different facial vertical skeletal patterns. Angle Orthod. 2013;83:948–55.CrossRefGoogle Scholar
  27. 27.
    Hernandez-Sayago E, Espinar-Escalona E, Barrerra-Mora JM, Ruiz-Navarro MB, Llamas-Carrerras JM, Solano-Reina E. Lower incisor position in different malocclusions and facial patterns. Med Oral Patol Oral Cir Bucal. 2013;18:e343–50.CrossRefGoogle Scholar
  28. 28.
    Baysal A, Ucar FI, Buyuk SK, Ozer T, Uysal T. Alveolar bone thickness and lower incisor position in skeletal class I and class II malocclusions assessed with cone-beam computed tomography. Korean J Orthod. 2013;43:134–40.CrossRefGoogle Scholar
  29. 29.
    Skieller V, Bjork A, Linde-Hansen T. Prediction of mandibular growth rotation evaluated from a longitudinal implant sample. Am J Orthod. 1984;86:359–70.CrossRefGoogle Scholar
  30. 30.
    Lee RS, Daniel FJ, Swartz M, Baumrind S, Korn EL. Assessment of a method for the prediction of mandibular rotation. Am J Orthod Dentofac Orthop. 1987;91:395–402.CrossRefGoogle Scholar
  31. 31.
    Leslie LR, Southard TE, Southard KA, et al. Prediction of mandibular growth rotation: assessment of the Skieller, Bjork, and Linde-Hansen method. Am J Orthod Dentofac Orthop. 1998;114:659–67.CrossRefGoogle Scholar
  32. 32.
    Baumrind S, Korn EL, West EL. Prediction of mandibular rotation: an empirical test of clinical performance. Am J Orthod Dentofac Orthop. 1984;86:371–85.CrossRefGoogle Scholar
  33. 33.
    Keim RG, Gottlieb EL, Nelson AH, Vogels DS 3rd. 2008 JCO study of orthodontic diagnosis and treatment procedures, part 1: results and trends. J Clin Orthod. 2008;42:625–40.PubMedGoogle Scholar
  34. 34.
    Proffit WR, Fields HW Jr, Sarver DM. Contemporary Orthodontics. 5th ed. St. Louis, MO: Mosby; 2015.Google Scholar
  35. 35.
    Dahlberg G. Statistical methods for medical and biological students. London: George Allen and Unwin; 1940. p. 122–32.Google Scholar
  36. 36.
    Castro LO, Castro IO, de Alencar AH, Valladares-Neto J, Estrela C. Cone beam computed tomography evaluation of distance from cementoenamel junction to alveolar crest before and after nonextraction orthodontic treatment. Angle Orthod. 2016;86:543–9.CrossRefGoogle Scholar
  37. 37.
    Garlock DT, Buschang PH, Araujo EA, Behrents RG, Kim KB. Evaluation of marginal alveolar bone in the anterior mandible with pretreatment and posttreatment computed tomography in nonextraction patients. Am J Orthod Dentofac Orthop. 2016;149:192–201.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sercan Akyalcin
    • 1
    Email author
  • Jeremy Scarpate
    • 2
  • Jeryl English
    • 3
  1. 1.Department of OrthodonticsTufts School of Dental MedicineBostonUSA
  2. 2.Royal Air ForceLakenheathUK
  3. 3.Department of Orthodontics, School of DentistryThe University of Texas Health Sciences CenterHoustonUSA

Personalised recommendations