Mandibular Flexure and Its Significance: An In Vivo Cone Beam-Computed Tomography Proof-of-Concept Study

The aim of this study was to assess intra-arch mandibular dimensional changes that may occur during mouth opening using cone beam-computed tomography (CBCT). Fifteen patients in need of any type of treatment whose execution considered a pre- and post-CBCT assessment consented and were enrolled. CBCTs were taken with the following settings: 90 kV, 8 mA, field of view (FOV) 140 by 100 mm (height and diameter), Voxel size 0.25 mm (high resolution). The pre-CBCT was executed in the maximum mandibular opening (MO), while the post-CBCT was in the maximum intercuspation (MI). A thermoplastic stent with radiopaque fiducial markers (steel ball bearings) was fabricated for each patient. Measurements were made using radiographic markers between contralateral canines and contralateral first molars and between ipsilateral canines and first molars on both sides. Paired t-tests were performed to evaluate the difference between open and closed positions on these four measurements. In the MO position were registered a significative tightening of the mandible at the canine (-0.49 mm, SD 0.54 mm; p < 0.001) and molar points (-0.81 mm, SD 0.63 mm; p < 0.001) and a significative shortening of the mandible on the right (-0.84 mm, SD 0.80 mm; p < 0.001) and left sides (-0.87 mm, SD 0.49 mm; p < 0.001). Within the study limitations, mandibular flexure determined a significant shortening and tightening between maximum intercuspation to maximum opening positions. Mandibular dimensional changes should be considered in light of other patient factors in the treatment planning of implant positioning and long-span complete arch implant-supported fixed prostheses in order to avoid technical complications.