Mandibular incisor alveolar housing and incisor-alveolar axis relationship in untreated skeletal Class III malocclusion: A cross-sectional CBCT study

Patients with skeletal Class III malocclusion may have limited alveolar support around the mandibular incisors, but conventional cephalometric measures do not directly describe the root-alveolus relationship. This retrospective cross-sectional study quantified labial and lingual alveolar bone thickness and examined whether signed IA-PAMD indicated apical root position within the symphysis. Pretreatment cone-beam computed tomography and lateral cephalometric records from 80 untreated patients (320 incisors) with signed ANB < 0° were analyzed. Bone thickness was measured at three root levels. Correlations and cluster-robust multivariable models adjusted for tooth, age, sex, signed ANB, GoGn-SN, and incisor mandibular plane angle. Mean labial thickness was 0.36, 0.49, and 2.40 mm at the cervical, middle, and apical levels; corresponding lingual values were 0.59, 1.39, and 4.01 mm. Labial bone was thinner than lingual bone (all P < 0.001), and labial thickness was below 0.5 mm in 80.3% of cervical and 63.4% of middle-root observations. Signed IA-PAMD correlated positively with labial apical thickness, negatively with lingual apical thickness, and not with total apical width. In adjusted models, each 1° increase in signed IA-PAMD was associated with 0.084 mm greater labial apical thickness (95% CI, 0.053-0.115), 0.092 mm lower lingual apical thickness (95% CI, -0.141 to -0.043), and no difference in total apical width (-0.008 mm; 95% CI, -0.082 to 0.065). The mirror-image labial and lingual coefficients, together with the near-zero total-width coefficient, support interpretation of signed IA-PAMD as a measure of root-apex eccentricity within the symphysis rather than aggregate apical bone support. It should not be interpreted as a treatment target or safety threshold, and the absence of a Class I comparator limits conclusions specific to skeletal Class III morphology.