Frequency of Straight and Angulated Screw-Channel Abutments in Virtually Planned Immediate Implants in Maxillary Anterior Teeth According to Sagittal Root Position Classification: A CBCT Cross-Sectional Study

Background: Sagittal root position (SRP) influences immediate implant planning in the maxillary anterior region. Although previous studies have reported straight screw-channel (SSC) and angulated screw-channel (ASC) frequencies, their relationship with SRP classification remains insufficiently characterized. Aim: The aim was to evaluate the association between SRP classification and projected restorative type in virtually planned immediate implants. Materials and Methods: This retrospective cross-sectional study included 300 selected CBCT scans from Imam Abdulrahman Bin Faisal University, Saudi Arabia, comprising 1800 maxillary anterior teeth. SRP classification, buccal wall thickness, virtual implant eligibility, implant dimensions, and restorative categories were recorded using predefined planning criteria. Mixed-effects models accounted for within-patient clustering, with significance set at p < 0.05. Results: The mean buccal wall thickness was 0.86 ± 0.30, 1.09 ± 0.46, and 0.88 ± 0.49 mm at 0, 2, and 4 mm from the crest, respectively. SRP Class I predominated (76.4%). Overall, 1436 sites (79.8%) fulfilled virtual implant planning criteria. Among the eligible sites, 82.5% were classified as ASC, 13.7% as SSC, and 3.8% as cement-retained. ASC frequencies among all sites within SRP Classes I, II, and III were 75.6%, 56.4%, and 52.4%, respectively. After adjustment for tooth type and patient clustering, eligible Class II/III sites had higher odds of SSC classification than Class I sites (OR = 2.60; 95% CI: 1.65–4.09). Conclusions: In this selected CBCT sample, SRP classification was associated with projected restorative requirements. ASC correction expanded the proportion of virtually eligible sites theoretically compatible with screw-retained restorations. These findings describe planning feasibility rather than demonstrated clinical outcomes.