Introduction: Implant planning in the posterior mandible requires a rigorous three-dimensional study of the alveolar height of the mandibular ridge and its relationship to the inferior alveolar nerve canal; the buccal-lingual distance will determine the choice and/or position of the implant.

Objective: To establish the relationship between the buccolingual predominance of the mandibular alveolar crest measured at the coronal, middle and apical levels and the vertical bone distance to the inferior alveolar canal using cone beam computed tomography (CBCT).

Methodology: This was an observational, analytical, cross-sectional, and retrospective study that included 138 TCCH patients between January 2024 and March 2026. Bilateral measurements were taken in the left and right mandibular alveolar ridge regions using BlueSkyPlan software. The analysis was performed using descriptive statistics, normality tests, parametric and non-parametric comparisons, and multiple linear regression, with a significance level of p < 0.05.

Findings: The mean alveolar height of the mandibular ridge was 13.25 mm for the left hemimaxilla and 13.15 mm for the right hemimaxilla, with no significant differences between sides. The buccolingual alveolar width showed a progressive increase from coronal to apical (3.4, 8.0, and 10.7 mm). In the multivariable model, coronal width maintained a positive and independent association with alveolar height (B = 0.508; p < 0.001). Sex also proved to be a significant variable (B = -1.446; p < 0.001), and the model showed overall statistical significance (F = 7.809; p < 0.001; adjusted R² = 0.129).