[Osteoporosis detection using cone-beam computed tomography]

Assessment of the occurrence of apical periodontitis and endodontically treated/non-treated teeth in a Lower Austrian patient population treated for osteoporosis: a cohort study

Introduction

Osteoporosis (OP) is a bone disease linked to low bone mass and heightened fracture risk. Apical periodontitis (AP) is an inflammation of the apical periodontium, visible on radiographs, often associated with infection or necrosis of the root canal system. Both conditions, AP and OP, share inflammation and ageing as common factors, warranting exploration of their potential interactions. This study examined the association between AP and endodontically treated/non-treated teeth in patients with OP in Lower Austria.

Methods

The authors included 425 patients (7924 examined teeth) aged over 60 years (average age 68±10 years) with 208 patients (3537 examined teeth) [179 women (3027 teeth) and 29 men (510 teeth)] initially diagnosed and treated for OP and a corresponding control group with 217 patients (4387 examined teeth) [187 women (3781 teeth) and 30 men (606 teeth)] without an OP diagnosis. For the diagnosis of AP, the panoramic radiographs and medical history taken at the initial presentation were analysed.

Results

In patients treated for OP, AP was diagnosed as follows: in 134 (26%) treated and 234 (9%) non-treated teeth among women (511 treated/2516 non-treated teeth) and in 23 (27%) treated and 50 (11%) non-treated teeth among men (83 treated/427 non-treated teeth). The control group without OP consisted of: women (569 treated/ 3212 non-treated teeth) in 147 (25%) treated and 403 (12%) non-treated teeth; men (77 treated/ 529 non-treated teeth) 17 (22%) treated and 29 (6%) non-treated teeth.When comparing AP in endodontically treated teeth according to sex, no statistically significant differences were observed between patients with and without OP (P>0.05). The same result was observed in endodontically non-treated teeth (P>0.05).

Conclusion

The authors' results indicate that there is no association between the occurrence of AP and endodontically or non-endodontically treated teeth in female and male patients treated for OP.

The Utility of Radiomorphometric Mandibular Indices on Cone Beam Computer Tomography in the Assessment of Bone Mass in Postmenopausal Women: A Cross-Sectional Study

BACKGROUND

The present study examined the potential use of computed tomography radiomorphometric mandibular indices on cone beam CT (CBCT) for the assessment of bone density in postmenopausal women with low bone mass.

METHODS

We included 104 postmenopausal women who received dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen (MF) region CBCT using a NewTom VGi EVO Cone Beam 3D system. We assessed the relationships between the following DXA parameters: lumbar, femoral neck, and total hip T-scores, bone mineral density (BMD), lumbar trabecular bone score (TBS), and mandibular inferior cortical bone thickness at 4 sites. The cross-sectional images were obtained, as follows: anterior (A)-10 mm anterior from the MF; molar (M)-10 mm posterior from the MF; posterior (P)-25 mm posterior from the MF; symphysis (S)-equidistant from the centers of the right and left MF.

RESULTS

We found that A and M indices showed statistically significant moderate positive correlations with lumbar spine, femoral neck, and total hip BMD, as well as TBS. The P index demonstrated moderate positive correlations with these measurements, while the S index did not show significant correlations with BMD or TBS in postmenopausal women.

CONCLUSIONS

These findings support the potential usefulness of CBCT-derived radiomorphometric mandibular indices for non-invasive bone health assessment in clinical practice.

Thickness of the hard palate : A new criterion for the diagnosis of osteoporosis?

BACKGROUND

We were looking for an osteoporosis screening in computed tomography (CT) exams, simple and without additional examinations. We hypothesized that the criterion of "decreasing cortical thickness", may have an influence on the hard palate. Therefore, we investigated whether thickness of the hard palate (HPT) may serve as an indicator of osteoporosis for patients imaged for other reasons.

METHODS

Patients with dual-energy x-ray absorptiometry (DXA) and CT were identified by a radiology information system (RIS)-based, full-text search. Measurement of thickness of hard palate done in existing CT image by radiologist and dentist and compared with available findings and DXA measurements.

RESULTS

We identified a "test group": 57 patients with DXA and CT available out of 449 patient population and we selected further 70 patients without bone diseases as "control groups". The measurements showed that HPT correlated with age and bone density. The mean HPT was 2.4 mm in normal, 0.9 mm in osteopenia, 0.8 mm in osteoporosis and 5.3 mm in osteopetrosis case. No bone "healthy" patient fell below 1 mm. The relationship between bone density and HPT has not been described previously. HPT was highest in the bone-healthy group and decreased with age, osteopenia, and osteoporosis. Osteopetrosis, as a disease with increased bone density showed an increase in HPT.

CONCLUSIONS

HPT correlates with bone disease. We propose a new criterion for assessment on CT and digital volume tomography (DVT) or cone beam computed tomography (CBCT). A threshold of 1.0 mm when applying a simple measurement of HPT on Head CT or DVT may serve as an indicator for potential osteopenia or osteoporosis as incidental finding without extra imaging further diagnosis and treatment leading to early notice of Osteoporosis.

Utility of Cone-Beam Computed Tomography in the Detection of Low Bone Mass-A Systematic Review

INTRODUCTION

Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass density.

MATERIALS AND METHODS

A systematic review of the literature was performed using the PubMed and SCOPUS databases, with terms referring to low bone mass and cone-beam computed tomography (CBCT).

RESULTS

Sixteen studies were included in the review. The results show different perspectives, but the evidence favors the use of CBCT, combined with dual-energy X-ray absorptiometry bone density scan (DXA) evaluation, for the assessment of the osteoporosis status of the aging population and, more specifically, in postmenopausal women. Radiographic density (RD) values of the dens and the left part of the first cervical vertebra show the strongest correlation coefficients and the highest sensitivity, specificity, and accuracy for predicting osteoporosis (OP) in the lumbar vertebrae and the femoral neck.

CONCLUSIONS

Our review suggests the potential of CBCT as a screening tool for patients with low bone mass using different radiomorphometric indices. Linear measurements of the inferior mandibular cortex were lower in osteoporotic individuals, indicating the perspective of CBCT also as a diagnostic tool for this disease.

Capability of CBCT to identify patients with low bone mineral density: a systematic review

The aim of this study was to systematically review the literature about the capability of CBCT images to identify individuals with low bone mineral density (BMD). As the literature is scarce regarding this topic, the purpose of this systematic review is also to guide future research in this area. A detailed search was performed in five databases without restrictions of time or languages. Additionally, a grey literature search was conducted. The Quality Assessment Tool for Diagnostic Accuracy Studies-2 was applied to evaluate the methodological design of selected studies. With the inclusion of only six studies, the evidence is limited to endorse the use of CBCT assertively as a diagnostic tool for low BMD. All of the three studies that analyzed radiomorphometric indices found that the linear measurements of the mandibular inferior cortex were lower in osteoporotic individuals. CBCT-derived radiographic density vertebral and mandibular measurements were also capable for differentiating individuals with osteoporosis from individuals with normal BMD. The analysis of the cervical vertebrae showed high accuracy measurements. This systematic review indicates a scarcity of studies regarding the potential of CBCT for screening individuals with low BMD. However, the studies indicate that radiomorphometric indices and CBCT-derived radiographic density should be promising tools for differentiating individuals with osteoporosis from individuals with normal BMD.