Application of Panoramic Radiography in the Detection of Osteopenia and Osteoporosis-Current State of the Art

Endodontic and periapical status of patients with osteoporosis: A cross-sectional study with age- and sex-matched controls

BACKGROUND

The aim of the authors was to evaluate the periapical and endodontic conditions of patients with osteoporosis and compare them with those of age- and sex-matched controls. The association between bisphosphonate (BiP) use and periapical and endodontic status in patients with osteoporosis was also investigated.

METHODS

Panoramic radiographs of 711 patients with osteoporosis and 711 age- and sex-matched healthy patients were examined. The presence and number of root canal-filled teeth (RCFT), inadequate RCFT (iRCFT), and teeth with apical periodontitis (AP) were evaluated. BiP treatment history of patients with osteoporosis was also recorded.

RESULTS

No significant difference was observed between the osteoporosis group and control group in terms of endodontic and periapical conditions. Results of bivariate logistic regression analysis showed a positive association between the number of teeth with AP and the number of iRCFT with AP and osteoporosis, and a negative association between the number of RCFT with AP and osteoporosis. Among the patients with osteoporosis, 37.5% used BiPs, specifically alendronate, ibandronate, zoledronate, and risedronate (34.3%, 24.9%, 10.6%, 7.2%, respectively). In addition, the results showed a negative association between BiP use and RCFT.

CONCLUSIONS

As the number of teeth with AP and number of iRCFT with AP increased, patients were more likely to be in the osteoporosis group. These findings imply that periapical lesions may enlarge and become more detectable in patients with osteoporosis with lower bone density, and enhanced inflammatory response.

PRACTICAL IMPLICATIONS

Dentists can collaborate with health care professionals to manage the overall health of patients with osteoporosis to reduce the impact of osteoporosis on oral health and effectively treat dental problems, such as AP.

The Association of Systemic and Mandibular Bone Mineral Density in Postmenopausal Females with Osteoporosis

Background/Objectives: Osteoporosis is a common general disease that mostly affects the skeletal system, including the jawbone. There is a link between systemic and mandibular osteoporosis. This study aimed at assessing the association between systemic (lumbar spine L1-L4, femoral neck, total hip) bone mineral density (BMD) and mandible BMD sites in Romanian postmenopausal females. Methods: A total of 97 menopausal patients were studied, 62 with osteoporosis and 35 females with no osteoporosis. For each patient, dual-energy X-ray absorptiometry (DXA) assessments of BMD in the mandible, proximal femur, total hip, and lumbar spine (L1-L4) were performed. Mandibular measurements were performed using the distal forearm software, followed by manual analysis after the bone contour was defined in each case. Results: Comparing the osteoporosis and control groups, there were significant differences in BMD at each examined location. The mandibular BMD (1.125 ± 0.181506 g/cm2) in the osteoporosis group was considerably smaller than in the control group (1.35497 ± 0.244397 g/cm2). Correlations between the BMD at different sites were significant: lumbar spine and femoral neck (r = 0.738, p < 0.0001), lumbar spine and total hip (r = 0.735, p < 0.0001), lumbar spine and mandible (r = 0.506, p < 0.0001), femoral neck and total hip (r = 0.891, p < 0.0001), femoral neck and mandible (r = 0.482, p < 0.0001), and total hip and mandible (r = 0.466, p < 0.0001). Conclusions: There were correlations between mandible BMD and lumbar spine, femoral neck, and total hip BMD, suggesting that osteoporosis affects mandibular bone density. BMD assessments at common locations may help predict mandibular BMD and the probability of osteoporosis.

Relation between maxillary sinus pneumatization and the thickness of the mandibular inferior border in panoramic radiographs

Background

Maxillary sinus pneumatization is a physiological process that can adversely affect bone availability for further dental rehabilitation. If a relation between the thickness of the mandibular cortex and maxillary sinus pneumatization is proven, future bone availability can be deducted.

Material and methods

In this cross-sectional study, 85 panoramic radiographs were evaluated. All patients were between 19 and 70, had at least lost a second premolar, first molar, or second molar on one side of the maxilla, and had these teeth on the other side. Four lines were digitally drawn on the radiographs to determine the superior and inferior borders of the sinus on both sides. The amount of inferior sinus border progression was deducted using the digitally-measured lines' ratios. The following tests were done using IBM SPSS ver. 24: Pearson's correlation coefficient test, Tukey's dual comparison posthoc test, One-way ANOVA test, and the independent T-test (p = 0.05).

Results

There was a negative correlation between the inferior mandibular cortex's thickness and the maxillary sinus's pneumatization (p < 0.001). Also, there was a significant difference between maxilla sinus pneumatization in the second premolar, first, and second molar areas based on the inferior mandibular cortex's thickness (p = 0.009).

Conclusions

Based on the present study, there is a significant relationship between the thickness of the inferior mandibular cortex and maxillary sinus pneumatization, especially for women and patients above 40 years old.