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Khadivi G, Akhtari A, Sharifi F, Zargarian N, Esmaeili S, Ahsaie MG, Shahbazi S. Diagnostic accuracy of artificial intelligence models in detecting osteoporosis using dental images: a systematic review and meta-analysis. Osteoporos Int 2024:10.1007/s00198-024-07229-8. [PMID: 39177815 DOI: 10.1007/s00198-024-07229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 08/10/2024] [Indexed: 08/24/2024]
Abstract
The current study aimed to systematically review the literature on the accuracy of artificial intelligence (AI) models for osteoporosis (OP) diagnosis using dental images. A thorough literature search was executed in October 2022 and updated in November 2023 across multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar. The research targeted studies using AI models for OP diagnosis from dental radiographs. The main outcomes were the sensitivity and specificity of AI models regarding OP diagnosis. The "meta" package from the R Foundation was selected for statistical analysis. A random-effects model, along with 95% confidence intervals, was utilized to estimate pooled values. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was employed for risk of bias and applicability assessment. Among 640 records, 22 studies were included in the qualitative analysis and 12 in the meta-analysis. The overall sensitivity for AI-assisted OP diagnosis was 0.85 (95% CI, 0.70-0.93), while the pooled specificity equaled 0.95 (95% CI, 0.91-0.97). Conventional algorithms led to a pooled sensitivity of 0.82 (95% CI, 0.57-0.94) and a pooled specificity of 0.96 (95% CI, 0.93-0.97). Deep convolutional neural networks exhibited a pooled sensitivity of 0.87 (95% CI, 0.68-0.95) and a pooled specificity of 0.92 (95% CI, 0.83-0.96). This systematic review corroborates the accuracy of AI in OP diagnosis using dental images. Future research should expand sample sizes in test and training datasets and standardize imaging techniques to establish the reliability of AI-assisted methods in OP diagnosis through dental images.
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Affiliation(s)
- Gita Khadivi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abtin Akhtari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicolette Zargarian
- School of Dentistry, Research Institute for Dental Sciences, Mkhitar Heratsi Yerevan State Medical University, Yerevan, Armenia
| | - Saharnaz Esmaeili
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Ghazizadeh Ahsaie
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheil Shahbazi
- Dental Research Center, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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2
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Yu B, Wang CY. Osteoporosis and periodontal diseases - An update on their association and mechanistic links. Periodontol 2000 2022; 89:99-113. [PMID: 35244945 DOI: 10.1111/prd.12422] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Periodontitis and osteoporosis are prevalent inflammation-associated skeletal disorders that pose significant public health challenges to our aging population. Both periodontitis and osteoporosis are bone disorders closely associated with inflammation and aging. There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25 years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low-cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration-approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co-management of systemic and localized bone loss.
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Affiliation(s)
- Bo Yu
- Division of Regenerative and Constitutive Sciences, School of Dentistry, University of California at Los Angeles, Los Angeles, California, USA
| | - Cun-Yu Wang
- Division of Oral Biology and Medicine, School of Dentistry, University of California at Los Angeles, Los Angeles, California, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, Broad Stem Cell Research Center and Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, USA
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3
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Jonasson G, Hassani-Nejad A, Hakeberg M. Mandibular cortical bone structure as risk indicator in fractured and non-fractured 80-year-old men and women. BMC Oral Health 2021; 21:468. [PMID: 34560860 PMCID: PMC8461912 DOI: 10.1186/s12903-021-01829-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the association between mandibular cortex parameters and fracture in a group of 286 men and women, 79–80 years of age. Study design In a cross-sectional study, the mandibular cortex was evaluated with Klemetti’s index for cortical erosion. The cortical thickness was measured with a ruler adjusting for the magnification factor. The odds ratio (OR) for fracture when having a severely eroded cortex or a cortex thickness < 3 mm was calculated. Results A normal cortex was found in 65% of men, whereas only 7% had a severely eroded cortex. The OR for severely eroded cortex as fracture risk predictor was significant (2.32; 95% CI 1.3–4.2), also when the female group was evaluated separately. A significant difference was found between the mean thickness for men (3.96 mm) and women (2.92 mm), respectively. The OR for cortical thickness < 3 mm was significant (2.00; 95% CI 1.1–3.6) in the total group, but not when men and women were evaluated separately. Conclusions Among old women, the cortical parameters were significantly associated with prevalent fracture. In old men, other circumstances may be more important.
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Affiliation(s)
- Grethe Jonasson
- Department of Behavioral and Community Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Box 450, 405 30, Gothenburg, Sweden. .,Research and Development Centre, Sven Eriksonplatsen 4, 50338, Borås, Sweden.
| | - Azar Hassani-Nejad
- Clinic of Oral and Maxillofacial Radiology, Public Dental Service, P.O.Box 7163, SE-402 33SE-402 33163, Gothenburg, Sweden
| | - Magnus Hakeberg
- Department of Behavioral and Community Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Box 450, 405 30, Gothenburg, Sweden
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Ferreira RV, Roizenblatt S, Szejnfeld VL. Dentists' knowledge about osteoporosis and their ability to identify the disease. Adv Rheumatol 2021; 61:49. [PMID: 34372946 DOI: 10.1186/s42358-021-00206-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoporosis is an underdiagnosed condition, and its seriousness is not considered until severe complications arise. This study aimed to evaluate general dentists' knowledge about osteoporosis and their ability to identify patients with this disease by assessing mandibular cortical width (MCW) and mandibular cortical index (MCI) on panoramic dental radiographs using a visual method. METHODS In this cross-sectional study, an email questionnaire regarding the diagnosis and prevention of osteoporosis was sent to 20,773 dentists in 2016. Those who completed the questionnaire were invited to participate in radiomorphometric training and then to analyze the MCI and MCW of 114 panoramic radiographs of postmenopausal women who underwent both panoramic radiography and bone densitometry. Based on the radiomorphometric indices and while blinded to the densitometry results, the dentists determined whether they would indicate densitometry for these patients. RESULTS The response rate was 2.3%: 485 dentists completed the questionnaire, and 50 evaluated panoramic radiographs using the MCW and MCI. All of them reported some knowledge about osteoporosis, but 41.6% demonstrated a misleading conceptualization of the disease. Approximately 90% reported minimal access to this information during graduation, and only 27.0% were exposed to the topic during their postgraduate studies. Interest in osteoporosis prevention was expressed by 70.7% of the respondents, and interest in learning the radiomorphometric indices was expressed by 99.0%. The sensitivity in the detection of low bone mineral density through the MCW and MCI was 52.9%, and the specificity was 64%. CONCLUSIONS Brazilian dentists demonstrated insufficient knowledge about osteoporosis and a low ability to detect osteopenia or osteoporosis by applying radiomorphometric indices.
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Affiliation(s)
| | - Suely Roizenblatt
- Department of Internal Medicine, Universidade Federal de Sao Paulo (UNIFESP), Rua Angelina Maffei Vita 670, Sao Paulo, SP, CEP:01455070, Brazil.
| | - Vera Lucia Szejnfeld
- Department of Internal Medicine, Universidade Federal de Sao Paulo (UNIFESP), Rua Angelina Maffei Vita 670, Sao Paulo, SP, CEP:01455070, Brazil
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Elleby C, Skott P, Jonasson G, Theobald H, Nyrén S, Salminen H. Two methods of evaluating mandibular trabecular pattern in intraoral radiographs and the association to fragility fractures during a 47-year follow up. Eur J Oral Sci 2021; 129:e12801. [PMID: 34101266 DOI: 10.1111/eos.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
In this longitudinal cohort study, we explored the association of fragility fractures to sparse trabecular bone pattern in intraoral radiographs using two methods, a visual and a semi-automated. Our aim was to study both sexes and to include younger age-groups, during a follow-up time of 47 years. The cohort consisted of 837 men and women aged 18-65 years, with intraoral radiographs from 1970-1971. The trabecular pattern was assessed in the mandibular premolar region with a visual and a semi-automated method. Data on fragility fractures were acquired from the Swedish National Patient Register for 47 years of follow-up time. Sparse trabecular pattern was found in 2.2% of the cohort using the visual method, and 18% were deemed at 'risk of osteoporosis' using the semi-automated method. A total of 132 individuals suffered at least one fragility fracture during the follow-up period. We found no significant association between fractures and sparse trabecular pattern using either method. This study shows that visual assessment, as a predictor of future fractures, may not be a suitable method for individuals of all ages and sexes. As for the semi-automated method, there is still very limited evidence for its fracture predictive ability.
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Affiliation(s)
- Charlotta Elleby
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Academic Centre for Geriatric Dentistry, Stockholm, Sweden.,Folktandvården Stockholms län AB, Stockholm, Sweden
| | - Pia Skott
- Academic Centre for Geriatric Dentistry, Stockholm, Sweden.,Folktandvården Stockholms län AB, Stockholm, Sweden.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Grethe Jonasson
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Holger Theobald
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Academic Primary Care Health Centre, Region Stockholm, Stockholm, Sweden
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Helena Salminen
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Aliaga I, Vera V, Vera M, García E, Pedrera M, Pajares G. Automatic computation of mandibular indices in dental panoramic radiographs for early osteoporosis detection. Artif Intell Med 2020; 103:101816. [PMID: 32143810 DOI: 10.1016/j.artmed.2020.101816] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
AIM A new automatic method for detecting specific points and lines (straight and curves) in dental panoramic radiographies (orthopantomographies) is proposed, where the human knowledge is mapped to the automatic system. The goal is to compute relevant mandibular indices (Mandibular Cortical Width, Panoramic Mandibular Index, Mandibular Ratio, Mandibular Cortical Index) in order to detect the thinning and deterioration of the mandibular bone. Data can be stored for posterior massive analysis. METHODS Panoramic radiographies are intrinsically complex, including: artificial structures, unclear limits in bony structures, jawbones with irregular curvatures and intensity levels, irregular shapes and borders of the mental foramen, irregular teeth alignments or missing dental pieces. An intelligent sequence of linked imaging segmentation processes is proposed to cope with the above situations towards the design of the automatic segmentation, making the following contributions: (i) Fuzzy K-means classification for identifying artificial structures; (ii) adjust a tangent line to the lower border of the lower jawbone (lower cortex), based on texture analysis, grey scale dilation, binarization and labelling; (iii) identification of the mental foramen region and its centre, based on multi-thresholding, binarization, morphological operations and labelling; (iv) tracing a perpendicular line to the tangent passing through the centre of the mental foramen region and two parallel lines to the tangent, passing through borders on the mental foramen intersected by the perpendicular; (v) following the perpendicular line, a sweep is made moving up the tangent for detecting accumulation of binary points after applying adaptive filtering; (vi) detection of the lower mandible alveolar crest line based on the identification of inter-teeth gaps by saliency and interest points feature description. RESULTS The performance of the proposed approach was quantitatively compared against the criteria of expert dentists, verifying also its validity with statistical studies based on the analysis of deterioration of bone structures with different levels of osteoporosis. All indices are computed inside two regions of interest, which tolerate flexibility in sizes and locations, making this process robust enough. CONCLUSIONS The proposed approach provides an automatic procedure able to process with efficiency and reliability panoramic X-Ray images for early osteoporosis detection.
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Affiliation(s)
- Ignacio Aliaga
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - Vicente Vera
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - María Vera
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - Enrique García
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - María Pedrera
- Hospital Clínico San Carlos, Complutense University, Madrid, Spain.
| | - Gonzalo Pajares
- Instituto del Conocimiento (Knowledge Institute). Complutense University, Madrid, Spain.
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7
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Computer-aided detection in musculoskeletal projection radiography: A systematic review. Radiography (Lond) 2018; 24:165-174. [DOI: 10.1016/j.radi.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/31/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022]
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8
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Guo X, Wei S, Lu M, Shao Z, Lu J, Xia L, Lin K, Zou D. RNA-Seq investigation and in vivo study the effect of strontium ranelate on ovariectomized rat via the involvement of ROCK1. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2018; 46:629-641. [PMID: 29381089 DOI: 10.1080/21691401.2018.1433188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Xiaojing Guo
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Shanghai Stomatological Hospital, Shanghai, China
| | - Silong Wei
- Department of Oral and Craniomaxillofacial Sciences, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengmeng Lu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Shanghai Stomatological Hospital, Shanghai, China
| | - Zhengwei Shao
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jiayu Lu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Lunguo Xia
- Department of Oral and Craniomaxillofacial Sciences, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaili Lin
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, School & Hospital of Stomatology, Tongji University, Shanghai, China
| | - Derong Zou
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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9
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Jonasson GB, Sundh V, Hakeberg M, Ahlqwist M, Lissner L, Hange D. Evaluation of clinical and radiographic indices as predictors of osteoporotic fractures: a 10-year longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:487-494. [PMID: 29273194 DOI: 10.1016/j.oooo.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate 2 radiographic and 3 clinical indices as predictors of future osteoporotic fractures. STUDY DESIGN In a prospective, longitudinal study with a 10-year fracture follow-up, the 2 radiographic indices mandibular cortical erosion (normal, mild/moderate erosion, and severe erosion of the inferior cortex) and cortex thickness were assessed using panoramic radiographs of 411 women, age 62 to 78 years. The clinical indices were the fracture assessment tool FRAX, the osteoporosis index of risk (OSIRIS), and the osteoporosis self-assessment tool (OST). RESULTS The relative risks (RRs) for future fracture were significant for FRAX greater than 15%, 4.1 (95% confidence interval [CI] 2.4-7.2), and for severely eroded cortices, 1.7 (95% CI 1.1-2.8). Cortical thickness less than 3 mm, OSIRIS, and OST were not significant fracture predictors (RR 1.1, 1.4, and 1.5, respectively). For the 5 tested fracture predictors, Fisher's exact test gave the following P values for differences between fracture and nonfracture groups: FRAX <.001, cortical erosion 0.023, OST 0.078, OSIRIS 0.206, and cortical thickness 0.678. The area under the curve was 0.69 for FRAX less than 15%, 0.58 for cortical erosion, and 0.52 for cortical thickness. Adding OSIRIS and OST did not change the area under the curve significantly. CONCLUSIONS FRAX and severely eroded cortices predicted fracture but cortical thickness, OSIRIS, and OST did not.
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Affiliation(s)
- Grethe B Jonasson
- Department of Behavioral and Community Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research & Development Unit, Sven Eriksonplatsen 4, Borås, Sweden.
| | - Valter Sundh
- Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Hakeberg
- Department of Behavioral and Community Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Ahlqwist
- Department of Oral and Maxillofacial Radiology, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- Section for Epidemiology and Social Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis. Br Dent J 2017; 224:26-31. [PMID: 29192692 DOI: 10.1038/sj.bdj.2017.1001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 01/14/2023]
Abstract
Introduction Oral bisphosphonates are the most commonly prescribed anti-resorptive drugs used in the treatment of osteoporosis, but osteonecrosis of the jaw is a serious complication. The early diagnosis of this destructive side effect is crucial in preventing excessive bone loss, pain and infection.Objective To aid dental practitioners in the early identification of bisphosphonate-related osteonecrosis of the jaw.Method A scoping review was carried out.Data sources We searched MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source (DOSS), Proquest Dissertation and Theses Search, to identify references that described clinical and radiological findings in medication-related osteonecrosis of the jaw (MRONJ).Data selection Nineteen references mentioned the earliest radiological changes in MRONJ with a description of the observations and were included in the analysis.Data synthesis The radiographic signs included osteosclerosis/lysis, widening of the periodontal ligament and thickening of the lamina dura and cortex. To assess the quality of original data on which recommendations had been made, these 19 studies were subjected to a quality appraisal.Conclusion Using bone exposure as a criterion for diagnosis of MRONJ, leads to delayed diagnosis and a poor response to treatment. In those patients at risk of bone exposure with MRONJ, insufficient information is present in the literature to allow the general dental practitioner to reliably identify the radiographic features indicating imminent bone exposure. A well-designed prospective study is needed.
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11
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Kwon AY, Huh KH, Yi WJ, Lee SS, Choi SC, Heo MS. Is the panoramic mandibular index useful for bone quality evaluation? Imaging Sci Dent 2017; 47:87-92. [PMID: 28680844 PMCID: PMC5489673 DOI: 10.5624/isd.2017.47.2.87] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study was to determine whether the panoramic mandibular index (PMI) is useful for assessing bone mineral density. We also analyzed the potential correlations between PMI parameters and patient age. Materials and Methods Four observers measured the PMI of both sides of the mental foramen using a picture archiving and communication system and images in the Digital Imaging and Communications in Medicine format. They studied 300 panoramic radiographic images of patients belonging to the following age groups: 40–49 years, 50–59 years, 60–69 years, 70–79 years, and 80–89 years. The observers were allowed to zoom in or out and to adjust the contrast of the images. Further, they were instructed to record the reasons for any measurements that could not be made. Then, we conducted a reliability analysis of the measured PMI and assessed the correlations between different patient age groups and the 3 parameters used for determining the PMI from the available data. Results Among the 600 data items collected, 23 items were considered unmeasurable by at least 1 observer for the following 4 reasons: postoperative state, lesion, unidentified mental foramen, and alveolar bone loss. The intraobserver reproducibility of the measurable data was 0.611-0.752. The mandibular cortical width (MCW) decreased significantly as patient age increased. Conclusion PMI had limited usability when the margin of the mental foramen was not clear. In contrast, MCW, a parameter used for determining the PMI, had fewer drawbacks than the PMI with respect to bone mineral density measurements and exhibited a significant correlation with patient age.
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Affiliation(s)
- Ah-Young Kwon
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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12
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Geraets W, Jonasson G, Hakeberg M. Predicting fractures using trabecular patterns on panoramic radiographs. Clin Oral Investig 2017; 22:377-384. [PMID: 28567531 PMCID: PMC5748394 DOI: 10.1007/s00784-017-2122-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/05/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The observer score of the trabecular pattern on panoramic radiographs is known to be a strong predictor of bone fractures. The aim of this study was to enhance the predictive power of panoramic radiographs by means of texture analysis methods. MATERIAL AND METHODS The study followed 304 postmenopausal women during 26 years. At the beginning of the study, panoramic radiographs were obtained. One observer assessed the trabecular pattern in the premolar region as dense, sparse, or alternating dense and sparse. In addition, on each radiograph, a region of interest was selected in the molar/premolar region and analyzed with texture analysis procedures. During 26 years of follow-up, 115 women suffered a fracture of the hip, spine, leg, or arm. Logistic regression was applied to test the predictive power of various variables with respect to fractures. RESULTS Of all variables, the observer score of the trabecular pattern correlated strongest with the occurrence of fractures. By itself, the score yielded an ROC curve with an area of 0.80 under the curve. Combining the observer score with the texture analysis features increased the area under the ROC curve to 0.85. CONCLUSIONS The trabecular pattern on panoramic radiographs provides a strong predictor of fractures, at least for postmenopausal women. The assessment by an observer combined with texture analysis procedures yields a predictive power that parallels best known predictions in literature. CLINICAL RELEVANCE This study illustrates that panoramic radiographs are state of the art predictors of postcranial fractures.
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Affiliation(s)
- Wil Geraets
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
| | - Grethe Jonasson
- Research & Development Unit in Southern Älvsborg County, Sven Eriksonplatsen 4, 50338, Borås, Sweden
- Department of Behavioral and Community Dentistry, Institute of Odontology, University of Gothenburg, Medicinaregatan 12E, Gothenburg, Sweden
| | - Magnus Hakeberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, University of Gothenburg, Medicinaregatan 12E, Gothenburg, Sweden
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13
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Sundh V, Hange D, Ahlqwist M, Hakeberg M, Lissner L, Jonasson G. FRAX and mandibular sparse trabeculation as fracture predictors: a longitudinal study from 1980 to 2002. Eur J Oral Sci 2017; 125:135-140. [DOI: 10.1111/eos.12341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Valter Sundh
- Section for Epidemiology and Social Medicine; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Primary Health Care Unit; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Dominique Hange
- Primary Health Care Unit; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Research & Development Unit in Southern Alvsborg County; Boras Sweden
| | - Margareta Ahlqwist
- Department of Oral and Maxillofacial Radiology; Institute of Odontology at the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Magnus Hakeberg
- Department of Behavioral and Community Dentistry; Institute of Odontology at the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Lauren Lissner
- Section for Epidemiology and Social Medicine; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Grethe Jonasson
- Research & Development Unit in Southern Alvsborg County; Boras Sweden
- Department of Behavioral and Community Dentistry; Institute of Odontology at the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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14
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Barngkgei I, Halboub E, Almashraqi AA, Khattab R, Al Haffar I. IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices. Imaging Sci Dent 2016; 46:185-202. [PMID: 27672615 PMCID: PMC5035724 DOI: 10.5624/isd.2016.46.3.185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 10/13/2015] [Accepted: 12/11/2015] [Indexed: 01/10/2023] Open
Abstract
Purpose The goal of this study was to develop a new index as an objective reference for evaluating current and newly developed indices used for osteoporosis screening based on dental images. Its name; IDIOS, stands for Index of Dental-imaging Indices of Osteoporosis Screening. Materials and Methods A comprehensive PubMed search was conducted to retrieve studies on dental imaging-based indices for osteoporosis screening. The results of the eligible studies, along with other relevant criteria, were used to develop IDIOS, which has scores ranging from 0 (0%) to 15 (100%). The indices presented in the studies we included were then evaluated using IDIOS. Results The 104 studies that were included utilized 24, 4, and 9 indices derived from panoramic, periapical, and computed tomographic/cone-beam computed tomographic techniques, respectively. The IDIOS scores for these indices ranged from 0 (0%) to 11.75 (78.32%). Conclusion IDIOS is a valuable reference index that facilitates the evaluation of other dental imaging-based osteoporosis screening indices. Furthermore, IDIOS can be utilized to evaluate the accuracy of newly developed indices.
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Affiliation(s)
- Imad Barngkgei
- Department of Oral Medicine, Faculty of Dentistry, Damascus University, Damascus, Syria.; Department of Oral Medicine, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Abeer Abdulkareem Almashraqi
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.; Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Razan Khattab
- Department of Periodontology, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Iyad Al Haffar
- Department of Oral Medicine, Faculty of Dentistry, Damascus University, Damascus, Syria
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15
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Jonasson G, Rythén M. Alveolar bone loss in osteoporosis: a loaded and cellular affair? Clin Cosmet Investig Dent 2016; 8:95-103. [PMID: 27471408 PMCID: PMC4948717 DOI: 10.2147/ccide.s92774] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Maxillary and mandibular bone mirror skeletal bone conditions. Bone remodeling happens at endosteal surfaces where the osteoclasts and osteoblasts are situated. More surfaces means more cells and remodeling. The bone turnover rate in the mandibular alveolar process is probably the fastest in the body; thus, the first signs of osteoporosis may be revealed here. Hormones, osteoporosis, and aging influence the alveolar process and the skeletal bones similarly, but differences in loading between loaded, half-loaded, and unloaded bones are important to consider. Bone mass is redistributed from one location to another where strength is needed. A sparse trabeculation in the mandibular premolar region (large intertrabecular spaces and thin trabeculae) is a reliable sign of osteopenia and a high skeletal fracture risk. Having dense trabeculation (small intertrabecular spaces and well-mineralized trabeculae) is generally advantageous to the individual because of the low fracture risk, but may imply some problems for the clinician.
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Affiliation(s)
- Grethe Jonasson
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg
- Research and Development Centre, Borås
| | - Marianne Rythén
- Research and Development Centre, Borås
- Specialist Clinic for Pediatric Dentistry, Public Dental Service, Mölndal, Sweden
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16
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Bandela V, Munagapati B, Karnati RKR, Venkata GRS, Nidudhur SR. Osteoporosis: Its Prosthodontic Considerations - A Review. J Clin Diagn Res 2015; 9:ZE01-4. [PMID: 26816999 PMCID: PMC4717718 DOI: 10.7860/jcdr/2015/14275.6874] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/30/2015] [Indexed: 11/24/2022]
Abstract
Osteoporosis is a disease of bone which is common in middle aged post-menopausal women. The osteoporotic bones will become weak and are prone to fractures. Osteoporosis means "porous bone" is a "silent disease". Healthy bone microscopically appears like a honeycomb but, in osteoporotic patients the spaces are much bigger. The osteoporotic bone will have less density or mass and the structure of bone tissue is abnormal. As the bone becomes less dense, they become weaker and more likely to fracture. Women are four times more likely to develop osteoporosis than men. Oral health maintenance for adults with osteoporosis is important. Bone weakness and loss may also affect the ridges that hold dentures resulting in poor fitting dentures. The patients require new dentures more often than those who have strong, healthy bones. Best way to handle problems is avoid delaying or postponing the dental treatment. Regular dental visits and healthy lifestyle is necessary in strengthening and maintenance of good bone health. Well balanced diet with high amounts of vitamin-D & calcium with regular physical activity is recommended.
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Affiliation(s)
- Vinod Bandela
- Assistant Professor, Department of Prosthodontics, G. Pulla Reddy Dental College & Hospital, Kurnool, India
| | - Bharathi Munagapati
- Professor, Department of Prosthodontics, G. Pulla Reddy Dental College & Hospital, Kurnool, India
| | - Rajeev K Reddy Karnati
- Professor and HOD, Department of Prosthodontics, G. Pulla Reddy Dental College & Hospital, Kurnool, India
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17
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Abstract
Osteoporosis is a major health problem affecting one in three women over the age of 50 and may not be detected until fractures occur. Since osteoporotic fractures are a health burden worldwide, identifying subjects with a high risk of osteoporosis and preventing osteoporosis-related mortality and morbidity are a very important health strategy. Women show an estrogen-related bone loss starting at menopause, predominantly occurring in trabecular bone. Diagnosis of osteoporosis is usually based on the bone mineral density measurement, but this is not a practical and economical technique for early detection. Therefore, investigators are interested in the possibility of detecting osteoporosis from the panoramic radiographs. Mandibular cortical bone undergoes resorptive activity in osteoporotic patients, leading to a decreased thickness and more porous inferior border. Therefore, studies have demonstrated the usefulness of cortical width and shape, determined from panoramic radiographs, in identifying elderly individuals with undetected osteoporosis, especially postmenopausal women. In conclusion, postmenopausal women with C3 category, Mental Index (MI) <3 mm, and panoramic mandibular index (PMI) <0.3 may be considered for further osteoporosis investigation.
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Affiliation(s)
- Ayse Gulsahi
- Department of Dentomaxillofacial Radiology, Baskent University, Ankara, Turkey
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18
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Graham J. Detecting low bone mineral density from dental radiographs: a mini-review. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2015; 12:178-82. [PMID: 26604946 PMCID: PMC4625777 DOI: 10.11138/ccmbm/2015.12.2.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over a number of years researchers have reported associations between osteoporosis or low bone mineral density and signs that can be detected on dental radiographs, particularly in the width of the inferior mandibular cortex and the texture of the trabecular bone. As patients visit the dentist more regularly than they visit their doctor, there is the possibility that such signs could be used as a means of identifying individuals at risk of developing osteoporosis or suffering from consequent fracture. This paper reviews the historical background behind this research and the current status, including recent developments in automation of measurement using computer image analysis.
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Affiliation(s)
- James Graham
- Centre for Imaging Science, Institute of Population Health, Faculty of Medicine and Human Sciences, The University of Manchester, United Kingdom
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19
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Calciolari E, Donos N, Park JC, Petrie A, Mardas N. Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis. J Dent Res 2014; 94:17S-27S. [PMID: 25365969 DOI: 10.1177/0022034514554949] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Different quantitative and qualitative indices calculated on oral panoramic radiographs have been proposed as useful tools to screen for reduced skeletal bone mineral density (BMD). Our aim was to systematically review the literature on linear and qualitative panoramic measures and to assess the accuracy of these indices by performing a meta-analysis of their sensitivity and specificity. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Fifty studies were included in the qualitative appraisal and 19 were considered for meta-analysis. The methodological quality of the retrieved studies, assessed with the QUADAS-2 tool, was on average low. Three indices were reported by most of the studies: mandibular cortical width, panoramic mandibular index, and the Klemetti index. Mandibular cortical width presented with a better accuracy in excluding osteopenia/osteoporosis (specificity), since patients with a cortical width more than 4 mm had a normal BMD in 90% of the cases. Almost all studies used a cutoff of 0.3 for the panoramic mandibular index, resulting in an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.723 (SE 0.160; 95% confidence interval [CI], 0.352-0.926) and 0.733 (SE 0.066; 95% CI, 0.587-0.841). The presence of any kind of mandibular cortical erosion gave an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.789 (SE 0.031; 95% CI, 0.721-0.843) and 0.562 (SE 0.047; 95% CI, 0.47-0.651) and a sensitivity and specificity in detecting osteoporosis, respectively, of 0.806 (SE 0.105; 95% CI, 0.528-0.9200) and 0.643 (SE 0.109; 95% CI, 0.417-0.820). The mandibular cortical width, panoramic mandibular index, and Klemetti index are overall useful tools that potentially could be used by dentists to screen for low BMD. Their limitations are mainly related to the experience/agreement between different operators and the different image quality and magnification of the panoramic radiographs.
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Affiliation(s)
- E Calciolari
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, United Kingdom
| | - N Donos
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, United Kingdom
| | - J C Park
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, United Kingdom Department of Periodontology, College of Dentistry, Dankook University, Cheonan, South Korea
| | - A Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, London, United Kingdom
| | - N Mardas
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, United Kingdom
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20
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Kim OS, Shin MH, Song IH, Lim IG, Yoon SJ, Kim OJ, Lee YH, Kim YJ, Chung HJ. Digital panoramic radiographs are useful for diagnosis of osteoporosis in Korean postmenopausal women. Gerodontology 2014; 33:185-92. [PMID: 24913816 DOI: 10.1111/ger.12134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether digital panoramic radiographs could be used for the diagnosis of osteoporosis through evaluation of the radiographs based on the correlation with bone mineral density (BMD). METHODS One hundred and ninety-four post-menopausal women were selected from participants who had participated in the Dong-gu study. Panoramic radiographic indices measured are mental index (MI), mandibular cortical index (MCI) and simple visual estimation (SVE). BMD at the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry (DXA). The Pearson's correlation test was performed to analyse the correlation between MI and age and BMD at the lumbar spine, femoral neck and total hip. Multiple linear regression analysis was performed to analyse the association of MI, MCI and SVE with BMD after adjusting for age, height and weight. To determine the optimal cut-off point of MI for the diagnosis of osteoporosis, the receiver operating characteristic analysis was performed. RESULTS The MI was positively correlated with BMDs: lumbar spine: r = 0.36, femoral neck: r = 0.59 and total hip: r = 0.58 (p < 0.001). As age increased, MI decreased (r = -0.46). BMD at the lumbar spine and total hip were significantly lower in participants with reduction of mandibular width, thinning and resorption of mandibular cortex by the MI, SVE and MCI, respectively. The optimal cut-off value of MI for the diagnosis of spinal osteoporosis was 2.22 mm. CONCLUSION Thickness and morphological changes of mandibular inferior cortical bone are associated with BMD, independent of age, height and weight. These results suggest that MI, MCI and SVE may be useful indices for the diagnosis of osteoporosis in a Korean population.
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Affiliation(s)
- Ok-Su Kim
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University, Medical School, Hak1dong, Donggu, Gwangju, Korea
| | - In-Hwa Song
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Il-Gu Lim
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Suk-Ja Yoon
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Dental Science Research Institute, Chonnnam National University, Gwangju, Korea
| | - Ok-Joon Kim
- Department of Oral Pathology, School of Dentistry, Dental Science Research Institute, Chonnnam National University, Gwangju, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Young-Joon Kim
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Hyun-Ju Chung
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
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21
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Castro-Mateos I, Pozo JM, Cootes TF, Wilkinson JM, Eastell R, Frangi AF. Statistical shape and appearance models in osteoporosis. Curr Osteoporos Rep 2014; 12:163-73. [PMID: 24691750 DOI: 10.1007/s11914-014-0206-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Statistical models (SMs) of shape (SSM) and appearance (SAM) have been acquiring popularity in medical image analysis since they were introduced in the early 1990s. They have been primarily used for segmentation, but they are also a powerful tool for 3D reconstruction and classification. All these tasks may be required in the osteoporosis domain, where fracture detection and risk estimation are key to reducing the mortality and/or morbidity of this bone disease. In this article, we review the different applications of SSMs and SAMs in the context of osteoporosis, and it concludes with a discussion of their advantages and disadvantages for this application.
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Affiliation(s)
- Isaac Castro-Mateos
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Mechanical Engineering Department, The University of Sheffield, Sheffield, UK,
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22
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Naitoh M, Takada ST, Kurosu Y, Inagaki K, Mitani A, Ariji E. Relationship between findings of mandibular cortical bone in inferior border and bone mineral densities of lumbar vertebrae in postmenopausal women. Okajimas Folia Anat Jpn 2014; 91:49-55. [PMID: 25797458 DOI: 10.2535/ofaj.91.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is important to assess the general bone condition in dental implant treatment. The relationships between the bone mineral densities (BMDs) of lumbar vertebrae and mandibular cortical bone condition in the inferior border using multi-slice computed tomography (CT) were assessed in postmenopausal women. If a strong correlation between them is obtained, the mandibular cortical bone condition may be useful to evaluate the general bone condition. Twenty-two postmenopausal women were enrolled in this investigation. The maximum CT value and width of the mandibular cortical bone (MCW-MSCT) were measured, and the mandibular cortical bone index (MCI-MSCT) was classified using multi-slice CT. BMDs of lumbar vertebrae were measured using dual energy X-ray absorptiometry (DXA), and then the percentage of the young adult mean (YAM) was analyzed. The correlations were investigated between the mandibular cortical bone condition and values of lumbar vertebrae. Weak correlations were observed between MCW-MSCT and the percentage of YAM. Also, significant differences in the percentage of YAM were noted between types of MCI-MSCT. The mandibular cortical bone index (MCI-MSCT) in the inferior border using multi-slice CT may be applicable to evaluate the influence of the general bone condition.
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Affiliation(s)
- Munetaka Naitoh
- Associate Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi-Gakuin University
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23
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Devlin H, Whelton C. Can mandibular bone resorption predict hip fracture in elderly women? A systematic review of diagnostic test accuracy. Gerodontology 2013; 32:163-8. [PMID: 24128044 DOI: 10.1111/ger.12077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this systematic review was to determine the diagnostic accuracy of the mandibular cortical width measurements and porosity in detecting hip osteoporosis. BACKGROUND All of the included studies used measurements on panoramic radiographs. MATERIALS AND METHODS Studies were included if they compared the radiographic measurements (or index tests) with central dual energy X-ray absorptiometry (DXA) of the hip as the reference standard. A measure of diagnostic accuracy such as sensitivity and specificity or area under the receiver operating characteristic curve was also required for inclusion. RESULTS Seven studies were identified. Meta-analysis was not possible because of the heterogeneity of the studies. The studies all demonstrated moderate diagnostic accuracy. CONCLUSION If a patient with a thin or porous mandibular cortex is identified by a chance radiographic finding, additional clinical risk factors need to be considered and the patient referred for further investigation with DXA where necessary.
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Affiliation(s)
- Hugh Devlin
- School of Dentistry, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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24
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Kavitha MS, Asano A, Taguchi A, Heo MS. The combination of a histogram-based clustering algorithm and support vector machine for the diagnosis of osteoporosis. Imaging Sci Dent 2013; 43:153-61. [PMID: 24083208 PMCID: PMC3784674 DOI: 10.5624/isd.2013.43.3.153] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 04/28/2013] [Accepted: 05/07/2013] [Indexed: 12/04/2022] Open
Abstract
Purpose To prevent low bone mineral density (BMD), that is, osteoporosis, in postmenopausal women, it is essential to diagnose osteoporosis more precisely. This study presented an automatic approach utilizing a histogram-based automatic clustering (HAC) algorithm with a support vector machine (SVM) to analyse dental panoramic radiographs (DPRs) and thus improve diagnostic accuracy by identifying postmenopausal women with low BMD or osteoporosis. Materials and Methods We integrated our newly-proposed histogram-based automatic clustering (HAC) algorithm with our previously-designed computer-aided diagnosis system. The extracted moment-based features (mean, variance, skewness, and kurtosis) of the mandibular cortical width for the radial basis function (RBF) SVM classifier were employed. We also compared the diagnostic efficacy of the SVM model with the back propagation (BP) neural network model. In this study, DPRs and BMD measurements of 100 postmenopausal women patients (aged >50 years), with no previous record of osteoporosis, were randomly selected for inclusion. Results The accuracy, sensitivity, and specificity of the BMD measurements using our HAC-SVM model to identify women with low BMD were 93.0% (88.0%-98.0%), 95.8% (91.9%-99.7%) and 86.6% (79.9%-93.3%), respectively, at the lumbar spine; and 89.0% (82.9%-95.1%), 96.0% (92.2%-99.8%) and 84.0% (76.8%-91.2%), respectively, at the femoral neck. Conclusion Our experimental results predict that the proposed HAC-SVM model combination applied on DPRs could be useful to assist dentists in early diagnosis and help to reduce the morbidity and mortality associated with low BMD and osteoporosis.
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Affiliation(s)
- Muthu Subash Kavitha
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea. ; Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
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25
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Roberts MG, Graham J, Devlin H. Image texture in dental panoramic radiographs as a potential biomarker of osteoporosis. IEEE Trans Biomed Eng 2013; 60:2384-92. [PMID: 23568478 DOI: 10.1109/tbme.2013.2256908] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previous studies have shown an association between osteoporosis and automatic measurements of mandibular cortical width on dental panoramic radiographs (DPRs). In this study, we show that additional image texture features increase this association and propose the combined features as a potential biomarker for osteoporosis. We used an existing dataset of 663 DPRs of female patients with bone mineral density (BMD) measurements. The mandibular cortex was located using a previously described computer algorithm. Texture features, based on co-occurrence matrices and fractal dimension, were measured in the bone within the cortex and also in the superior basal bone above the cortex. These, augmented by cortical width measurements, were used by a random forest classifier to identify osteoporosis at femoral neck, total hip, and lumbar spine. Classification performance was assessed by ROC analysis. Area-under-curve (AUC) values for identifying osteoporosis at femoral neck were 0.830, 0.824, and 0.872 using, respectively, cortical width alone, cortical texture (co-occurrence matrix features) alone, and combined width and texture. At 80% sensitivity, these classifiers produced specificity values of 74.4%, 73.6%, and 80.0%, respectively. Fractal dimension was a less effective texture feature. Prediction of osteoporosis at the lumbar spine was poorer, but a combined width and superior basal bone texture classifier gave a significant improvement in AUC at over the use of width alone.
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Affiliation(s)
- Martin G Roberts
- Centre for Imaging Science, Institute of Population Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, M13 9PT, U K.
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26
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Abstract
This article describes how dentists can recognize osteoporosis before fractures develop, and discusses whether osteoporosis affects tooth loss or inhibits implant osseointegration. Some success in diagnosing osteoporosis has been obtained using clinical questionnaires that attempt to identify those who have strong risk factors for the disease, and analysis of the sparse trabeculation and thinning of the mandibular cortex often seen in dental panoramic radiographs. The role of osteoporosis in periodontal disease is unclear as there are many conflicting reports, but the evidence suggests that tooth loss may be more prevalent in patients with osteoporosis.
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Affiliation(s)
- Hugh Devlin
- School of Dentistry, University of Manchester, UK.
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27
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Lurie A, Tosoni GM, Tsimikas J, Walker F. Recursive hierarchic segmentation analysis of bone mineral density changes on digital panoramic images. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:549-58.e1. [PMID: 22668434 DOI: 10.1016/j.oooo.2011.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 10/18/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate that histogram analysis and mathematical modeling of digital panoramic images (DPIs) processed using recursive hierarchic segmentation (RHSEG) discriminates normal, osteopenic, and osteoporotic cancellous bone. STUDY DESIGN Forty-seven DPIs of postmenopausal women were grouped into normal, osteopenic, and osteoporotic; dual-energy x-ray absorptiometry was the reference standard. RHSEG of the mandibular angle and canine/premolar trabecular regions of interest was performed. After histogram and histogram bin analysis and generation of relative intensity functions, generalized linear mixed model analysis was used to model the data and likelihood ratio testing used to assess group differences. RESULTS Histogram analyses discriminated among the groups. Receiver operating characteristic analysis of the canine/premolar data yielded area-under-the-curve accuracies of 0.78 for osteoporosis and 0.74 for osteopenia. Discrimination of osteoporosis required cubic analysis, discrimination of osteopenia required quartic analysis, and neither model alone discriminated among all groups. CONCLUSIONS Analyses and mathematical modeling of mandibular trabecular bone on RHSEG-processed DPIs discriminated normal, osteoporotic, and osteopenic patients.
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Affiliation(s)
- Alan Lurie
- Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, Connecticut 06030-1605, USA.
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28
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Mandibular bone changes in 24 years and skeletal fracture prediction. Clin Oral Investig 2012; 17:565-72. [PMID: 22547324 DOI: 10.1007/s00784-012-0745-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction. MATERIALS AND METHODS From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense. RESULTS Visually, the mandibular compact and trabecular bone transformed gradually during the 24 years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78 %) than the non-sparse group (27-31 %), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24 years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993. CONCLUSION Dental radiographs contain enough information to identify women most at risk of future fracture. CLINICAL RELEVANCE When observing sparse mandibular trabeculation, dentists can identify 40-69 % of women at risk for future fractures, depending on participant age at examination.
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Kavitha MS, Asano A, Taguchi A, Kurita T, Sanada M. Diagnosis of osteoporosis from dental panoramic radiographs using the support vector machine method in a computer-aided system. BMC Med Imaging 2012; 12:1. [PMID: 22248480 PMCID: PMC3269982 DOI: 10.1186/1471-2342-12-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 01/16/2012] [Indexed: 11/24/2022] Open
Abstract
Background Early diagnosis of osteoporosis can potentially decrease the risk of fractures and improve the quality of life. Detection of thin inferior cortices of the mandible on dental panoramic radiographs could be useful for identifying postmenopausal women with low bone mineral density (BMD) or osteoporosis. The aim of our study was to assess the diagnostic efficacy of using kernel-based support vector machine (SVM) learning regarding the cortical width of the mandible on dental panoramic radiographs to identify postmenopausal women with low BMD. Methods We employed our newly adopted SVM method for continuous measurement of the cortical width of the mandible on dental panoramic radiographs to identify women with low BMD or osteoporosis. The original X-ray image was enhanced, cortical boundaries were determined, distances among the upper and lower boundaries were evaluated and discrimination was performed by a radial basis function. We evaluated the diagnostic efficacy of this newly developed method for identifying women with low BMD (BMD T-score of -1.0 or less) at the lumbar spine and femoral neck in 100 postmenopausal women (≥50 years old) with no previous diagnosis of osteoporosis. Sixty women were used for system training, and 40 were used in testing. Results The sensitivity and specificity using RBF kernel-SVM method for identifying women with low BMD were 90.9% [95% confidence interval (CI), 85.3-96.5] and 83.8% (95% CI, 76.6-91.0), respectively at the lumbar spine and 90.0% (95% CI, 84.1-95.9) and 69.1% (95% CI, 60.1-78.6), respectively at the femoral neck. The sensitivity and specificity for identifying women with low BMD at either the lumbar spine or femoral neck were 90.6% (95% CI, 92.0-100) and 80.9% (95% CI, 71.0-86.9), respectively. Conclusion Our results suggest that the newly developed system with the SVM method would be useful for identifying postmenopausal women with low skeletal BMD.
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Affiliation(s)
- M S Kavitha
- Graduate School of Engineering, Hiroshima University, and Sanada Hospital, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima 739-8527, Japan
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Jonasson G, Sundh V, Ahlqwist M, Hakeberg M, Björkelund C, Lissner L. A prospective study of mandibular trabecular bone to predict fracture incidence in women: a low-cost screening tool in the dental clinic. Bone 2011; 49:873-9. [PMID: 21777710 DOI: 10.1016/j.bone.2011.06.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/07/2011] [Accepted: 06/27/2011] [Indexed: 11/28/2022]
Abstract
Bone structure is the key to the understanding of fracture risk. The hypothesis tested in this prospective study is that dense mandibular trabeculation predicts low fracture risk, whereas sparse trabeculation is predictive of high fracture risk. Out of 731 women from the Prospective Population Study of Women in Gothenburg with dental examinations at baseline 1968, 222 had their first fracture in the follow-up period until 2006. Mandibular trabeculation was defined as dense, mixed dense plus sparse, and sparse based on panoramic radiographs from 1968 and/or 1980. Time to fracture was ascertained and used as the dependent variable in three Cox proportional hazards regression analyses. The first analysis covered 12 years of follow-up with self-reported endpoints; the second covered 26 years of follow-up with hospital verified endpoints; and the third combined the two follow-up periods, totaling 38 years. Mandibular trabeculation was the main independent variable predicting incident fractures, with age, physical activity, alcohol consumption and body mass index as covariates. The Kaplan-Meier curve indicated a graded association between trabecular density and fracture risk. During the whole period covered, the hazard ratio of future fracture for sparse trabeculation compared to mixed trabeculation was 2.9 (95% CI: 2.2-3.8, p<0.0001), and for dense versus mixed trabeculation was 0.21 (95% CI: 0.1-0.4, p<0.0001). The trabecular pattern was a highly significant predictor of future fracture risk. Our findings imply that dentists, using ordinary dental radiographs, can identify women at high risk for future fractures at 38-54 years of age, often long before the first fracture occurs.
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Affiliation(s)
- Grethe Jonasson
- Research & Development Unit in Southern Alvsborg County, Sven Eriksonplatsen 4, SE-503 38 Borås, Sweden.
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Kavitha MS, Samopa F, Asano A, Taguchi A, Sanada M. Computer-aided measurement of mandibular cortical width on dental panoramic radiographs for identifying osteoporosis. ACTA ACUST UNITED AC 2011; 3:36-44. [PMID: 22298519 DOI: 10.1111/j.2041-1626.2011.00095.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To develop a computer-aided diagnosis system to continuously measure mandibular inferior cortical width on dental panoramic radiographs and evaluate the system's efficacy in identifying postmenopausal women with low-skeletal bone mineral density. METHODS Mandibular inferior cortical width was continuously measured by enhancing the original X-ray image, determining cortical boundaries, and evaluating all distances between the upper and lower boundaries in the region of interest. The system's efficacy in identifying osteoporosis at the lumbar spine and the femoral neck was evaluated for 100 women (≥50 years): 50 in the development of the tool and 50 in its validation. RESULTS The sensitivity and specificity of the cortical measurements for identifying the development patients were 90% (95% confidence interval shown in parentheses) (63.0-87.0) in women with low spinal bone mineral density, and 81.8% (70.1-91.8) and 69.2% (56.2-81.8) in those with low femoral bone mineral density, respectively. Corresponding values in the validation patients were 93.3% (85.9-100) and 82.9% (71.4-92.7) at the lumbar spine, and 92.3% (84.5-99.5) and 75.7% (63.0-87.0) at the femoral neck, respectively. CONCLUSION Our new computer-aided diagnosis system is a useful procedure in triage screening for osteoporosis.
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Affiliation(s)
- Muthu Subash Kavitha
- Graduate School of Engineering, Hiroshima University, Higashi-Hiroshima, Hiroshima, Japan.
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Roberts M, Yuan J, Graham J, Jacobs R, Devlin H. Changes in mandibular cortical width measurements with age in men and women. Osteoporos Int 2011; 22:1915-25. [PMID: 20886206 DOI: 10.1007/s00198-010-1410-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED Automated software was used to measure the mandibular cortical width in a large sample of dental radiographs. We determined that cortical thinning normally starts in women at age 42.5 years and accelerates thereafter. We can estimate population referral rates and thus enable cost benefit analyses for osteoporosis detection by dentists. INTRODUCTION Previous studies have shown that the mandibular cortical width is significantly correlated with the bone mineral density at sites which may undergo osteoporotic fracture, e.g. hip. Mandibular cortical width can be determined automatically from dental panoramic radiographs that dentists frequently request, using appropriate software. We study the distribution of cortical width given age to predict those patients requiring further investigation for osteoporosis. METHODS The mandibular cortical width was measured in 4,949 dental panoramic tomograms, in patients aged 15-94 years. The inferior and superior cortical edges were detected automatically using a global active shape model image search, followed by an active appearance model search. Nonparametric statistical analysis and nonlinear piecewise linear/quadratic regression were used to analyse the data. RESULTS For females, the mean cortical width had a linear increase before the age of 17 years, a period of no change (estimate = 3.25 mm, se = 0.01) until the age of 42.5 years, followed by a quadratic decrease with age. For males, it had a linear increase before the age of 19 years, a constant value (estimate = 0.37 mm, se = 0.01) until the age of 36 years and then a slow linear decrease. The rate of decrease in mean cortical width goes from 0.049 to 0.105 standard deviations per year in the 60-80-year-old female age group, in line with published bone mineral density T-score reductions. CONCLUSIONS The pattern of decrease in mandibular cortical width with age was similar to the known pattern of bone loss from the hip, accelerating in women after the age of 42.5 years.
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Affiliation(s)
- M Roberts
- Imaging Science and Biomedical Engineering, School of Cancer and Enabling Sciences, University of Manchester, Manchester, UK
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Kyrgidis A, Tzellos TG, Toulis K, Antoniades K. The facial skeleton in patients with osteoporosis: a field for disease signs and treatment complications. J Osteoporos 2011; 2011:147689. [PMID: 21403823 PMCID: PMC3042625 DOI: 10.4061/2011/147689] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 12/31/2010] [Accepted: 01/15/2011] [Indexed: 01/04/2023] Open
Abstract
Osteoporosis affects all bones, including those of the facial skeleton. To date the facial bones have not drawn much attention due to the minimal probability of morbid fractures. Hearing and dentition loss due to osteoporosis has been reported. New research findings suggest that radiologic examination of the facial skeleton can be a cost-effective adjunct to complement the early diagnosis and the follow up of osteoporosis patients. Bone-mass preservation treatments have been associated with osteomyelitis of the jawbones, a condition commonly described as osteonecrosis of the jaws (ONJ). The facial skeleton, where alimentary tract mucosa attaches directly to periosteum and teeth which lie in their sockets of alveolar bone, is an area unique for the early detection of osteoporosis but also for the prevention of treatment-associated complications. We review facial bone involvement in patients with osteoporosis and we present data that make the multidisciplinary approach of these patients more appealing for both practitioners and dentists. With regard to ONJ, a tabular summary with currently available evidence is provided to facilitate multidisciplinary practice coordination for the treatment of patients receiving bisphosphonates.
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Affiliation(s)
- Athanassios Kyrgidis
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
- Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Thrasivoulos-George Tzellos
- Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Konstantinos Toulis
- Department of Endocrinology, 424 Military Hospital, Thessaloniki 56429, Greece
| | - Konstantinos Antoniades
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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Hedström L, Baigi A, Bergh H. The relation between bone mineral density in the heel and pixel intensity in the mandibular jaw bone among elderly women. Dentomaxillofac Radiol 2010; 39:409-13. [PMID: 20841458 DOI: 10.1259/dmfr/50171873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the correlation between pixel intensity (PI) in digital radiographs of the lower jaw and bone mineral density (BMD) in the heels of post-menopausal women (as measured with DXL, a combination of dual energy X-ray absorptiometry and lasers). METHODS Two intraoral periapical digital radiographs were taken in the right and left mandible premolar region, and the digital images were analysed by a computer program (Dimaxis) regarding PI. As the radiographs were taken, the BMD of the patient's left heel was measured via a portable Calscan device. The patient answered a questionnaire concerning risk factors. The correlation between variables was analysed using statistical tests. RESULTS A significant correlation was found between the PI in the left (P = 0.001) and right (P = 0.004) mandible and the BMD of the left heel for the whole group. A pronounced correlation was found to exist for women > 70 years old. Based on a cut-off value of the PI, to differentiate between healthy individuals and those who required further analysis for osteoporosis, the following values were obtained: sensitivity 0.74, specificity 0.50, positive predictive value 0.77 and negative predictive value 0.46. CONCLUSION A positive correlation was found between PI in digital radiographs of the mandible and the BMD of the heel. The low predictive value does not allow any definite conclusions to be drawn from the present study. A reasonable recommendation could be for future studies to employ a larger study population to explore the effect on this value.
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Affiliation(s)
- L Hedström
- Public Dental Services, P.O. Box 1254, S-432 24 Varberg, Sweden.
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Horner K, Allen P, Graham J, Jacobs R, Boonen S, Pavitt S, Nackaerts O, Marjanovic E, Adams JE, Karayianni K, Lindh C, van der Stelt P, Devlin H. The relationship between the OSTEODENT index and hip fracture risk assessment using FRAX. ACTA ACUST UNITED AC 2010; 110:243-9. [DOI: 10.1016/j.tripleo.2010.03.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 03/19/2010] [Accepted: 03/19/2010] [Indexed: 11/25/2022]
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Panoramic radiographs for identifying individuals with undetected osteoporosis. JAPANESE DENTAL SCIENCE REVIEW 2009. [DOI: 10.1016/j.jdsr.2009.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Many patients with osteoporosis go undiagnosed because typically no symptoms are present before a fracture. Triage screening to refer patients to appropriate medical professionals for further investigation would be useful to address the increase in the incidence of osteoporotic fractures. Dental clinics may offer a new triage screening pathway because dentists frequently take radiographs of bones in the course of dental treatment. A major premise for such triage screening in dental clinics is that dentists can readily use a screening tool in their dental practice. For example, cortical width and shape of the mandible detected on panoramic radiographs may be appropriate indices for triaging individuals with osteoporosis. To date, several investigators have demonstrated significant associations between cortical indices on panoramic radiographs and bone mineral density of the skeleton generally, such as the spine and femur, biochemical markers of bone turnover and risk of osteoporotic fractures. Further, in two recent Japanese clinical trials, approximately 95% of women who were identified by trained dentists in their clinics using cortical shape findings did have osteopenia or osteoporosis. These findings support the possibility that dental clinics may offer a new triage platform to identify individuals with otherwise undetected osteoporosis.
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Affiliation(s)
- A Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Hirooka, Shiojiri, Japan.
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Yasar F, Sener S, Yesilova E, Akgünlü F. Mandibular cortical index evaluation in masked and unmasked panoramic radiographs. Dentomaxillofac Radiol 2009; 38:86-91. [PMID: 19176650 DOI: 10.1259/dmfr/56808511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The first aim of this study was to evaluate intra- and interobserver agreement in evaluating the mandibular cortical index (MCI) in masked and unmasked panoramic radiographs. The second aim was to evaluate the effect of previous experience of MCI classification on the observers' performance. METHODS Three observers separately evaluated MCI, twice in masked and twice in unmasked panoramic radiographs, with 2 week intervals. The observations were repeated more than 9 months later. The second and third observers were inexperienced in evaluating MCI. Weighted kappa statistics were used to evaluate the inter- and intraobserver agreement. RESULTS In the first session of the study, the kappa values for intraobserver agreements in masked panoramic radiographs were between 0.565 and 0.789; in unmasked panoramic radiographs, they were between 0.420 and 0.732. The kappa values for interobserver agreement were between 0.131 and 0.392 in masked radiographs and between 0.043 and 0.225 in unmasked radiographs. In the second session of the study, the kappa values for intraobserver agreements in masked panoramic radiographs were between 0.586 and 0.786. The kappa values for intraobserver agreements in unmasked panoramic radiographs were between 0.558 and 0.781. The kappa values for interobserver agreement were between 0.146 and 0.510 in masked radiographs and between 0.174 and 0.568 in unmasked radiographs. CONCLUSIONS Masking has no effect on the evaluation of panoramic radiographs for MCI. Previous experience causes higher intraobserver agreement. Intra- and interobserver agreement increases along with the increased experience in MCI evaluations.
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Affiliation(s)
- F Yasar
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Selcuk University, Kampüs Selcuklu, Konya, Turkey.
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Nackaerts O, Horner K, Jacobs R, Karayianni K, Mitsea A, Berkas L, Mastoris M, Lindh C, van der Stelt PF, Marjanovic E, Adams JE, Pavitt S, Devlin H. Is self-reported alcohol consumption associated with osteoporotic mandibular bone loss in women? Eur J Oral Sci 2009; 117:7-12. [DOI: 10.1111/j.1600-0722.2008.00596.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Amarasena N, Yoshihara A, Hirotomi T, Takano N, Miyazaki H. Association between serum calcium and periodontal disease progression in non-institutionalized elderly. Gerodontology 2008; 25:245-50. [DOI: 10.1111/j.1741-2358.2007.00211.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lamster IB, Wolf DL. Primary Health Care Assessment and Intervention in the Dental Office. J Periodontol 2008; 79:1825-32. [DOI: 10.1902/jop.2008.080124] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Osteoporosis is characterized by an increased risk of bone fractures, affecting especially the forearm, vertebrae and hip. Women are more commonly affected than men because their peak bone density is usually less than that of men at adulthood and declines at the menopause. Early detection of osteoporosis is advisable to prevent the often devastating consequences of hip fracture later in life, though a mass screening programme is not considered cost-effective. Once osteoporotic individuals are identified, drug treatment can be effective in increasing their bone mineral density and reducing fracture rates. Is it possible for dentists to accurately detect early osteoporotic changes on dental radiographs and the affected individuals to be referred to a medical specialist? If the radiographs were taken for other diagnostic purposes, this would increase the cost effectiveness of this regime.
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Affiliation(s)
- H Devlin
- The School of Dentistry, University of Manchester, Manchester, UK.
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Nackaerts O, Jacobs R, Devlin H, Pavitt S, Bleyen E, Yan B, Borghs H, Lindh C, Karayianni K, van der Stelt P, Marjanovic E, Adams JE, Horner K. Osteoporosis detection using intraoral densitometry. Dentomaxillofac Radiol 2008; 37:282-7. [DOI: 10.1259/dmfr/30424604] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study. Br Dent J 2008; 204:E16; discussion 560-1. [PMID: 18425076 DOI: 10.1038/sj.bdj.2008.317] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2008] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine if thinning (<3 mm width) of the lower cortical border of the mandible on dental panoramic radiographs, as well as other clinical risk factors, may provide a useful diagnostic test for osteoporosis in young postmenopausal women. DESIGN Six hundred and fifty-two subjects (age range 45-70 years) were involved in this multi-centre, cross-sectional study. SETTING Patients were recruited from centres in Leuven (Belgium), Athens (Greece), Manchester (UK), and Malmo (Sweden). SUBJECTS AND METHODS The subject's age, body weight, whether the patient took hormone replacement therapy or had a history of low trauma fracture were used to form a clinical osteoporosis risk assessment (the OSteoporosis Index of RISk or OSIRIS index). Each patient also received a dental panoramic radiographic examination. RESULTS One hundred and forty subjects had osteoporosis involving at least one of the measurement sites (lumbar spine, femoral neck or total hip). Those with osteoporosis tended to have a low OSIRIS score and a thinned cortical mandibular border. The area under the ROC curve for using both cortical width and OSIRIS to predict osteoporosis was 0.90 (95% CI = 0.87 to 0.92). There was a significant improvement in the diagnostic ability of the combined OSIRIS and cortical width test over both tests applied separately (p <0.001). The cost effectiveness of the cortical width and OSIRIS model was improved by using a high specificity threshold rather than high sensitivity. However, this analysis ignores the costs associated with missed cases of osteoporosis. CONCLUSION Dentists have a role to play in the detection and referral of patients at high risk of osteoporosis.
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Abstract
PURPOSE To evaluate the dental and periodontal health of adolescents and young women with restrictive anorexia nervosa (AN), and relationship between bone mineral density (BMD) assessed by dual energy Xray absorptiometry (DXA) and dental radiographs. STUDY DESIGN Twenty-three young women, median age 17.6 years (range 14.4-27.2), were studied within three months of entering a clinical trial. DXA BMD measurements were obtained and subjects underwent a comprehensive dental examination, including panoramic and bitewing dental radiographs. Three observers assessed mandibular cortical width (MCW) in the mental foramen region on panoramic radiographs. RESULTS Dental findings included very good to excellent oral hygiene. Gingival recession was evident in 10 participants (43%). Dental erosion was not seen and the mean decayed missing or filled teeth (DMFT) was 8.6. There was a weak positive correlation between BMD by DXA and MCW on radiographs. CONCLUSIONS We report dental manifestations associated with restrictive AN, and the association between bone assessments by DXA and dental radiographs in this patient group. Despite subnormal DXA measurements in most patients, essentially all adolescents had a normal dental examination. Dental providers should be cognizant of the fact that many patients with eating disorders may not display the "classic" findings reported in the literature.
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Roldán JF, Escalante A, del Rincón I. Impaired arterial function associated with thinning of cortical bone in rheumatoid arthritis. ACTA ACUST UNITED AC 2008; 59:523-30. [DOI: 10.1002/art.23530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Isales CM. Role of the Oral and Maxillofacial Surgeon in the Diagnosis and Treatment of Patients with Osteoporosis. Oral Maxillofac Surg Clin North Am 2007; 19:475-85, v. [DOI: 10.1016/j.coms.2007.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Horner K, Devlin H. Osteoporosis risk assessment by dentists: a new pathway for access to therapy? Expert Rev Endocrinol Metab 2007; 2:293-298. [PMID: 30743804 DOI: 10.1586/17446651.2.3.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Keith Horner
- a Professor of Oral and Maxillofacial Imaging, University of Manchester, School of Dentistry, Manchester M15 6FH, UK.
| | - Hugh Devlin
- b Reader in Restorative Dentistry, University of Manchester, School of Dentistry, Manchester M15 6FH, UK.
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Horner K, Karayianni K, Mitsea A, Berkas L, Mastoris M, Jacobs R, Lindh C, van der Stelt P, Marjanovic E, Adams J, Pavitt S, Devlin H. The mandibular cortex on radiographs as a tool for osteoporosis risk assessment: the OSTEODENT Project. J Clin Densitom 2007; 10:138-46. [PMID: 17449308 DOI: 10.1016/j.jocd.2007.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 02/19/2007] [Accepted: 02/19/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study was to measure the accuracy of porosity of the mandibular cortex on dental panoramic radiographs (DPRs) in diagnosis of osteoporosis, alone and in combination with a clinical risk index. Six hundred seventy-one women (45-70yr) were recruited in the study, and dual-energy X-ray absorptiometry of the hip and lumbar spine was performed. A clinical index of osteoporosis risk (OSIRIS) and a DPR were obtained for each subject. The cortical appearance on the DPR was classified using the mandibular cortical index (MCI) by 5 observers. receiver operating characteristic (ROC) curve analysis was performed with calculation of area under the ROC curve (AUC) and sensitivity and specificity at various thresholds. Complete data were available for 653 subjects, of whom 21.6% had osteoporosis. The AUC for OSIRIS was 0.838. When used alone as the diagnostic test, MCI AUC for the 5 observers ranged from 0.560 to 0.670, significantly less than OSIRIS. Intraobserver and interobserver repeatability of MCI assessment was inconsistent. We conclude that MCI has limited value for osteoporosis diagnosis, being most appropriate as a method of fortuitous case-finding.
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Affiliation(s)
- Keith Horner
- School of Dentistry, University of Manchester, Manchester, UK.
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