A novel method of dental panoramic tomogram analysis: a perspective tool for a screening test for osteoporosis

Osteoporosis risk group: Screening for osteoporosis in dental clinics using panoramic radiographs

Osteoporosis is a specific condition which is characterized by low bone mineral density (BMD) and deterioration of bone structure resulting in an increased susceptibility to fractures. It contributes to a great deal of morbidity and mortality, and is a large burden to the healthcare system, especially in the case of the elderly population. In the last four decades, a plethora of studies have reported characteristic oral radiographic findings in the early stages of osteoporosis, suggesting the possible use of oral radiographic signs for the early detection of the condition. Digital orthopantomographs (OPGs) are usually taken for the screening of dental patients during routine dental evaluations. These radiographs and the characteristic changes seen on them may have a significant role in the screening for initial osteoporotic changes. A number of precise radiomorphometric indices of the mandible have also been developed to allow quantification of the mandibular bone mass for identification of the initial signs of osteoporosis. The present review focuses on the possible role of panoramic radiographs in the initial screening for osteoporosis in dental clinics in high-risk groups.

Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis

Osteoporotic fractures are associated with an increased risk of subsequent fractures, a higher rate of mortality, and incremental medical costs. Incidental findings, which include some measurements related to the mandibular inferior cortex and the alveolar trabecular bone pattern of the mandible determined on panoramic radiographs, are considered to be a useful tool for identifying asymptomatic individuals at risk of having osteoporosis and/or fragility fractures. We undertook a worldwide literature survey and present the following clinical recommendations. Postmenopausal female dental patients with a mandibular inferior cortical width of less than 3 mm on panoramic radiographs may be at risk of having low skeletal bone mineral density (BMD) or osteoporosis, but not fragility fractures. In addition, those with a severely eroded mandibular inferior cortex may have an increased risk of having low skeletal BMD, osteoporosis, and fragility fractures. The alveolar trabecular bone pattern of the mandible might be useful for identifying female dental patients at risk of having fragility fractures, although further investigation is necessary to confirm this possibility. These incidental findings on panoramic radiographs, when used for identifying asymptomatic postmenopausal female patients at risk of having osteoporosis in general dental practice, may be helpful in reducing the incidence of first fractures, with a consequent reduction in the secondary fractures, medical costs, and mortality associated with osteoporotic fragility fractures, without incurring any additional cost.

Correlations between periodontal disease, mandibular inferior cortex index and the osteoporotic fracture probability assessed by means of the fracture risk assessment body mass index tool

Background

The aim was to examine correlations between radiological signs of chronic periodontitis, Mandibular Inferior Cortex (MIC) index and osteoporotic fracture probability based on the FRAX BMI tool.

Methods

The material comprised 422 panoramic radiographs taken in patients aged 40–89, 270 females and 152 males. The severity of chronic periodontitis and resorption of mandibular inferior cortex based on MIC index were assessed. A diagnostic survey was conducted to estimate 10-year major and hip osteoporotic fracture probability (MOFP, HOFP) by means of the FRAX BMI tool - an algorithm that allows to calculate osteoporotic fracture probability based on assessing bone fracture risk factors knowing only BMI value.

Results

The conducted analysis based on U Mann-Whitney test revealed that mean 10-year MOFP was significantly higher (p = 0.00) in women than in men. Mean 10-year MOFP in females was 4.8% (SD = 3.95%) and in males 3.21% (SD = 2.35%). Mean 10-year HOFP in women was 1.35% (SD = 2.07%) and was significantly higher (p = 0.03) than in men – 0.79% (SD = 1.18%).MOFP is significantly higher in patients with moderate and severe periodontitis than in those with mild periodontitis. Significant difference between MIC values and MOFP (p = 0.00) and HOFP (p = 0.00) was found. Osteoporotic fracture probability was significantly higher in patients with MIC stages C2 and C3 than C1.

Conclusions

The FRAX BMI tool with radiological evaluation of periodontal disease severity and MIC index may be used in dental practice in determining individual risk of osteoporotic fracture in females and provide new opportunities of selecting those potentially more prone to such fractures.

Trial registration

The approval of the local bioethics committee was obtained (KE-0254/107/2017).

IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices

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.

Utilization of computer-aided detection system in diagnosing unilateral maxillary sinusitis on panoramic radiographs

OBJECTIVES

It is unclear whether computer-aided detection (CAD) systems for panoramic radiography can help inexperienced dentists to diagnose maxillary sinusitis. The aim of this study was to clarify whether a CAD system for panoramic radiography can contribute to improved diagnostic performance for maxillary sinusitis by inexperienced dentists.

METHODS

The panoramic radiographs of 49 patients with maxillary sinusitis and 49 patients with healthy sinuses were evaluated in this study. The diagnostic performance of the CAD system was determined. 12 inexperienced dentists and 4 expert oral and maxillofacial radiologists observed the total of 98 panoramic radiographs and judged the presence or absence of maxillary sinusitis, under conditions with and without the support of the CAD system. The receiver operating characteristic curves of the two groups were compared.

RESULTS

The CAD system provided sensitivity of 77.6%, specificity of 69.4% and accuracy of 73.5%. The diagnostic performance of the inexperienced dentists increased with the support of the CAD system. When the inexperienced dentists diagnosed maxillary sinusitis with CAD support, the area under the curve (AUC) was significantly higher than that without CAD support. When the focus was only on panoramic radiographs in which CAD support led to a correct diagnosis, the AUC of the inexperienced dentists increased to an equivalent level to that of the experienced radiologists.

CONCLUSIONS

The CAD system supported the inexperienced dentists in diagnosing maxillary sinusitis on the panoramic radiographs. If the accuracy of the CAD system can be increased, the benefits of CAD support will be further enhanced.