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Gullberg J, Al-Okshi A, Homar Asan D, Zainea A, Sundh D, Lorentzon M, Lindh C. The challenge of applying digital image processing software on intraoral radiographs for osteoporosis risk assessment. Dentomaxillofac Radiol 2022; 51:20210175. [PMID: 34324394 PMCID: PMC8693323 DOI: 10.1259/dmfr.20210175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate rater agreement and the accuracy of a semi-automated software and its fully automated tool for osteoporosis risk assessment in intraoral radiographs. METHODS A total of 567 intraoral radiographs was selected retrospectively from women aged 75-80 years participating in a large population-based study (SUPERB) based in Gothenburg, Sweden. Five raters assessed participants' risk of osteoporosis in the intraoral radiographs using a semi-automated software. Assessments were repeated after 4 weeks on 121 radiographs (20%) randomly selected from the original 567. Radiographs were also assessed by the softwares' fully automated tool for analysis. RESULTS Overall interrater agreement for the five raters was 0.37 (95% CI 0.32-0.41), and for the five raters with the fully automated tool included as 'sixth rater' the overall Kappa was 0.34 (0.30-0.38). Intrarater agreement varied from moderate to substantial according to the Landis and Koch interpretation scale. Diagnostic accuracy was calculated in relation to reference standard for osteoporosis diagnosis which is T-score values for spine, total hip and femoral neck and presented in form of sensitivities, specificities, predictive values, likelihood ratios and odds ratios. All raters' mean sensitivity, including the fully automated tool, was 40,4% (range 14,3%-57,6%). Corresponding values for specificity was 69,5% (range 59,7%-90,4%). The diagnostic odds ratios ranged between 1 and 2.7. CONCLUSION The low diagnostic odds ratio and agreement between raters in osteoporosis risk assessment using the software for analysis of the trabecular pattern in intraoral radiographs shows that more work needs to be done to optimise the automation of trabecular pattern analysis in intraoral radiographs.
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Affiliation(s)
| | - Ayman Al-Okshi
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Sebha University, Sebha, Libya
| | | | - Anita Zainea
- Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Daniel Sundh
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Diba SF, Gracea RS, Shantiningsih RR, Hidjah K. Analysis of mandible trabecular structure using digital periapical radiographs to assess low bone quality in postmenopausal women. Saudi Dent J 2021; 33:997-1003. [PMID: 34938042 PMCID: PMC8665195 DOI: 10.1016/j.sdentj.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/22/2021] [Accepted: 07/04/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze the quality of mandibular trabecular structure in postmenopausal women using periapical radiographs. Postmenopausal women are subjected to low bone quality; hence, early detection methods are needed. In addition to bone mineral density (BMD), trabecular architecture must be assessed to determine bone quality. The mandible represents bone quality and allows the assessment of trabecular structure from periapical radiographs. MATERIAL AND METHODS Lumbar (BMDL) and femoral BMD (BMDF) examinations were performed using dual-energy X-ray absorptiometry (DXA) in 31 postmenopausal women and divided into normal, osteopenia, and osteoporotic groups. Periapical radiographs were taken at both posterior sites of the mandible. The region of interest was taken 2 mm from the apical root of the first molar. Trabecular parameters consisting of trabecular thickness (Tb.Th) and bone percentage (BA/TA) were measured using BoneJ. RESULTS Both trabecular parameters were significantly correlated with BMDF [BA/TA (r = 0.3796; p < 0.05) and Tb.Th (r = 0.508; p < 0.05)]. BA/TA and Tb.Th were significantly different between the osteoporosis and normal groups (p < 0.05) contrast to osteopenia and normal groups (p > 0.05). CONCLUSION Changes in mandibular trabeculae structure in postmenopausal women can be assessed using periapical radiographs.
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Affiliation(s)
- Silviana Farrah Diba
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rellyca Sola Gracea
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rurie Ratna Shantiningsih
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Khasnur Hidjah
- Department of Computer Science, Faculty of Engineering and Design, Universitas Bumigora, Mataram, Indonesia
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Sela EI, Pulungan R, Widyaningrum R, Shantiningsih RR. Method for Automated Selection of the Trabecular Area in Digital Periapical Radiographic Images Using Morphological Operations. Healthc Inform Res 2019; 25:193-200. [PMID: 31406611 PMCID: PMC6689511 DOI: 10.4258/hir.2019.25.3.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/21/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of this study is to propose a method that automatically select the trabecular bone area in digital periapical radiographic images using a sequence of morphological operations. Methods The study involved 50 digital periapical radiographic images of women aged from 36 to 58 years old. The proposed method consists of three stages: teeth detection, trabecular identification, and validation. A series of morphological operations—top-hat and bottom-hat filtering, automatic thresholding, closing, labeling, global thresholding, and image subtraction—are performed to automatically obtain the trabecular bone area in images. For validation, the results of the proposed method were compared with those of two dentists pixel by pixel. Three parameters were used in the validation: trabecular area, percentage of agreed area, and percentage of disagreed area. Results The proposed method obtains the trabecular bone area in a polygon. The obtained trabecular bone area is usually larger than that of previous studies, but is usually smaller than the dentists'. On average over all images, the trabecular area produced by the proposed method is 5.83% smaller than that identified by dentists. Furthermore, the average percentage of agreed area and the average percentage of disagreed area of the proposed method against the dentists' results were 75.22% and 8.75%, respectively. Conclusions The shape of the trabecular bone area produced by the proposed method is similar and closer to that identified by dentists. The method, which consists of only simple morphological operations on digital periapical radiographic images, can be considered for selecting the trabecular bone area automatically.
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Affiliation(s)
- Enny Itje Sela
- Department of Informatics, University of Technology Yogyakarta, Yogyakarta, Indonesia
| | - Reza Pulungan
- Department of Computer Science and Electronics, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rini Widyaningrum
- Department of Dentomaxillofacial Radiology, Universitas Gadjah Mada, Yogyakarta, Indonesia
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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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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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Haghnegahdar A, Zarif Najafi H, Sabet M, Saki M. Assessment of the changes in alveolar bone quality after fixed orthodontic therapy: A trabecular structure analysis. J Dent Res Dent Clin Dent Prospects 2017; 10:201-206. [PMID: 28096944 PMCID: PMC5237665 DOI: 10.15171/joddd.2016.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/15/2016] [Indexed: 11/21/2022] Open
Abstract
Background. Tooth displacement changes the periodontium. The aim of orthodontic treatment is desired tooth movement with minimum side effects on the alveolar bone quality. The aim of the present study was to assess changes of alveolar trabeculation in children, young adults and adults and the two genders. Methods. In this cross-sectional study, 63 patients who had been treated in Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran, were chosen with convenient sampling method. They were divided into three groups based on their age. Their digitized panoramic radiographs (PRs) were evaluated at six interdental sites from the mesial aspect of the mandibular second molars to the distal aspect of the mandibular first premolars using a visual index. The trabeculation pattern was assigned as either dense (score 3), dense-sparse (score 2) or sparse (score 1). Data were imported to SPSS. Mean of the scores before treatment (score B) and mean of them after treatment (score A) were compared for each group with paired t-test. Changes between score B and sore A of the groups were compared using one-way ANOVA and post hoc tests. Results. Mean score A was significantly higher than mean score B in children (P = 0.001). In contrast, mean score A was significantly lower than mean score B in young adults (P = 0.003). Conclusion. Orthodontists should be cautious when treating young adults and adults regarding the probable, yet possibly temporary, negative effects of orthodontic therapy on the alveolar bone quality.
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Affiliation(s)
- Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Zarif Najafi
- Orthodontics Research Center, Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sabet
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Saki
- Student Research Committee, Orthodontics Research Center, Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Kathirvelu D, Anburajan M. Prediction of low bone mass using a combinational approach of cortical and trabecular bone measures from dental panoramic radiographs. Proc Inst Mech Eng H 2014; 228:890-8. [PMID: 25179243 DOI: 10.1177/0954411914548700] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study is to extract cortical and trabecular features of the mandible and to develop a novel combinational model of mandibular cortical thickness, trabecular bone area and age in order to predict low bone mineral density or osteoporosis from a dental panoramic radiograph. The study involved 64 south Indian women (age = 52.5 ± 12.7 years) categorised into two groups (normal and low bone mineral density) based on total femur bone mineral density. The dental panoramic radiographs were obtained by a digital scanner, and measurement of total bone mineral density at the right femur was performed by a dual-energy X-ray absorptiometry scanner. The mandibular cortical thickness and panoramic mandibular index were measured bilaterally, and the mean values were considered. The region of interest of 128 × 128 pixels around the mental foramen region was manually cropped and subjected to pre-processing, normalisation and average threshold-based segmentation to determine trabecular bone area. Multiple linear regression analyses of cortical and trabecular measures along with age were performed to develop a combinational model to classify subjects as normal and low bone mineral density. The proposed approach demonstrated strong correlation (r = 0.76; p < 0.01) against the total bone mineral density and resulted in accuracy, sensitivity and positive predictive values of 0.84, 0.92 and 0.85, respectively; the receiver operating characteristic outcomes disclosed that the area under the curve was 0.89.Our results suggest that the proposed combinational model could be useful to diagnose subjects with low bone mineral density.
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Affiliation(s)
- D Kathirvelu
- Department of Biomedical Engineering, SRM University, Kattankulathur, Tamil Nadu, India
| | - M Anburajan
- Department of Biomedical Engineering, SRM University, Kattankulathur, Tamil Nadu, India
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