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Aslan E, Onem E, Mert A, Baksi BG. Comparison of quantitative radiomorphometric predictors of healthy and MRONJ-affected bone using panoramic radiography and cone-beam CT. Dentomaxillofac Radiol 2024; 53:407-416. [PMID: 38810135 PMCID: PMC11358619 DOI: 10.1093/dmfr/twae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES To determine the most distinctive quantitative radiomorphometric parameter(s) for the detection of MRONJ-affected bone changes in panoramic radiography (PR) and cone-beam CT (CBCT). METHODS PR and sagittal CBCT slices of 24 MRONJ patients and 22 healthy controls were used for the measurements of mandibular cortical thickness (MCT), fractal dimension (FD), lacunarity, mean gray value (MGV), bone area fraction (BA/TA), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N). MCT was measured in the mental foramen region. While FD and lacunarity were measured on mandibular trabecular and cortical regions-of-interest (ROIs), the remaining parameters were measured on trabecular ROIs. The independent samples t-test was used to compare the measurements between the MRONJ and control groups for both imaging modalities (P = .05). RESULTS MCT was the only parameter that differentiated MRONJ-affected bone in both PR and CBCT (P < .05). None of the remaining parameters revealed any difference for MRONJ-affected bone in CBCT (P > .05). FD, lacunarity, MGV, BA/TA, and Tb.Sp could distinguish MRONJ-affected trabecular bone in PR (P < .05). The correspondent ROI for both imaging methods that was reliable for detecting MRONJ-affected bone was the trabecular bone distal to the mental foramen above the inferior alveolar canal (ROI-3). CONCLUSIONS MCT is a reliable parameter for the discrimination of MRONJ-affected bone in both PR and CBCT images. PR may be used to detect MRONJ-affected trabecular bone using FD, lacunarity, MGV, BA/TA, and Tb.Sp measurements as well.
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Affiliation(s)
- Elif Aslan
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, 35040, Turkey
| | - Erinc Onem
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, 35040, Turkey
| | - Ali Mert
- Department of Statistics, Ege University School of Science, Izmir, 35040, Turkey
| | - B Guniz Baksi
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, 35040, Turkey
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Khubrani YH, Geha H, Katkar RA, Maghsoodi-Zahedi T, Moore W, Abdelkarim AZ. Efficacy of the CALM ® Algorithm in Reducing Motion-Induced Artifacts in CBCT Imaging: A Fractal Dimension Analysis of Trabecular Bone. Dent J (Basel) 2024; 12:262. [PMID: 39195106 DOI: 10.3390/dj12080262] [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: 07/07/2024] [Revised: 07/31/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE The primary goal of this investigation was to ascertain the efficacy of the CALM® motion artifact reduction algorithm in diminishing motion-induced blurriness in Cone Beam Computed Tomography [CBCT] images. The assessment was conducted through Fractal Dimension [FD] analysis of the trabecular bone. METHODS AND MATERIALS A desiccated human mandible was subjected to Planmeca ProMax 3D® scanning under eight distinct protocols, marked by variations in motion presence [at 5, 10, and 15 degrees] and the deployment of CALM®. In every scan, five distinct regions of interest [ROIs] were designated for FD analysis, meticulously avoiding tooth roots or cortical bone. The FD was computed employing the box-counting method with Image-J 1.53 software. RESULTS Our findings reveal that a 5-degree motion does not significantly disrupt FD analysis, while a 10-degree motion and beyond exhibit statistical differences and volatility among the sites and groups. A decreased FD value, signifying a less intricate or "rough" bone structure, correlated with amplified motion blurriness. The utilization of CALM® software seemed to counteract this effect in some instances, reconciling FD values to those akin to the control groups. Nonetheless, CALM®'s efficacy differed across sites and motion degrees. Interestingly, at one site, CALM® application in the absence of motion resulted in FD values considerably higher than all other groups. CONCLUSION The study indicates that motion, particularly at 10 degrees or more, can considerably impact the FD analysis of trabecular bone in CBCT images. In some situations, the CALM® motion artifact reduction algorithm can alleviate this impact, though its effectiveness fluctuates depending on the site and degree of motion. This underscores the necessity of factoring in motion and the employment of artifact reduction algorithms during the interpretation of FD analysis outcomes in CBCT imaging. More research is necessary to refine the application of such algorithms and to comprehend their influence on different sites under varying motion degrees.
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Affiliation(s)
- Yahia H Khubrani
- Department of Oral and Maxillofacial Radiology, Jazan University College of Dentistry, Jazan 82621, Saudi Arabia
| | - Hassem Geha
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Rujuta A Katkar
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Taraneh Maghsoodi-Zahedi
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - William Moore
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Ahmed Z Abdelkarim
- Division of Oral and Maxillofacial Radiology, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA
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Afzoon S, Ghorbani F, Hasani M. Evaluation of the mandibular condyles trabecular structure in patients with severe class III pattern: a computed tomography (CT) fractal analysis study. Sci Rep 2023; 13:18183. [PMID: 37875543 PMCID: PMC10598208 DOI: 10.1038/s41598-023-45407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
Class III malocclusion is a combination of dental and skeletal disorders that causes discrepancies in occlusion. Malocclusion can affect the structure of the Temporomandibular joint (TMJ) resulting in many problems, one of which is affecting the internal structure of the bone. This study aimed to examine the morphological features of class III patients' trabecular structure of the mandibular condyle in comparison with normal class I individuals using fractal analysis (FA). To study the internal structure of the mandibular condyle bone, Computed Tomography (CT) scans of 45 severe class III patients (age: 16-46) who were the candidates for orthognathic surgery were selected and matched by age and sex with 45 normal class I individuals. The trabecular bone structure of the left and right mandibular condyles in three CT planes of the study group and control group were evaluated employing the FA. The result of the present study indicated that the fractal dimensions (FD) values of class III patients were lower than those of the normal class I individuals in axial (class I: 1.31 ± 0.02, class III: 1.28 ± 0.02), sagittal (class I: 1.25 ± 0.03, class III: 1.19 ± 0.08), and coronal (class I: 1.5 ± 0.06, class III: 1.45 ± 0.07) planes (P < 0.001). There were no significant differences between the FD values of the males and females. The intra-group evaluation revealed that there was no correlation between age and FD values. No evidence of laterality was found regarding the FD values of the right and left condyles. Given the noticeable differences between the FD values, it can be implied that severe class III malocclusion may affect the trabecular pattern of the cancellous bone of the mandibular condyle compared to class I individuals. Therefore, due to the altered trabecular structure, clinicians should be cautious when planning treatments for these patients.
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Affiliation(s)
- Saeed Afzoon
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Ghorbani
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahvash Hasani
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kurşun BÜ, Akan E. Evaluation of trabecular bone changes according to the type of prosthesis in patients using bisphosphonates: a retrospective study. Braz Oral Res 2023; 37:e089. [PMID: 37672422 DOI: 10.1590/1807-3107bor-2023.vol37.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2022] [Indexed: 09/08/2023] Open
Abstract
The objective of the study was to retrospectively compare the fractal size values calculated in the trabecular bone according to the type of complete removable denture, removable partial denture, and partial fixed prosthesis between patients using bisphosphonates and healthy patients, retrospectively. Panoramic radiographs of a total of 200 patients, (100 using bisphosphonates,100 control group), were taken from the right and left molar regions before and after treatment with 72 × 72 pixels. The fractal dimension (FD) was computed by using ImageJ Software using the box-counting method on the images obtained. There was an interaction effect between the trabecular bone change-patient group-the type of prosthesis used and the parameters of the area (p < 0.05). In patients using complete removable dentures and removable partial dentures in the maxilla and mandibula in the molar region, a greater decrease in FD values was observed in the control group than in the patient group using bisphosphonates. An increase in FD values over time was observed in the patient group using bisphosphonates with partial fixed maxillary and mandibular prostheses compared to the control group. Partial fixed prostheses should be preferred primarily instead of complete removable or removable partial dentures in patients using bisphosphonates to prevent osteonecrosis due to dental trauma.
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Affiliation(s)
- Begüm Ünlü Kurşun
- Izmir Tinaztepe University, Department of Prosthetic Dentistry, Izmir, Turkey
| | - Ender Akan
- University of Katip Çelebi, Department of Prosthetic Dentistry, Izmir, Turkey
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Yilmaz SG, Bayrak S. DETERMINATION OF MANDIBULAR BONE CHANGES IN PATIENTS WITH PRIMARY HYPOTHYROIDISM TREATED WITH LEVOTHYROXINE SODIUM. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2023; 19:201-207. [PMID: 37908892 PMCID: PMC10614580 DOI: 10.4183/aeb.2023.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background This study aimed to assess fractal dimension (FD) and the radiomorphometric indexes on the digital panoramic radiography (DPR) of patient with primary hypothyroidism receiving levothyroxine sodium replacement therapy. Methods A total of 115 subjects were included in this cross sectional retrospective study. According to the results of the thyroid function tests, the subjects were divided into two groups as primary hypothyroidism (levothyroxine sodium replacement therapy given), (n = 57) and the healthy control group (n = 58). The fractal dimension (FD), panoramic mandibular index (PMI), mandibular cortical width (MCW), gonial index (GI) and mandibular cortical index (MCI) values of all patients were calculated on DPRs. The statistical analysis of all data was performed with SPSS version 22. Results The distributions of age and gender in the primary hypothroidism group were similar to control group (p = 0.19 and p = 0.62, respectively). The two groups did not differ statistically significantly in terms of FD, PMI, MCW, GI, and MCI. Conclusion We determined that mandibular cortical and trabecular bone structure did not significantly differ between healthy individuals and patients receiving drug replacement theraphy due to hypothyroidism, but our results should be further supported with the investigation of clinical parameters.
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Affiliation(s)
- S. Günen Yilmaz
- Akdeniz University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Antalya
| | - S. Bayrak
- Bolu Abant İzzet Baysal University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Bolu, Turkey
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Evaluation of chronic renal failure with cone beam computed tomography radiomorphometric indices and fractal analysis in the mandible. Oral Radiol 2023; 39:133-142. [PMID: 35484445 DOI: 10.1007/s11282-022-00614-1] [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: 11/27/2021] [Accepted: 04/08/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The purpose of this study is to evaluate the mandibular bone structure of patients with chronic renal failure (CRF) and compare to control group via the fractal analysis (FA) and radiomorphometric indices in the cone beam computed tomography (CBCT) images. METHODS Three observers retrospectively investigated 44 CBCT images to compare patients with CRF to healthy controls. FA was performed in two different areas, volume of interests (VOI) were chosen in the mandibular ramus and corpus. The CT cortical index (CTCI), CT mental index (CTMI), and CT mandibular index (CTI) were performed to determine cortical porosity and thickness. The normality distribution of numerical data was tested using the Kolmogorov-Smirnova and Shapiro-Wilk tests. According to the results, the Mann-Whitney U test and independent group t test were used for parameters. The chi-square test was used to evaluate the distribution of categorical variables by groups. RESULTS There were statistically significant differences in VOI1 and VOI2. The fractal dimension (FD) values in VOI1 and VOI2 were significantly lower in study group. There were no significant differences in CTCI, CTMI and CTI measurements between both groups. CONCLUSIONS CRF is a prevalent cause of radiographic abnormalities in jawbones. The FD values in trabecular bone decreased in study group, although there were no significant differences in the radiomorphometric indices. FA in CBCT images could be useful for a three-dimensional evaluation of trabecular bone structure.
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Sinanoglu A, Cakir Karabas H, Soluk Tekkesin M, Bektas Kayhan K, Coskunses FM, Ozcan I. Does Fractal Analysis Have a Role in Diagnosis of Langerhans Cell Histiocytosis? J Oral Maxillofac Surg 2022; 80:1852-1857. [PMID: 35988692 DOI: 10.1016/j.joms.2022.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Langerhans cell histiocytosis (LCH) of the jaws is a rare disease and is often diagnosed at an advanced stage. This study aims to assess the trabecular pattern of jaws via fractal analysis (FA) on initial panoramic radiographs (OPG) of the patients with LCH to facilitate interpretation of the radiographic changes. METHODS A case-control study investigated LCH cases with jaw involvement retrieved from the databases of Istanbul and Kocaeli Universities between 2010 and 2021. Initial OPGs of LCH cases and OPGs of healthy sex- and age-matched controls were investigated with FA. All images were assessed using ImageJ software. On each OPG, a total of 6 regions of interest (ROIs) located on the mandible were investigated bilaterally. The independent variables were the trabecular patterns of jaws of LCH cases and their control matches. The outcome variables were the fractal dimension (FD) values obtained from the ROIs on OPGs. Data were analyzed using the Mann-Whitney U test and Student's t test. RESULTS Fifteen LCH-control pairs were investigated. In one ROI located in the supracortical area above the left mandibular angle, FD values of LCH cases (1.273 ± 112.8) were significantly lower than controls (1.308 ± 85.3; P < .05). Lower FD values were also calculated for some of the remaining ROIs, but there was no significant difference between groups (P > .05). CONCLUSIONS Regarding our results, FA was not a useful parameter to discern radiographical trabecular changes between LCH cases and controls. Multicenter studies with larger populations are needed to investigate the potential of FA in the identification of this rare disease.
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Affiliation(s)
- A Sinanoglu
- Chair and Associate Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey.
| | - H Cakir Karabas
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - M Soluk Tekkesin
- Professor, Department of Tumor Pathology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - K Bektas Kayhan
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - F M Coskunses
- Private Practitioner, Oral and Maxillofacial Surgery, Kocaeli, Turkey
| | - I Ozcan
- Chair and Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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8
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Carvalho BF, de Castro JGK, de Melo NS, de Souza Figueiredo PT, Moreira-Mesquita CR, de Paula AP, Sindeaux R, Leite AF. Fractal dimension analysis on CBCT scans for detecting low bone mineral density in postmenopausal women. Imaging Sci Dent 2022; 52:53-60. [PMID: 35387102 PMCID: PMC8967487 DOI: 10.5624/isd.20210172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to compare the fractal dimension (FD) measured at 2 bone sites (second cervical vertebra and mandible) on cone-beam computed tomography (CBCT). The research question was whether FD could serve as an accessory tool to refer postmenopausal women for densitometric analysis. Therefore, the reliability and accuracy of FD were evaluated. Materials and Methods In total, 103 postmenopausal women were evaluated, of whom 52 had normal bone mineral density and 51 had osteoporosis, according to dual X-ray absorptiometry of the lumbar spine and hip. On the CBCT scans, 2 regions of interest were selected for FD analysis: 1 at the second cervical vertebra and 1 located at the mandible. The correlations between both measurements, intra- and inter-observer agreement, and the accuracy of the measurements were calculated. A P value less than 0.05 was considered to indicate statistical significance for all tests. Results The mean FD values were significantly lower at the mandibular region of interest in osteoporotic patients than in individuals with normal bone mineral density. The areas under the curve were 0.644 (P=0.008) and 0.531 (P=0.720) for the mandibular and vertebral sites, respectively. Conclusion FD at the vertebral site could not be used as an adjuvant tool to refer women for osteoporosis investigation. Although FD differed between women with normal BMD and osteoporosis at the mandibular site, it demonstrated low accuracy and reliability.
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Affiliation(s)
| | | | | | | | - Carla Ruffeil Moreira-Mesquita
- Division of Oral Radiology, Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | | | - Rafael Sindeaux
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - André Ferreira Leite
- Division of Oral Radiology, Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
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A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva ®) Related Osteonecrosis of the Jaw: A Retrospective Study. J Clin Med 2021; 10:jcm10112390. [PMID: 34071481 PMCID: PMC8197814 DOI: 10.3390/jcm10112390] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva® at the Institut de Cancérologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: “exposed” for patients with bone exposure and “fistula” when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the “exposed” group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the “fistula” group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.
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Kaba YN, Öner Nİ, Amuk M, Bilge S, Soylu E, Demirbaş AE. Evaluation of trabecular bone healing using fractal dimension analysis after augmentation of alveolar crests with autogenous bone grafts: a preliminary study. Oral Radiol 2021; 38:139-146. [PMID: 34003449 DOI: 10.1007/s11282-021-00536-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate bone remodeling after alveolar crest augmentation with autogenous bone grafts. METHODS 50 patients who were applied augmentation due to alveolar deficiency were included in this study. Fractal dimensions were measured on the radiographs in the preoperative, postoperative, follow-up periods. The ROI was selected specific to each patient, but repeated in a standardized manner on subsequent radiographs. RESULTS A total of 50 patients were included in the study; There were 31 females and 19 males. Implants were placed in all patients without any complications. The mean fractal dimensions on the graft recipient side were statistically higher in the postoperative 5th month compared to the postoperative 1st week (p = 0.002). The mean fractal dimensions on the donor side were statistically higher in the preoperative and postoperative 5th month compared to the postoperative 1st week (p < 0.001). CONCLUSION Any clinical imaging method cannot fully reflect the histological microstructures of the bone. Evaluating the fractal analysis together with the clinical results can demonstrate adequate bone healing and quality prior to implant placement. Fractal analysis is a non-invasive, reproducible, method but further, prospective, randomized, controlled clinical studies are needed to estimate bone quality prior to implant placement.
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Affiliation(s)
- Yusuf Nuri Kaba
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Neşe İspekter Öner
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey. .,Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey.
| | - Mehmet Amuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Suheyb Bilge
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Emrah Soylu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Ahmet Emin Demirbaş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
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Kim JE, Yoo S, Choi SC. Several issues regarding the diagnostic imaging of medication-related osteonecrosis of the jaw. Imaging Sci Dent 2020; 50:273-279. [PMID: 33409135 PMCID: PMC7758260 DOI: 10.5624/isd.2020.50.4.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/23/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
This review presents an overview of some diagnostic imaging-related issues regarding medication-related osteonecrosis of the jaws (MRONJ), including imaging signs that can predict MRONJ in patients taking antiresorptive drugs, the early imaging features of MRONJ, the relationship between the presence or absence of bone exposure and imaging features, and differences in imaging features by stage, between advanced MRONJ and conventional osteomyelitis, between oncologic and osteoporotic patients with MRONJ, and depending on the type of medication, method of administration, and duration of medication. The early diagnosis of MRONJ can be made by the presence of subtle imaging changes such as thickening of the lamina dura or cortical bone, not by the presence of bone exposure. Most of the imaging features are relatively non-specific, and each patient's clinical findings and history should be referenced. Oral and maxillofacial radiologists and dentists should closely monitor plain radiographs of patients taking antiresorptive/antiangiogenic drugs.
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Affiliation(s)
- Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Sumin Yoo
- School of Dental Hygiene, Kyungdong University Medical Campus, Wonju, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
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12
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Raphael KG, Janal MN, Tadinada A, Santiago V, Sirois DA, Lurie AG. Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex. J Oral Rehabil 2020; 47:1319-1329. [PMID: 32885475 PMCID: PMC7693250 DOI: 10.1111/joor.13087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023]
Abstract
Background Adverse effects of masticatory muscle injections of Botulinum Toxin (Btx) have been noted in animal and, less dramatically, human studies. Objective Among women treated in multiple community‐based private practices, to compare TMJ bone density and mandibular condylar volume between patients with myofascial TMJD receiving multiple masticatory muscle Btx treatments and similarly diagnosed women not receiving such treatment. Methods Cohorts consisted of women whose treatment charts indicated a diagnosis of myofascial TMJD: 35 received at least 2 Btx treatment cycles; 44 received none. Bone density at pre‐specified regions of interest (ROI) was defined by grey scale values from Cone Beam CT, adjusting for a fixed density phantom included in each scan. Mean bone density and mandibular condyle volume were compared between groups. Dose‐response effects were tested within the Btx‐exposed group. Results The mean density of primary and secondary ROIs was similar between exposure groups, as was condylar volume. Among Btx‐exposed women, increasing dose of Btx to the temporalis muscle was inversely proportional to the density of the trabecular area of the mandible body. Many Btx‐exposed women received smaller doses of Btx to the masseter muscles than in most TMJD Btx clinical trials. Conclusion Masticatory muscle injections of Btx failed to produce clinically significant TMJ bone‐related changes. Should Btx receive regulatory approval for treatment of myofascial TMJD, a phase IV study is recommended to evaluate potential adverse effects of Btx on bone and muscle when administered at higher doses and/or for more treatment cycles.
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Affiliation(s)
| | - Malvin N Janal
- New York University College of Dentistry, New York, NY, USA
| | - Aditya Tadinada
- University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | | | - David A Sirois
- New York University College of Dentistry, New York, NY, USA
| | - Alan G Lurie
- University of Connecticut School of Dental Medicine, Farmington, CT, USA
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13
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Fractal dimension in CBCT images as predictor for MRONJ: a retrospective cohort study. Clin Oral Investig 2020; 25:2113-2118. [PMID: 32827078 PMCID: PMC7966145 DOI: 10.1007/s00784-020-03523-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
Objective To estimate boxcounting fractal dimension in a standardized approach in CBCT images of the mandible and maxilla in a group of patients with MRONJ in comparison to a healthy control group. Material and methods From our records, a study group consisting of 80 maxillary and mandibular CBCTs in 77 cases of patients having MRONJ was collected. The control group consisted of 84 mandibular and maxillary CBCTs in a total of 78 patients. Using the boxcounting method, fractal dimension (FD) was estimated in a standardized fashion either cranially to the apex of the canine (maxilla) or beneath the tooth apices of the lower molars in the bone area above the mandibular canal (mandible). Intra-observer reproducibility of the FD-measurements was assessed by 6 repeated measurements in 10 individuals. FD values were correlated to age and sex of the individuals as well as to region of interest (ROI) sizes. Results FD in the study group (1.684 ± 0.051) was roughly 3.5 % lower than in the control group (1.745 ± 0.026, p < 0.0001). Sex and age had a significant (p < 0.001) influence on FD values in the study group, yet not in the control group. FD values increased with age (study group, spearman-rho: 0.2895, p < 0.05) and also ROI size (both groups, p < 0.0001). Reproducibility was good (intra-class correlation coefficient (ICC): 0.87). Conclusions Fractal dimension as assessed by boxcounting seems to be a good descriptor for MRONJ in jaw bones. Influence of age and sex on the outcome values needs to be further investigated in future studies. Clinical relevance CBCTs could be assessed with respect to FD to obtain an overview of the disease status of MRONJ patients.
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Simpione G, Caldas RJ, Soares MQS, Rubira-Bullen IRF, Santos PSS. Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis. J Clin Exp Dent 2020; 12:e285-e290. [PMID: 32190200 PMCID: PMC7071540 DOI: 10.4317/jced.56265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/08/2020] [Indexed: 11/11/2022] Open
Abstract
Background Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP.
Material and Methods All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions.
Results The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change.
Conclusions In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs. Key words:Cone-Beam computed tomography, osteonecrosis, bisphosphonate-associated osteonecrosis of the jaw.
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Affiliation(s)
- Guilherme Simpione
- Master student, Bauru School of Dentistry, University of Sao Paulo, Brazil
| | | | - Mariana Q S Soares
- Post-doctoral student Bauru School of Dentistry, University of Sao Paulo, Brazil
| | - Izabel R F Rubira-Bullen
- Associate Professor, Department of Surgery, Stomatology, Radiology and Pathology, Faculty of Dentistry of Bauru - USP
| | - Paulo S S Santos
- Associate Professor, Department of Surgery, Stomatology, Radiology and Pathology, Faculty of Dentistry of Bauru - USP
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Hayek E, Aoun G, Bassit R, Nasseh I. Correlating Radiographic Fractal Analysis at Implant Recipient Sites with Primary Implant Stability: An In Vivo Preliminary Study. Cureus 2020; 12:e6539. [PMID: 31929956 PMCID: PMC6939963 DOI: 10.7759/cureus.6539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives The aim of this study was to demonstrate a possible correlation between radiographic trabecular bone quantified with fractal dimensions analysis and values of primary implant stability deliberated using the Osstell® monitor (Integration Diagnostics AB, Goteborgsvagen, Sweden) with the density of bone specimens harvested from the implant recipient sites and calculated using the mass and volume of the bone bloc specimens. Material and methods Fifty implants of the same brand, diameter, and length were inserted with the same surgical procedures; 25 implants in the molar premolar region of the maxilla and 25 implants in the mandibular posterior region of only healthy male patients between 20 and 50 years of age. Prior to the placement of the implants, biopsies were taken from the selected site for density calculation using a calibrated trephine. Two photostimulable phosphor digital periapical radiographs were obtained for each patient and two regions of interest were selected for a fractal dimension analysis: one site before implantation and the same site immediately postoperatively adjacent to the implant. Results There were correlations between the fractal dimensions and implant stability quotient as well as between fractal dimensions and bone density. No significant difference was found between the fractal dimensions of pre- and postoperative periapical radiographs for the same region of interest and between implant stability quotient values of the maxillae and mandible sites. Conclusion All executed analyses were helpful in assessing the bone density in the recipient site of implant placement using fractal dimensions, offering complementary information about predictable bone density assessed on a periapical radiograph.
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Affiliation(s)
- Elie Hayek
- Oral and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, LBN
| | - Georges Aoun
- Oral and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, LBN
| | - Roger Bassit
- Oral Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, LBN
| | - Ibrahim Nasseh
- Oral and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, LBN
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Feitosa ÉF, Vasconcellos MM, Magalhães RJP, Domingos-Vieira AC, Visconti MA, Guedes FR, Maiolino A, Torres SR. Bisphophonate alterations of the jaw bones in individuals with multiple myeloma. Dentomaxillofac Radiol 2019; 49:20190155. [PMID: 31670576 DOI: 10.1259/dmfr.20190155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To verify quantitative differences of the mandibular cortical and trabecular bone between patients with multiple myeloma (MM) under bisphosphonate (BP) therapy and a control group never exposed to BP. METHODS Clinical and demographic characteristics were collected through medical records and interviews. Mandibular cortical thickness (MCT) and fractal dimension (FD) were measured on cone beam computed tomography (CBCT) images, on the molar region, in both groups. Additionally, FD was measured on periapical digital intraoral radiography and results were compared to CBCT measurements. RESULTS There were 33 patients with MM under BP therapy and 28 controls, with no significant differences in gender and age between groups. Pamidronate was used by all MM patients, either associated or not to other types of BP. The median MCT was higher in MM group exposed to BP (5.20 mm) than in controls (3.50 mm, p < 0.001). There were no significant differences in the median FD between patients in the MM group and controls, on CBCT (0.95 vs 0.90, p = 0.814) and periapical digital intraoral radiography (0.98 vs 0.96, p = 0.963), respectively, even when more than one type of BP was used. CONCLUSIONS The MCT represents an useful tool in the detection of bone dimensional changes caused by BP, in patients with MM. Additional studies are necessary to improve the knowledge on the quantitative evaluation of trabecular jaw bone, in individuals with MM, under BP therapy.
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Affiliation(s)
- Édila Figuerêdo Feitosa
- Department of Internal Medicine, Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Monteiro Vasconcellos
- Department of Oral Pathology and Diagnosis, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto José Pessoa Magalhães
- Department of Internal Medicine, Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Castro Domingos-Vieira
- Department of Oral Pathology and Diagnosis, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Augusta Visconti
- Department of Oral Pathology and Diagnosis, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabio Ribeiro Guedes
- Department of Oral Pathology and Diagnosis, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Angelo Maiolino
- Department of Internal Medicine, Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Regina Torres
- Department of Oral Pathology and Diagnosis, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Kato CN, Barra SG, Tavares NP, Amaral TM, Brasileiro CB, Mesquita RA, Abreu LG. Use of fractal analysis in dental images: a systematic review. Dentomaxillofac Radiol 2019; 49:20180457. [PMID: 31429597 DOI: 10.1259/dmfr.20180457] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study reviewed the use of fractal analysis (FA) in dental images. METHODS A search was performed using PubMed, MEDLINE, LILACS, Web of Science and SCOPUS databases. The inclusion criteria were human studies in the English language, with no date restriction. RESULTS 78 articles were found in which FA was applied to panoramic radiographs (34), periapical radiographs (21), bitewing radiographs (4), cephalometric radiograph (1), cone beam CT (15), micro-CT (3), sialography (2), and ultrasound (2). Low bone mineral density (21) and systemic or local diseases (22) around the bone of dental implants were the main subjects of the study of FA. Various sizes and sites of the regions of interest were used to evaluate the bone structure. Different ways were used to treat the image and to calculate FA. FA of 43 articles showed significant differences in the comparison of groups, mainly between healthy and sick patients. CONCLUSIONS FA in Dentistry has been widely applied to the study of images. Panoramic and periapical radiographs were those most frequently used. The Image J software and the box-counting method were extensively adopted in the studies reviewed herein. Further studies are encouraged to improve clarification of the parameters that directly influence FA.
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Affiliation(s)
- Camila Nao Kato
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sâmila G Barra
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Núbia Pk Tavares
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Tânia Mp Amaral
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cláudia B Brasileiro
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo A Mesquita
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lucas G Abreu
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Şahin O, Odabaşı O, Demiralp KÖ, Kurşun-Çakmak EŞ, Aliyev T. Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:78-86. [DOI: 10.1016/j.oooo.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 01/09/2023]
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Imaginological characterization of multiple myeloma lesions of the jaws through cone-beam computed tomography. Oral Radiol 2019; 36:168-176. [PMID: 31222625 DOI: 10.1007/s11282-019-00394-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To establish an evaluation protocol for the identification and description of the variations in multiple myeloma (MM) lesions of the jaws, by means of cone-beam computed tomography (CBCT). MATERIALS AND METHODS Tomography exams from 33 MM patients were evaluated in this retrospective observational study. The reconstructions were analyzed simultaneously, according to the established protocol, with the following description criteria: anatomic location, size, margins, inner aspect, relationship with adjacent structures, and presence or absence of a punched-out aspect. The exams were further subdivided into groups of patients using, or not bisphosphonates. RESULTS There were osteolytic lesions in 100% of cases, most of which were extended to more than one anatomical region. Poorly defined margins were more frequent in the maxilla than in the mandible. Extensive bone resorption presenting multilocular areas was the most frequently observed aspect, being 86.2% for maxilla and 87.9% for mandible. In relation to bisphosphonates, patients who used the medication had more poorly defined bone margins and contortions (68.6%) than those who did not undergo drug therapy (31.4%). No well-defined lesions were observed (p = 0.34%). CONCLUSION It was possible to establish a protocol for evaluation of MM lesions in CBCT images and to identify that when evaluated three-dimensional, lesions tend to be poorly defined and have no pattern of description, as described in two-dimensional "punched-out".
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Chen W, Wang F. A speculative extension of the differential operator definition to fractal via the fundamental solution. CHAOS (WOODBURY, N.Y.) 2018; 28:113105. [PMID: 30501214 DOI: 10.1063/1.5008532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
This paper makes a speculative extension of the fundamental solution of the standard integer-order differential operators to fractal. Then, the fractal fundamental solution is used via the implicit calculus equation modeling approach to define differential operators on fractal for modeling complex mechanical behaviors of fractal materials. By employing the singular boundary method, a recent boundary discretization technique with the fundamental solution, this study also makes numerical simulation of fractal Laplace problems of multiply-connected and composite material. Results show the validity and rationality of the conjectured definition of Laplace operator on fractal. Furthermore, the fractional and the fractal Laplace operators are also compared in our numerical experiments.
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Affiliation(s)
- Wen Chen
- State Key Laboratory of Hydrology-Water Resources and Hydraulic Engineering, Center for Numerical Simulation Software in Engineering and Sciences, College of Mechanics and Materials, Hohai University, Nanjing 210098, China
| | - Fajie Wang
- Power & Energy Storage System Research Center, National Engineering Research Center for Intelligent Electrical Vehicle Power System, Qingdao University, Qingdao 266071, China
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21
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ALCÂNTARA CEP, CASTRO MAA, NORONHA MSD, MARTINS-JUNIOR PA, MENDES RDM, CALIARI MV, MESQUITA RA, FERREIRA AJ. Hyaluronic acid accelerates bone repair in human dental sockets: a randomized triple-blind clinical trial. Braz Oral Res 2018; 32:e84. [DOI: 10.1590/1807-3107bor-2018.vol32.0084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022] Open
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Servais JA, Gaalaas L, Lunos S, Beiraghi S, Larson BE, Leon-Salazar V. Alternative cone-beam computed tomography method for the analysis of bone density around impacted maxillary canines. Am J Orthod Dentofacial Orthop 2018; 154:442-449. [PMID: 30173848 DOI: 10.1016/j.ajodo.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Genetic and environmental etiologic factors have been described for maxillary canine impaction, except for the trabecular bone characteristics in the impacted area. The aim of this study was to evaluate the surface area and fractal dimension of the alveolar bone on cone-beam computed tomography (CBCT) images of patients with maxillary impacted canines. METHODS The sample comprised preorthodontic treatment CBCT images of 49 participants with maxillary impacted canines (31 unilateral and 18 bilateral). CBCT images were acquired in portrait mode (17 × 23 cm high field of view) at 120 kV, 5 mA, 8.9-seconds exposure time, and 0.3-mm voxel size. Coronal slices (0.3 mm) were obtained from the right and left alveolar processes between the first and second maxillary premolars. We collected 64 × 64-pixel regions of interest between the premolars to assess maxillary bone area and fractal dimension using ImageJ software (National Institutes of Health, Bethesda, Md). Comparisons were made using paired t tests and linear regression. Repeated measurements were obtained randomly from about 20% of the sample. RESULTS In subjects with unilateral impactions, the maxillary bone area (P = 0.0227) was higher in the impacted side, with a mean difference of 245.5 pixels (SD, 569.2), but the fractal dimension (P = 0.9822) was not, -0.0003 pixels (SD, 0.082). Comparisons of unilateral and bilateral subjects using a general linear mixed model test confirmed the increased bone area in the impacted side (P = 0.1062). The repeated measurements showed similar results. CONCLUSIONS The maxillary alveolar bone area is increased in the impacted side compared with the nonimpacted side.
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Affiliation(s)
- Jerad A Servais
- School of Dentistry, University of Minnesota, Minneapolis, Minn
| | | | - Scott Lunos
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minn
| | - Soraya Beiraghi
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, Minn
| | - Brent E Larson
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, Minn
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Goller-Bulut D, Özcan G, Avci F. Changes in dimension of neurovascular canals in the mandible and maxilla: A radiographic finding in patients diagnosed with MRONJ. Med Oral Patol Oral Cir Bucal 2018; 23:e282-e289. [PMID: 29680848 PMCID: PMC5945243 DOI: 10.4317/medoral.22274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this retrospective study was to compare the morphological features of neurovascular canals and foramina of patients with medication-related osteonecrosis of the jaws (MRONJ) and healthy individuals by using cone beam computed tomography (CBCT). Material and Methods The CBCT images of 58 patients under bisphosphonate therapy diagnosed with MRONJ and age gender- matched controls were retrospectively evaluated. The diameter of mandibular and nasopalatine canal and mandibular, mental and lingual foramina were measured on several sections of CBCT. The value of mental index (MI) and panoramic mandibular index (PMI) were also assessed. Results The mean value of diametric measurements for all neurovascular canals and foramina in MRONJ patients were narrower than controls. Left mandibular foramen was the most affected area (p<0.001). There were significantly difference in all measurements of mental foramen, lingual foramen and mandibular incisive canal between two groups (p<0.05). PMI of MRONJ subjects were also significantly differences in both sides (p<0.05). Conclusions In MRONJ patient, neurovascular canals and foramina are affected due to the alterations in bone remodeling. Therefore, the diametric measurement of neurovascular canals and assessment of MI and PMI on CBCT, is a potentially useful method for detection of early changes associated with bisphosphonate therapy and for predict areas where new necrosis may occur. Key words:Bisphosphonate, MRONJ, CBCT, neurovascular canals, PMI.
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Affiliation(s)
- D Goller-Bulut
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry Abant İzzet Baysal University, 14000, Bolu, Turkey,
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Demiralp KÖ, Kurşun-Çakmak EŞ, Bayrak S, Akbulut N, Atakan C, Orhan K. Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study. Oral Radiol 2018; 35:23-28. [PMID: 30484181 DOI: 10.1007/s11282-018-0321-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was performed to evaluate the trabecular pattern of patients with cancer taking bisphosphonates on panoramic images using fractal dimension (FD) analysis by comparison with healthy subjects and to assess whether any difference exists between regions. METHODS FD analysis was conducted using ImageJ 1.3 software (National Institutes of Health, Bethesda, MD, USA) with the box-counting method on panoramic radiographs of 33 patients taking bisphosphonates (13 males and 20 females) and 33 healthy sex- and age-matched individuals. RESULTS FD values were higher (1.39 ± 0.14) in the study group than control group (1.38 ± 0.07) (p ≤ 0.05). No difference was detected in the FD values among the tested regions. The mean FD values in the control and study groups were as follows: region 1, 1.49 and 1.41 (p = 0.54); region 2, 1.36 and 1.37 (p = 0.84); region 3, 1.35 and 1.42 (p = 0.11); and region 4, 1.39 and 1.39 (p = 0.90), respectively. Female patients showed significantly lower values above the mandibular canal on the distal side of the second premolar and anterior to the mental foramen than did male patients (p ≤ 0.05). Age was unrelated to the FD in the study group (p ≥ 0.05). CONCLUSIONS The FD values of the patients with cancer taking bisphosphonates were higher than those of the controls. FD analysis showed the potential for examining bone structure in panoramic radiographs. Studies with a larger sample size are necessary to confirm these results.
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Affiliation(s)
- Kemal Özgür Demiralp
- Türkiye Public Hospitals Agency, Ministry of Health, Cankaya, 06490, Ankara, Turkey
| | | | - Seval Bayrak
- Dentomaxillofacial Radiology Department, Dentistry Faculty, Abant İzzet Baysal University, Gölköy Yerleşkesi, Gölköy Kampüsü, Gölköy, 14280, Bolu Merkez, Bolu, Turkey.
| | - Nihat Akbulut
- Dentomaxillofacial Surgery Department, Dentistry Faculty, Gaziosmanpasa University, Tasliciftlik yerleskesi, Merkez, 60250, Tokat Merkez, Tokat, Turkey
| | - Cemal Atakan
- Statistics Department, Faculty of Sciences, Ankara University, Dogol Cad., Besevler, 06100, Yenimahalle, Ankara, Turkey
| | - Kaan Orhan
- Dentomaxillofacial Radiology Department, Faculty of Dentistry, Ankara University, Besevler, 06500, Ankara, Turkey
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Magat G, Ozcan Sener S. Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography. Oral Radiol 2018; 35:35-42. [PMID: 30484179 DOI: 10.1007/s11282-018-0316-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was performed to compare the fractal dimension (FD), bone area fraction (BAF), and gray scale value (GSV) on digital panoramic radiography (DPR) and cross-sectional cone-beam computed tomography (CBCT) using image analysis and to determine whether a relationship exists among parameters associated with bone quality. METHODS Thirty edentulous human hemimandibles were scanned by DPR and CBCT. Ninety regions of interest (ROIs) were evaluated on DPR and CBCT images to calculate the FD and BAF. The GSV of the ROI on CBCT was also calculated. RESULTS Statistically significant differences were observed in the FD values of the ROIs between DPR and CBCT (p = 0.002) and in the BAF values of ROIs between DPR and CBCT (p = 0.017). The Spearman's correlation test revealed a statistically significant high correlation between the FD and BAF values of the ROIs on DPR and between the FD and BAF values of the ROIs on CBCT (p < 0.01). No significant correlations were observed between the GSVs of ROIs on CBCT and the FD values of ROIs on DPR, the BAF values of ROIs on DPR, the FD values of ROIs on CBCT, and the BAF values of ROIs on CBCT (p > 0.05). CONCLUSIONS The GSV did not support the FD and BAF. Additionally, DPR and CBCT did not have similar image quality for assessing the FD, BAF, and GSV. In evaluating the trabecular structure, the use of panoramic radiographs should be continued because the image resolution of CBCT is lower and its generalized dose is higher than that of panoramic radiography. These results may serve as a reference for clinical practitioners using dental CBCT to analyze the trabecular structures of alveolar bones.
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Affiliation(s)
- Guldane Magat
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Necmettin Erbakan University, Karaciğan Mahallesi, No:A, Ankara Cd., No:74, 42050, Karatay/Konya, Turkey.
| | - Sevgi Ozcan Sener
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Necmettin Erbakan University, Karaciğan Mahallesi, No:A, Ankara Cd., No:74, 42050, Karatay/Konya, Turkey
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Guerra ENS, Almeida FT, Bezerra FV, Figueiredo PTDS, Silva MAG, De Luca Canto G, Pachêco-Pereira C, Leite AF. Capability of CBCT to identify patients with low bone mineral density: a systematic review. Dentomaxillofac Radiol 2017; 46:20160475. [PMID: 28555506 PMCID: PMC5965944 DOI: 10.1259/dmfr.20160475] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to systematically review the literature about the capability of CBCT images to identify individuals with low bone mineral density (BMD). As the literature is scarce regarding this topic, the purpose of this systematic review is also to guide future research in this area. A detailed search was performed in five databases without restrictions of time or languages. Additionally, a grey literature search was conducted. The Quality Assessment Tool for Diagnostic Accuracy Studies-2 was applied to evaluate the methodological design of selected studies. With the inclusion of only six studies, the evidence is limited to endorse the use of CBCT assertively as a diagnostic tool for low BMD. All of the three studies that analyzed radiomorphometric indices found that the linear measurements of the mandibular inferior cortex were lower in osteoporotic individuals. CBCT-derived radiographic density vertebral and mandibular measurements were also capable for differentiating individuals with osteoporosis from individuals with normal BMD. The analysis of the cervical vertebrae showed high accuracy measurements. This systematic review indicates a scarcity of studies regarding the potential of CBCT for screening individuals with low BMD. However, the studies indicate that radiomorphometric indices and CBCT-derived radiographic density should be promising tools for differentiating individuals with osteoporosis from individuals with normal BMD.
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Affiliation(s)
| | | | | | | | - Maria A G Silva
- Faculty of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Graziela De Luca Canto
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Camila Pachêco-Pereira
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - André F Leite
- Health Sciences Faculty, University of Brasília, Brasília, Brazil
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Gönen ZB, Yillmaz Asan C, Zararsiz G, Kiliç E, Alkan A. Osseous changes in patients with medication-related osteonecrosis of the jaws. Dentomaxillofac Radiol 2017; 47:20170172. [PMID: 28871814 DOI: 10.1259/dmfr.20170172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive agents. The aim of this study was to investigate the osseous changes in patients with MRONJ. METHODS Cone beam CT (CBCT) images of 25 patients with MRONJ and controls were retrospectively evaluated. Buccal, lingual, apical cortical bone thicknesses; buccal, lingual, apical intracortical and cancellous bone density; diameter of mental foramen and incisive canal, and width of mental foramen were measured. RESULTS Buccal and apical cortical bone thicknesses were increased; however intracortical radiodensity values decreased in the Study Group when compared with the Control Group (p = 0.007, p = 0.001). Narrowing of incisive canal was observed in patients with MRONJ (p = 0.000). CONCLUSIONS Clinician should have awareness about narrowing of incisive canal, apical and buccal cortical bone thickening, decreasing in cancellous bone radiodensity, and the lingual cortex destruction in patients with MRONJ.
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Affiliation(s)
- Zeynep Burcin Gönen
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry and Genome - Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Canay Yillmaz Asan
- 2 Department of Oral and Maxillofacial Surgery, Ministry of Dental Health Hospital, Kayseri, Turkey
| | - Gökmen Zararsiz
- 3 Department of Biostatistics, Faculty of Medicine, Erciyes University and Turcosa Analytics Solutions Ltd. Co, Erciyes Teknopark, Kayseri, Turkey
| | - Erdem Kiliç
- 4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem University, Istanbul, Turkey
| | - Alper Alkan
- 4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem University, Istanbul, Turkey
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Spevak EM, Tsymbal AN. Bisphosphonate-related osteonecrosis of the jaw: current state of the problem. ACTA ACUST UNITED AC 2017. [DOI: 10.17750/kmj2017-91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The article presents review of the literature on the current state of the problem of bisphosphonate-related osteonecrosis of the jaw. In Russia and abroad there are numerous reports of atypical lesions of the maxilla associated with taking medications on the basis of phosphorus or its analogues, in particular bisphosphonates. This is an issue: if earlier bisphosphonate treatment complications were limited to individual clinical observations, currently their frequency, according to different authors, reaches 8-27%. Bisphosphonate-related osteonecrosis of the jaw is characterized by unique etiopathogenic, clinical and diagnostic features that distinguish it from other inflammatory, degenerative and iatrogenic diseases of orofacial region, so it is reasonable to isolate it into an independent nosology, requiring a comprehensive study. According to current data, bisphosphonate-related osteonecrosis of the jaw is a complication of antiresorptive therapy, characterized by necrosis and exposure of bone area, which persists for more than 8 weeks, followed by the process progression in the absence of radiation therapy to the head area in history. Bisphosphonates are antiresorptive agents, potent inhibitors of bone tissue destruction, widely used for the treatment of bone metastasis, multiple myeloma, and hypercalcemia in cancer patients. However, the development of complications such as osteonecrosis of the jaw greatly reduces the positive effects of treatment, and extremely bothersome for patients. Osteonecrosis-related pyo-inflammatory processes of admaxillary tissue, the appearance of persistent sinus tracts on the skin and in the mouth, the risk of pathologic fracture of the jaw impair the quality of life of patients. Presented in the article analysis of currently known data about the bisphosphonate-related osteonecrosis of the jaw should attract the attention of dental surgeons, maxillofacial surgeons, endocrinologists, oncologists to this problem.
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Hirahara N, Muraoka H, Noda M, Muramatsu T, Tokunaga S, Kaneda T. Change in the Magnetic Resonance Imaging Signal of the Mandibular Condyle Due to Bisphosphonate-Related Osteonecrosis of the Jaw. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Naohisa Hirahara
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Marie Noda
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Teruaki Muramatsu
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Satoshi Tokunaga
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo
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Ozcan G, Sekerci AE, Gönen ZB. Are there any differences in mandibular morphology of patients with bisphosphonate-related osteonecrosis of jaws?: a case-control study. Dentomaxillofac Radiol 2016; 45:20160047l. [PMID: 27181052 PMCID: PMC5124773 DOI: 10.1259/dmfr.20160047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/01/2016] [Accepted: 05/11/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES: The aim of this study was to compare the morphological differences in the mandible between patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) and healthy individuals and to detect the correlation between these parameters on panoramic radiography and CBCT. METHODS: The CBCT and panoramic images of patients with BRONJ (n = 32) and control groups (n = 32) were included in the study. All the comparisons were analyzed between the osteonecrosed and healthy sides of patients with BRONJ and control group. The panoramic radiographs were used to measure the values of the condyle angle, gonial angle, antegonial angle, antegonial depth, condylar height and ramal height. The mandibular cortical index (MCI) and bone quality index (BQI) were also examined on cross-sectional scans of CBCT images. RESULTS: There were significant differences in the MCI (p = 0.014) and BQI (p = 0.021) between the left and right side of the BRONJ group and also between the osteonecrosed side of the BRONJ and control group (p < 0.0001). No significant difference was found in other comparisons. CONCLUSIONS: The outcomes of the present study indicate that bisphosphonates influenced some internal morphological changes in the mandible. These changes may be a reason of BRONJ. But, these changes are not reflective of the measured values obtained using panoramic radiographs on the external morphology of the mandible.
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Affiliation(s)
- Gozde Ozcan
- Department of Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Ahmet E Sekerci
- Department of Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Zeynep B Gönen
- Department of Maxillofacial Surgery, Faculty of Dentistry, Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
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Apolinário AC, Sindeaux R, de Souza Figueiredo PT, Guimarães ATB, Acevedo AC, Castro LC, de Paula AP, de Paula LM, de Melo NS, Leite AF. Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment. Dentomaxillofac Radiol 2016; 45:20150400. [PMID: 26954289 DOI: 10.1259/dmfr.20150400] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To verify radiomorphometric indices and fractal dimension (FD) in dental panoramic radiographs (DPRs) of children with different types of osteogenesis imperfecta (OI) and also to verify the effect of pamidronate (PAM) treatment in such panoramic analyses. METHODS In this retrospective study, 197 DPRs of 62 children with OI Types I, III and IV who were in treatment with a comparable dosage of intravenous PAM were selected. The mandibular cortical width (MCW), mandibular cortical index, visual estimation of the cortical width and FD of three standardized trabecular and cortical mandibular regions of interest were obtained from the radiographs. Factorial analysis of variance and Fisher test were used to compare FD and MCW measurements in children with different types of OI for different PAM cycles. RESULTS Children with all types of OI have thinner and more porous mandibular cortices at the beginning of treatment. There were significant differences between MCW and FD of the cortical bone, regarding different types of OI and number of PAM cycles (p = 0.037 and p = 0.044, respectively). FD measurements of the trabecular bone were not statistically different among OI types nor were PAM cycles (p > 0.05). CONCLUSIONS Children with OI presented cortical bone alterations after PAM treatment. Both MCW and the FD of the cortical bone were higher in children with OI after PAM treatment. It is argued that cortical bone should be considered for analyzing patients with OI, as well as to monitor the progress of PAM treatment.
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Affiliation(s)
- Ana C Apolinário
- 1 Department of Dentistry, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brazil
| | - Rafael Sindeaux
- 1 Department of Dentistry, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brazil
| | - Paulo T de Souza Figueiredo
- 2 Department of Rheumatology, Oral Radiology, Department of Dentistry, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro, Brazil
| | - Ana T B Guimarães
- 3 Biological Sciences Department, State University of West Paraná, Rua Universitária, Cascavel, Paraná, Brazil
| | - Ana C Acevedo
- 4 Oral Care Center for Inherited Diseases, Department of Dentistry, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro, Brazil
| | - Luiz C Castro
- 5 Division of Endocrinology, University of Brasília's Hospital, Brasília, Brazil
| | - Ana P de Paula
- 6 Hospital de Base of Federal District, Brasília, Brazil
| | - Lilian M de Paula
- 4 Oral Care Center for Inherited Diseases, Department of Dentistry, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro, Brazil
| | - Nilce S de Melo
- 7 Oral Pathology, Department of Dentistry, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro Asa Norte, Brazil
| | - André F Leite
- 2 Department of Rheumatology, Oral Radiology, Department of Dentistry, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro, Brazil
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Güngör E, Yildirim D, Çevik R. Evaluation of osteoporosis in jaw bones using cone beam CT and dual-energy X-ray absorptiometry. J Oral Sci 2016; 58:185-94. [DOI: 10.2334/josnusd.15-0609] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Enes Güngör
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Zirve University
| | - Derya Yildirim
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Süleyman Demirel University
| | - Remzi Çevik
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Dicle University
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Pauwels R, Jacobs R, Singer SR, Mupparapu M. CBCT-based bone quality assessment: are Hounsfield units applicable? Dentomaxillofac Radiol 2015; 44:20140238. [PMID: 25315442 DOI: 10.1259/dmfr.20140238] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CBCT is a widely applied imaging modality in dentistry. It enables the visualization of high-contrast structures of the oral region (bone, teeth, air cavities) at a high resolution. CBCT is now commonly used for the assessment of bone quality, primarily for pre-operative implant planning. Traditionally, bone quality parameters and classifications were primarily based on bone density, which could be estimated through the use of Hounsfield units derived from multidetector CT (MDCT) data sets. However, there are crucial differences between MDCT and CBCT, which complicates the use of quantitative gray values (GVs) for the latter. From experimental as well as clinical research, it can be seen that great variability of GVs can exist on CBCT images owing to various reasons that are inherently associated with this technique (i.e. the limited field size, relatively high amount of scattered radiation and limitations of currently applied reconstruction algorithms). Although attempts have been made to correct for GV variability, it can be postulated that the quantitative use of GVs in CBCT should be generally avoided at this time. In addition, recent research and clinical findings have shifted the paradigm of bone quality from a density-based analysis to a structural evaluation of the bone. The ever-improving image quality of CBCT allows it to display trabecular bone patterns, indicating that it may be possible to apply structural analysis methods that are commonly used in micro-CT and histology.
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Affiliation(s)
- R Pauwels
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Pauwels R, Faruangsaeng T, Charoenkarn T, Ngonphloy N, Panmekiate S. Effect of exposure parameters and voxel size on bone structure analysis in CBCT. Dentomaxillofac Radiol 2015; 44:20150078. [PMID: 26054572 DOI: 10.1259/dmfr.20150078] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effect of exposure parameters and voxel size on bone structure analysis in dental CBCT. METHODS 20 cylindrical bone samples underwent CBCT scanning (3D Accuitomo 170; J. Morita, Kyoto, Japan) using three combinations of tube voltage (kV) and tube current-exposure time product (mAs), corresponding with a CT dose index of 3.4 mGy: 90 kV and 62 mAs, 73 kV and 108.5 mAs, and 64 kV and 155 mAs. Images were reconstructed with a voxel size of 0.080 mm. In addition, the 90 kV scan was reconstructed at voxel sizes of 0.125, 0.160, 0.200, 0.250 and 0.300 mm. The following parameters were measured: bone surface (BS) and bone volume (BV) per total volume (TV), fractal dimension, connectivity density, anisotropy, trabecular thickness (Tb. Th.) and trabecular spacing (Tb. Sp.), structure model index (SMI), plateness, branches, junctions, branch length and triple points. RESULTS For most parameters, there was no significant effect of the kV value. For BV/TV, "90 kV" differed significantly from the other kV settings; for SMI, "64 vs 73 kV" was significant. For BS/TV, fractal dimension, connectivity density, branches, junctions and triple points values incrementally decreased at larger voxel sizes, whereas an increase was seen for Tb. Th., Tb. Sp., SMI and branch length. For anisotropy and plateness, no (or little) effect of voxel size was seen; for BV/TV, the effect was inconsistent. CONCLUSIONS Most bone structure parameters are not affected by the kV if the radiation dose is constant. Parameters dealing with the trabecular structure are heavily affected by the voxel size.
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Affiliation(s)
- R Pauwels
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,2 OMFS-IMPATH Research Group, Oral Imaging Center, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - T Faruangsaeng
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - T Charoenkarn
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - N Ngonphloy
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - S Panmekiate
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Torres SR, Chen CSK, Leroux BG, Lee PP, Hollender LG, Lloid M, Drew SP, Schubert MM. Mandibular inferior cortical bone thickness on panoramic radiographs in patients using bisphosphonates. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:584-92. [PMID: 25864820 PMCID: PMC4395858 DOI: 10.1016/j.oooo.2015.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/25/2015] [Accepted: 02/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The goal of this study was to detect dimensional changes in the mandibular cortical bone associated with bisphosphonate (BP) use and to correlate measurements of the cortical bone with the cumulative dose of BPs. STUDY DESIGN Mandibular inferior cortical bone thickness (MICBT) was measured under the mental foramen on panoramic radiographs of patients with and without bisphosphonate-related osteonecrosis of the jaws (BRONJ) taking BPs and controls. RESULTS Patients with BRONJ had the highest mean MICBT (6.81 ± 1.35 mm), compared with patients without BRONJ taking BPs (5.44 ± 1.09 mm) and controls (4.79 ± 0.85 mm) (P < .01). Mean MICBT of patients with BRONJ was significantly higher than that of patients without BRONJ taking BPs. There was a correlation between MICBT and cumulative dose of zolendronate. CONCLUSIONS Measurement of MICBT on panoramic radiographs is a potentially useful tool for the detection of dimensional changes associated with BP therapy.
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Affiliation(s)
- Sandra R. Torres
- Associate Professor, Department of Oral Pathology and Diagnosis of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Visiting Faculty at University of Washington, Seattle, US
| | - Curtis S. K. Chen
- Professor and Director of Oral Radiology Specialty Program, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, US
| | - Brian G. Leroux
- Professor, Dental Public Health Sciences and Biostatistics, School of Dentistry, University of Washington, Seattle, US
| | - Peggy P. Lee
- Assistant Professor, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, US
| | - Lars G. Hollender
- Professor, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, US
| | - Michelle Lloid
- Clinical Associate Professor, Department of Oral Medicine, University of Washington, Seattle, USA
| | | | - Mark M. Schubert
- Professor, Department of Oral Medicine, School of Dentistry, University of Washington, Director, Oral Medicine Service, Seattle Cancer Care Alliance, Seattle, US
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Panmekiate S, Ngonphloy N, Charoenkarn T, Faruangsaeng T, Pauwels R. Comparison of mandibular bone microarchitecture between micro-CT and CBCT images. Dentomaxillofac Radiol 2015; 44:20140322. [PMID: 25564887 DOI: 10.1259/dmfr.20140322] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare microarchitecture parameters of bone samples scanned using micro-CT (µCT) to those obtained by using CBCT. METHODS A bone biopsy trephine bur (3 × 10 mm) was used to remove 20 cylindrical bone samples from 20 dry hemimandibles. Samples were scanned using µCT (µCT 35; SCANCO Medical, Brüttisellen, Switzerland) with a voxel size of 20 µm and CBCT (3D Accuitomo 170; J. Morita, Kyoto, Japan) with a voxel size of 80 µm. All corresponding sample scans were aligned and cropped. Image analysis was carried out using BoneJ, including the following parameters: skeleton analysis, bone surface per total volume (BS/TV), bone volume per total volume (BV/TV), connectivity density, anisotropy, trabecular thickness and spacing, structure model index, plateness and fractal dimension. Pearson and Spearman correlation coefficients (R) were calculated. CBCT values were then calibrated using the slope of the linear fit with the µCT values. The mean error after calibration was calculated and normalized to the standard deviation of the µCT values. RESULTS R-values ranged between 0.05 (plateness) and 0.83 (BS/TV). Correlation was significant for both Spearman and Pearson's R for 8 out of 16 parameters. After calibration, the smallest normalized error was found for BV/TV (0.48). For other parameters, the error range was 0.58-2.10. CONCLUSIONS Despite the overall correlation, this study demonstrates the uncertainty associated with using bone microarchitecture parameters on CBCT images. Although clinically relevant parameter ranges are not available, the errors found in this study may be too high for some parameters to be considered for clinical application.
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Affiliation(s)
- S Panmekiate
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 2015; 30:3-23. [PMID: 25414052 DOI: 10.1002/jbmr.2405] [Citation(s) in RCA: 827] [Impact Index Per Article: 91.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 11/08/2022]
Abstract
This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, ill-fitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.
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Imaging findings of bisphosphonate-related osteonecrosis of the jaws: a critical review of the quantitative studies. Int J Dent 2014; 2014:784348. [PMID: 25018769 PMCID: PMC4075086 DOI: 10.1155/2014/784348] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/09/2014] [Indexed: 01/25/2023] Open
Abstract
Objectives. This paper offers a critical review of published information on the imaging strategies used for diagnosing bisphosphonate-associated osteonecrosis of the jaw (BRONJ) in patients taking intravenous bisphosphonates, pointing at the different methodologies and results of existing literature. Methods. Electronic literature search was performed in order to identify as many quantitative studies that discussed the imaging findings of BRONJ up to February 2014. Initially, the search for articles was based on the following four types of imaging modalities for evaluating BRONJ: computed tomography, plain film radiographs, magnetic resonance imaging, and nuclear bone scanning. Results. Eleven out of the 79 initially selected articles met the inclusion criteria. Most of the selected articles were cross-sectional studies. Regarding the selected studies, 54.5% have used plain films radiographs and 54.5% were based on computed tomography findings. All of the selected studies showed a small number of patients and none of the selected studies have tested the accuracy of the imaging examination for evaluating BRONJ. Conclusions. This critical review showed a scarcity of quantitative studies that analyzed the typical imaging findings related to BRONJ. Further studies are necessary in order to analyze the role of different imaging techniques in the assessment of BRONJ.
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Diniz-Freitas M, Fernández-Montenegro P, Fernández-Feijoo J, Limeres-Posse J, González-Mosquera A, Vázquez-García E, Diz-Dios P. Mandibular cortical indices on cone-beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates. Gerodontology 2014; 33:155-60. [DOI: 10.1111/ger.12121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Márcio Diniz-Freitas
- Dental Medico-Surgical Research Group (OMEQUI); School of Medicine and Dentistry; Santiago de Compostela University; Santiago de Compostela Spain
| | - Paula Fernández-Montenegro
- Dental Medico-Surgical Research Group (OMEQUI); School of Medicine and Dentistry; Santiago de Compostela University; Santiago de Compostela Spain
| | - Javier Fernández-Feijoo
- Dental Medico-Surgical Research Group (OMEQUI); School of Medicine and Dentistry; Santiago de Compostela University; Santiago de Compostela Spain
| | - Jacobo Limeres-Posse
- Dental Medico-Surgical Research Group (OMEQUI); School of Medicine and Dentistry; Santiago de Compostela University; Santiago de Compostela Spain
| | - Antonio González-Mosquera
- Dental Medico-Surgical Research Group (OMEQUI); School of Medicine and Dentistry; Santiago de Compostela University; Santiago de Compostela Spain
| | - Emma Vázquez-García
- Primary Care Buccodental Health Unit; Marín Health Centre; Galician Health Service (SERGAS); Pontevedra Spain
| | - Pedro Diz-Dios
- Dental Medico-Surgical Research Group (OMEQUI); School of Medicine and Dentistry; Santiago de Compostela University; Santiago de Compostela Spain
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Pauwels R, Nackaerts O, Bellaiche N, Stamatakis H, Tsiklakis K, Walker A, Bosmans H, Bogaerts R, Jacobs R, Horner K. Variability of dental cone beam CT grey values for density estimations. Br J Radiol 2013; 86:20120135. [PMID: 23255537 DOI: 10.1259/bjr.20120135] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the use of dental cone beam CT (CBCT) grey values for density estimations by calculating the correlation with multislice CT (MSCT) values and the grey value error after recalibration. METHODS A polymethyl methacrylate (PMMA) phantom was developed containing inserts of different density: air, PMMA, hydroxyapatite (HA) 50 mg cm(-3), HA 100, HA 200 and aluminium. The phantom was scanned on 13 CBCT devices and 1 MSCT device. Correlation between CBCT grey values and CT numbers was calculated, and the average error of the CBCT values was estimated in the medium-density range after recalibration. RESULTS Pearson correlation coefficients ranged between 0.7014 and 0.9996 in the full-density range and between 0.5620 and 0.9991 in the medium-density range. The average error of CBCT voxel values in the medium-density range was between 35 and 1562. CONCLUSION Even though most CBCT devices showed a good overall correlation with CT numbers, large errors can be seen when using the grey values in a quantitative way. Although it could be possible to obtain pseudo-Hounsfield units from certain CBCTs, alternative methods of assessing bone tissue should be further investigated. ADVANCES IN KNOWLEDGE The suitability of dental CBCT for density estimations was assessed, involving a large number of devices and protocols. The possibility for grey value calibration was thoroughly investigated.
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Affiliation(s)
- R Pauwels
- Department of Oral Health Sciences, University of Leuven, Leuven, Belgium.
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Pauwels R, Jacobs R, Bosmans H, Schulze R. Future prospects for dental cone beam CT imaging. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/iim.12.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:402-16. [DOI: 10.1097/spc.0b013e3283573126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Larson BE. Cone-beam computed tomography is the imaging technique of choice for comprehensive orthodontic assessment. Am J Orthod Dentofacial Orthop 2012; 141:402, 404, 406 passim. [PMID: 22464520 DOI: 10.1016/j.ajodo.2012.02.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Brent E Larson
- Division of Orthodontics, University of Minnesota, Minneapolis, MN 55455, USA.
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Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:695-703. [DOI: 10.1016/j.oooo.2011.11.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/01/2011] [Accepted: 11/09/2011] [Indexed: 11/18/2022]
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