A retrospective study of digital subtraction technique to detect sclerotic changes in alveolar bone on intraoral radiographs of bisphosphonate-treated patients

Quantitative Segmentation Analysis of the Radiological Changes by Using ITK-SNAP: Risk Assessment of the Severity and Recurrence of Medication-related Osteonecrosis of the Jaw

Background and purpose: Medication-related osteonecrosis of the jaw (MRONJ) severely impairs patients' quality of life and is remarkably refractory to treatment. There are lots of studies about identification of the radiographic features of MRONJ, yet reports about quantitative radiographic analysis for the risk assessment of the severity and recurrence of MRONJ are rarely heard. The aim of this study was to investigate the volumes of osteolytic lesions and radiodensity values of osteosclerotic lesions in MRONJ patients by using ITK-SNAP for severity prediction and prognosis evaluation. Materials and methods: Of 78 MRONJ patients (78 lesions) involved in this retrospective study, 53 were presented as osteolytic lesions and 25 were presented as osteosclerotic changes alone. Comprehensive CBCT images, demographics and clinical data of patients were investigated. The volumetric analysis and radiodensity measurement were performed by ITK-SNAP. SPSS 25.0 were used for statistical analysis. Results: The osteolytic lesion volumes in MRONJ patients receiving intravenous bisphosphonates (P=0.004) and patients without osteoporosis (P=0.027) were significantly large. No significant correlation between the volumes and bisphosphonates duration was found (P=0.094). The radiodensity values of osteosclerotic lesions was significantly correlated with bisphosphonates duration (P=0.040). The surrounding area of post-surgical lesions in MRONJ patients with recurrence showed significantly great radiodensity values (P=0.025). No significant correlation between the radiodensity values and the transformation from osteosclerotic lesions to osteolytic lesions was observed (P=0.507). Conclusion: MRONJ patients receiving intravenous bisphosphonates develop into large volumes of osteolytic lesions more easily. Long-term bisphosphonates duration is possibly related with higher bone density of osteosclerotic lesions, while higher density is not associated with the transformation from osteosclerotic lesions to osteolytic lesions. A rise of bone mineral density nearby post-surgical lesions is probably a predictor for MRONJ recurrence.

Reproducibility of subtraction radiography in monitoring changes in approximal carious lesions in children: An in vivo study

BACKGROUND

Laboratory studies have shown that digital subtraction radiography (DSR) can be a more effective tool, than conventional radiography, in monitoring changes in carious lesions. The clinical performance of the technique, however, has not been sufficiently researched.

AIM

To compare the reproducibility of DSR to that of bitewing radiographs, in monitoring changes in approximal caries in the mixed dentition. A secondary aim was to determine whether assessment outcomes differed as a function of the method used.

DESIGN

Six assessors evaluated 310 lesions first on bitewings, then with DSR. The overall reproducibility was evaluated via intra-class correlation coefficient (ICC). Intra- and inter-rater reproducibility were assessed using weighted Kappa. Paired t test was used to assess differences in the reproducibility across methods.

RESULTS

The overall reproducibility for DSR was (ICC = 0.47, 95% CI = 0.31-0.56). Intra- and inter-rater reproducibility were 0.65 and 0.44, respectively. The overall reproducibility for bitewings was ICC = 0.45, 95% CI = 0.42-0.57. Intra- and Inter-rater reproducibility were 0.71 and 0.46, respectively. Differences in the reproducibility across methods were not statistically significant. Significantly more lesions were scored as progressed using DSR.

CONCLUSIONS

The reproducibility of DSR in monitoring changes in approximal caries is comparable to that of bitewings. Additionally, DSR detected higher proportion of progression than bitewing assessments.

Early imaging signs of the use of antiresorptive medication and MRONJ: a systematic review

OBJECTIVE

The main aim is to identify, by means of different imaging modalities, the early bone changes in patients "at risk" and in stage 0 MRONJ.

MATERIALS AND METHODS

A search of the literature was performed on PubMed, Embase, Web of Science, and Cochrane Library databases, until June 9, 2020. No language or year restrictions were applied. Screening of the articles, data collection, and qualitative analysis was done. The Newcastle-Ottawa Scale (NOS) was used for observational studies, and the Systematic Review Centre for Laboratory Animal Experimentation's (SYRCLE) risk of bias tool for the animal studies.

RESULTS

A total of 1188 articles were found, from which 47 were considered eligible, whereas 42 were suitable for the qualitative analysis. They correspond to 39 human studies and 8 animal studies. Radiographic findings such as bone sclerosis, osteolytic areas, thickening of lamina dura, persisting alveolar socket, periapical radiolucency, thicker mandibular cortex, widening of the periodontal ligament space, periodontal bone loss, and enhancement of the mandibular canal were identified as early bone changes due to antiresorptive therapy. All those findings were also reported later in Stage 0 patients.

CONCLUSION

The main limitations of these results are the lack of prospective data and comparisons groups; therefore, careful interpretation should be made. It is a fact that radiographic findings are present in antiresorptive-treated patients, but the precise timepoint of occurrence, their relation to the posology, and potential risk to develop MRONJ are not clear.

CLINICAL RELEVANCE

The importance of a baseline radiographic diagnosis for antiresorptive-treated patients.

New Oral Surgery Materials for Bone Reconstruction-A Comparison of Five Bone Substitute Materials for Dentoalveolar Augmentation

This article presents a comparison of bone replacement materials in terms of their ability to produce living bone image at the place of their implantation. Five bone replacement materials are compared (Osteovit-porous collagen, Cerasorb Foam-collagen scaffolding of synthetic β tricalcium phosphate, Osbone-synthetic hydroxyapatite, Endobone-deproteinized bovine-derived cancellous bone hydroxyapatite, and Cerasorb-synthetic β tricalcium phosphate). Intraoral radiographs are taken immediately after implantation and 12 months later. The texture analysis was performed to assess (texture index, TI) the level of structure chaos (entropy) in relation to the presence of longitudinal elements visible in radiographs (run length emphasis moment). The reference ratio of the chaotic trabecular pattern (Entropy) to the number of longitudinal structures, i.e., trabeculae (LngREmph), is 176:100 (i.e., 1.76 ± 0.28). Radiological homogeneity immediately after the implantation procedure is a result of the similar shape of its particles (Osbone, Endobone and Cerasorb) or radiolucency (Osteovit, Cerasorb Foam). The particles visible in radiographs were similar in the LngREmph parameters applied to the reference bone, but not in the co-occurrence matrix features. The TI for Osteovit during a 12-month follow-up period changed from 1.55 ± 0.26 to 1.48 ± 0.26 (p > 0.05), for Cerasorb Foam from 1.82 ± 0.27 to 1.63 ± 0.24 (p < 0.05), for Osbone from 1.97 ± 0.31 to 1.74 ± 0.30 (p < 0.01), and for Endobone from 1.86 ± 0.25 to 1.84 ± 0.25 (p > 0.05), The observed structure in the radiological image of bone substitute materials containing calcium phosphates obtains the characteristics of a living bone image after twelve months.

Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis

Introduction Oral bisphosphonates are the most commonly prescribed anti-resorptive drugs used in the treatment of osteoporosis, but osteonecrosis of the jaw is a serious complication. The early diagnosis of this destructive side effect is crucial in preventing excessive bone loss, pain and infection.Objective To aid dental practitioners in the early identification of bisphosphonate-related osteonecrosis of the jaw.Method A scoping review was carried out.Data sources We searched MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source (DOSS), Proquest Dissertation and Theses Search, to identify references that described clinical and radiological findings in medication-related osteonecrosis of the jaw (MRONJ).Data selection Nineteen references mentioned the earliest radiological changes in MRONJ with a description of the observations and were included in the analysis.Data synthesis The radiographic signs included osteosclerosis/lysis, widening of the periodontal ligament and thickening of the lamina dura and cortex. To assess the quality of original data on which recommendations had been made, these 19 studies were subjected to a quality appraisal.Conclusion Using bone exposure as a criterion for diagnosis of MRONJ, leads to delayed diagnosis and a poor response to treatment. In those patients at risk of bone exposure with MRONJ, insufficient information is present in the literature to allow the general dental practitioner to reliably identify the radiographic features indicating imminent bone exposure. A well-designed prospective study is needed.

Radiographic evidence of treatment with bisphosphonates

Bony disease is typically evident with radiographic examination. Loss of bone mass consistent with osteoporosis is evident on plain dental radiographs, and it is reasonable to expect that anti-resorptive treatment of osteoporosis would lead to changes in radiodensity of structures visible on dental radiographs. Review of a number of radiographs of patients receiving anti-resorptive (bisphosphonate) treatment appears to confirm increased radiodensity of the structures, which may have implications in risk assessment of complications following dental procedures.

Are there any differences in mandibular morphology of patients with bisphosphonate-related osteonecrosis of jaws?: a case-control study

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.

Accuracy of Digital Subtraction Radiography in the Detection of Vertical Root Fractures

INTRODUCTION

The objective of this study was to evaluate the accuracy of digital subtraction radiography in the diagnosis of vertical root fractures (VRFs).

METHODS

Twenty decoronated uniradicular human teeth were placed in the alveoli of a dry mandible and radiographed twice, first without (unfilled roots) and then with (filled roots) a gutta-percha cone placed into the root canal. Roots were then removed from the dry mandible, and vertical fractures were created with the aid of a universal testing machine. The fractured roots were repositioned in the mandibular alveoli and again radiographed twice. Radiographic images were subtracted by using the Regeemy software in 3 test situations: group 1, initial radiographic images of unfilled roots and images of fractured or non-fractured unfilled roots; group 2, initial radiographic images of unfilled roots and images of fractured or non-fractured filled roots; and group 3, initial radiographic images of filled roots and images of fractured or non-fractured filled roots. Three examiners evaluated all the original digital radiographs, as well as the subtracted images, for the presence or absence of VRFs. Numerical data were subject to statistical analysis with the use of receiver operator characteristic (ROC) curves.

RESULTS

The areas under the ROC curve for groups 1, 2, and 3 were 0.86, 0.73, and 0.66, respectively. For the original digital radiographs, areas under the ROC curve were 0.80 (without gutta-percha) and 0.73 (with gutta-percha). No statistically significant differences were found between subtracted and original images.

CONCLUSIONS

Digital subtraction radiography could be considered as an alternative tool for the investigation of VRFs because of its comparable diagnostic accuracy to existing methods.

Mandibular inferior cortical bone thickness on panoramic radiographs in patients using bisphosphonates

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.

Effects of the long-term administration of alendronate on the mechanical properties of the basal bone and on osseointegration

OBJECTIVE

To evaluate the effect of the long-term administration of alendronate on the mechanical properties of the basal bone and on osseointegration.

MATERIAL AND METHODS

One hundred and sixty female rats were randomly allocated into two equally sized groups: the control (CTL) group, which received the subcutaneous administration of saline solution, and the alendronate (ALD) group, which received the subcutaneous administration of alendronate (1 mg/kg/week). After 120 days of these therapies, one implant was placed in each rat tibia. Ten animals in each group were euthanized at 5, 10, 15, 20, 25, 30, 45, or 60 days after surgery. The tibias with implants evaluated regarding the removal torque, bone-implant contact (BIC), the bone area fraction occupancy (BAFO), and Ca/P ratio. The femurs were evaluated regarding bone mineral density (BMD) and using mechanical tests to evaluate the maximal force of fracture, stiffness, and tenacity.

RESULTS

The ALD group presented statistically significant higher BMD (all periods except 15 days), maximal force of fracture (at 20, 30, and 45 days), tenacity (at 10, 20, 30, and 45 days), stiffness (45 days), removal torque (at 20, 25 and 30 days), BIC (at 20 and 60 days), and BAFO (at 20, 30, and 45 days) than the CTL group. No differences were found between the groups regarding the Ca/P ratio.

CONCLUSION

Previous long-term therapy with alendronate caused an increase in the BMD, maximal force of fracture of the bone without changing the inorganic composition and elastic deformability of this tissue. Furthermore, the ALD therapy enhanced osseointegration.