Fractal properties of the trabecular pattern of the mandible in chronic renal failure

Mandibular bone imaging assessment in chronic kidney disease: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis sought to assess the published research on mandibular cortical and trabecular bone patterns (TBPs) in individuals with chronic kidney disease (CKD) assessed by radiomorphometric index (RMI) analysis on dental radiographs.

STUDY DESIGN

The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Observational studies that radiographically evaluated cortical and TBPs were analyzed. Risk of bias was assessed according to the Joanna Briggs Institute Critical Appraisal Checklists. Quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analysis was performed for studies using dichotomous models or verifying mean differences according to RMI type.

RESULTS

Thirteen papers were included. Mandibular cortical index (MCI) and mental index (MI) were the most frequently evaluated RMIs. For MCI, the estimated risk ratio for decreased bone mineral density indicated by greater porosity in the cortices was 13.7% in CKD patients (95% confidence interval: 0.04-0.24; P = .008) when compared to healthy individuals. MI mean differences in CKD compared to control groups ranged from -0.5100 to -0.2000 mm. However, risk of bias was generally high and quality of evidence was very low.

CONCLUSIONS

MCI and MI are useful screening tests in assessing bone patterns but must be evaluated with caution due to the risk of bias and low quality of evidence in the published literature.

Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases

OBJECTIVE

The aim of this study is to determine the age-based prevalence of dens invaginatus cases and to learn the radiologic findings. In addition, fractal analysis of the periapical regions of unilateral dens invaginatus cases and contralateral teeth was performed to determine the effect of possible microleakage on fractal dimension.

METHODS

A total of 136 patients (170 teeth) identified in panoramic radiographs taken for diagnostic purposes between January 2018 and December 2023 at our Department of Oral and Maxillofacial Radiology were included in the study. Data were analysed using IBM SPSS V23. The Chi-square test was used for comparing categorical variables between groups. The relationship between the FD values calculated around the apexes of the teeth with unilateral dens invaginatus and the contralateral teeth was analyzed by paired t test. A significance level of p < 0.050 was adopted.

RESULTS

The mean age of the cases was calculated as 28.1 (8-63) years. 66 (48.5%) of the cases were female, and 70 (51.1%) were male. The lateral incisor was the most affected tooth among these cases. Bilateral cases were observed in 34 patients. Type 2 was detected in 93 patients, Type 1 in 35 patients, and Type 3 dens invagination in 8 patients. Dens invaginatus cases were observed in 134 maxillary and 2 mandibular teeth. Periapical lesions were seen in 22 of these cases.

CONCLUSIONS

Dens invaginatus cases are a congenital anomaly encountered at any age. Early diagnosis is crucial to prevent the loss of pulp vitality due to these invaginations. It should be noted that these invaginations can affect both jaws. However, due to the prevalence of occurrence in the maxillary anterior teeth and asymptomatic nonvitality, particular attention should be paid to evaluating this region.

Degenerative Temporomandibular Disorders: An Assessment of Bone Trabecular Structure Using Fractal Analysis in Digital Panoramic Radiographs

Introduction Fractal analysis has proved to be a salient tool to quantitatively assess the qualitative changes in the bone trabeculae of patients with hyperparathyroidism, osteoporosis, and various temporomandibular disorders, including osteoarthritis (OA) and rheumatoid arthritis of temporomandibular joint (TMJ), in several previous studies. The purpose of this study was to use fractal analysis to assess alterations in the trabecular pattern of the mandibular condyle in patients with degenerative temporomandibular disorders. Materials and methods This study comprised 98 subjects with 49 subjects in the study group and 49 subjects in the control group, aged 18-50 years. Age and sex in the control group were matched to those in the case group. The subjects were assessed clinically with the Diagnostic Criteria for Temporomandibular Disorders. Digital panoramic X-ray equipment with set parameters of 70 kvp, 8 mA, and 16-second exposure duration was used to take panoramic radiographs. Fractal analysis was done and the calculated fractal dimension value was obtained using ImageJ version 1.48 software (National Institutes of Health, Bethesda, MD). The same observer used Muir and Goss's method to rate the total degenerative changes in the condylar surfaces, which were substantiated by the calculated fractal dimension value. The data were statistically analyzed. Results The results revealed a significant difference (p-value = 0.041) between the mean fractal value in the case group's (1.35) and the control group's (1.38) left sides whereas the differences in the mean fractal values between the case and control groups on the right side was not significant (p-value = 0.49). Conclusion It is recommended to use the fractal dimension value and the total degenerative severity score together to quantify degenerative changes in the TMJ OA rather than exclusively relying on fractal value.

Evaluation of Bone Mineral Changes in Panoramic Radiographs of Hypothyroid and Hyperthyroid Patients Using Fractal Dimension Analysis

Objective Hyperthyroidism and hypothyroidism are endocrinopathies that cause a decrease in bone mineral density. The aim of this study is to investigate possible bone changes in the mandible caused by hyperthyroidism and hypothyroidism using fractal analysis (FA) on panoramic radiographs. Material and Methods Panoramic radiographs of a total of 180 patients, including 120 patient groups (60 hyperthyroid, 60 hypothyroid) and 60 healthy control groups, were used. Five regions of interests (ROI) were determined from panoramic radiographs and FA was performed. ROI1: geometric midpoint of mandibular notch and mandibular foramen, ROI2: geometric midpoint of mandibular angle, ROI3: anterior of mental foramen, ROI4: basal cortical area from distal mental foramen to distal root of first molar, ROI5: geometric center of mandibular foramen and mandibular ramus. Results While a significant difference was observed between the patient and control groups regarding ROI1 and ROI2 (p < 0.05); there was no significant difference between the groups in relation to ROI3, ROI4, and ROI5. All FA values were lower in the hyperthyroid group than in the hypothyroid group. Conclusion Fractal analysis proves to be an effective method for early detection of bone mass changes. In the present study, it was concluded that while the mandibular cortical bone was intact, trabecular rich regions were affected by osteoporosis caused by thyroid hormones. Necessary precautions should be taken against the risk of osteoporosis in patients with thyroid hormone disorders.

Five-year change of panoramic radiomorphometric indices and fractal dimension values in type 2 diabetes patients

OBJECTIVES

Diabetes mellitus is a chronic disease characterized by dysregulation of glucose metabolism, with characteristic long-term complications accompanied by changes in bone quality. The purpose of this study is to compare the results with a control group by performing radiomorphometric analyses on panoramic radiographs obtained 5 years apart to examine changes in the mandibular bone cortex and microstructures of type 2 diabetes mellitus (T2DM) patients.

METHODS

Two panoramic radiographs that were taken 5 years (mean 5.26 ± 0.134) apart from 52 patients with T2DM (n:26) and a control group (n:26) were used. A total of 104 images were evaluated. Analyses were done from the condyle (FD1), angulus (FD2), distal second premolar apex (FD3), and anterior to the mental foramen (FD4) for fractal dimension (FD) in the mandible. Symphysis index (SI), anterior index (AI), molar index (MI), posterior index (PI), and panoramic mandibular index (PMI) measurements were taken for cortical analysis. Three-way ANOVA, three-way robust ANOVA, two-way ANOVA, and two-way robust ANOVA tests were used for statistical analysis (p < 0.05).

RESULTS

After a 5-year period, there was a significant decrease in all FD measures of the mandible in both T2DM and control groups (p < 0.05). This resulted in a statistical difference in the main effect of time. After a 5-year period, no significant difference in mandibular cortical measures was identified between the T2DM and control groups (p > 0.05).

CONCLUSION

According to panoramic radiography, the mandibular trabecular structure deteriorated after 5 years, whereas cortical values remained the same. It concluded that T2DM had no effect on these results.

Fractal characteristics of the trabecular pattern of the mandible in patients with renal transplantation

OBJECTIVE

In this study, we examined the mandibular trabecular bone structures by performing fractal dimension (FD) analysis in patients who underwent renal transplantation (RTx).

METHODS

Our study is an observational study with 69 RTx patients and 35 control group patients. The mean FD values of the patient and control groups were calculated and compared. In addition, biochemical parathyroid hormone (PTH), serum calcium, phosphorus, alkaline phosphatase (ALP), and vitamin-D parameters and FD values of both groups were analyzed.

RESULTS

FD values were significantly lower in the patient group than in the healthy group (p < .05). In the RTx group compared to the control group, ALP (90.71 ± 34.25-66.54 ± 16.8, respectively) (p < .001) and PTH (75.76 ± 38.01-38.17 ± 12.39, respectively) (p < .001) values were higher. There was a positive correlation between the FD values and ALP (rspearman  = .305, p = .011) and a negative correlation between FD values and vitamin-D (rspearman  = .287, p = .017) of patients with RTx.

CONCLUSION

FD values were found to be lower in patients who underwent RTx compared to the control group. It should be considered that FD analysis can be a method that can be used to evaluate trabecular bone structure in patients undergoing RTx.

Evaluation of alterations in length and calcification of the styloid process in patients with end-stage renal failure

OBJECTIVE

This study compared alterations in length and types of elongation and calcification of the styloid process (SP) between patients with end-stage renal failure (ESRF) who received renal transplantation, patients with ESRF undergoing dialysis, and a healthy control group.

STUDY DESIGN

The SPs of 58 patients who had undergone renal transplants, 58 patients who received dialysis treatment, and 58 healthy individuals were examined with panoramic radiographs. Length measurements were made from the apex to the base of the SP. Elongation types were classified into 5 groups: normal, non-segmented, pseudo-segmented, segmented, and non-continuous. Calcification types were classified into 4 groups: external, partial, nodular, and complete.

RESULTS

SP length was significantly greater in the renal transplantation and dialysis groups than in the control group (P < .001) and significantly longer in the renal transplantation group than in the dialysis group (P < .001). There was a significant difference between the groups regarding elongation types (P < .001), with the non-segmented type more frequent in the dialysis and renal transplant groups than in the control group. There was no significant difference in calcification types between groups (P = .225). Elongation and calcification types differed between sexes (P ≤ .008) CONCLUSIONS: Orofacial pain complaints in patients with ESRF should raise the suspicion of abnormal elongation and calcification of the SP, perhaps a manifestation of Eagle syndrome. It would be useful to evaluate the SPs of these patients clinically and radiographically.

Evaluation of the effect of sickle cell disease on the mandibular bone of children and adolescents by image texture and radiomorphometric analysis

OBJECTIVES

Sickle cell disease (SCD) can cause osteoporotic changes in the jaw bones. In this study, it was aimed to evaluate possible bone changes using fractal analysis (FA) and morphometric analyses in dental panoramic radiographs of children and adolescents diagnosed with both homozygous and heterozygous forms of SCD.

METHODS

Sixty-five individuals (33 SCD, 32 controls) aged 6-17 years were included in the study. Four separate areas of interest (ROI) were selected for the right and left sides of all panoramic radiographs, and the FA value of the ROIs was calculated. Mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI) and were evaluated. Data were statistically analyzed and p < 0.05 was accepted for statistical significance.

RESULTS

Fractal values of right and left ROI1 (the center of the mandibular angle.) and ROI4 (the cortical bone), and right ROI2 (the middle of the mandibular ramus) were statistically lower in the case group (p < 0.05). Right ROI2 and ROI4 fractal values of individuals in the case group were lower than those on the left side (p < 0.05). While MCI categories did not differ from the case-control group (p > 0.05), PMI and MCW values were lower in the case group (p < 0.05). All evaluated parameters did not differ according to age and gender (p > 0.05).

CONCLUSION

The results of this study showed that SCD affects the mandible. FA, MCW and PMI parameters can be used to detect early osteoporotic changes in the disease.

The mandibular bone structure in children by fractal dimension and its correlation with pixel intensity values: a pilot study

OBJECTIVES

To identify a normal pattern of mandibular trabecular bone in children based on the fractal dimension (FD), and its possible correlation with pixel intensity (PI) values, to facilitate the early diagnosis of possible diseases and/or future bone alterations.

MATERIALS AND METHODS

The 50 panoramic images were selected and divided into two groups, according to the children's age: 8-9 (Group 1; n = 25) and 6-7 (Group 2; n = 25). For FD and PI analyses, three regions of interest (ROIs) were selected, and their mean values were evaluated for each ROI, according to each group, using the t test for independent samples and the model of generalized estimation equations (GEE). Subsequently, these mean values were correlated by the Pearson test.

RESULTS

Comparing the groups, FD and PI did not differ from each other for any of the measured regions (p > 0.00). It was observed that in the mandible branch (ROI1), FD and PI means were 1.26 ± 0.01 and 81.0 ± 2.50, respectively. In the mandible angle (ROI2), the means were 1.21 ± 0.02 (FD) and 72.8 ± 2.13 (PI); and in the mandible, cortical (ROI3) values of FD = 1.03 ± 0.01 and PI = 91.3 ± 1.75 were obtained. There was no correlation between FD and PI in any of the analyzed ROI (r < 0.285). The FD means of ROI1 and ROI2 did not differ from each other (p = 0.053), but both were different from ROI3 (p < 0.00). All PI values differed from each other (p < 0.00).

CONCLUSION

The bone trabeculate pattern in 6-9-year-old children presented FD between 1.01 and 1.29. Besides that, there was no significant correlation between FD and PI.

Evaluation of trabecular bone changes according to the type of prosthesis in patients using bisphosphonates: a retrospective study

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.

DETERMINATION OF MANDIBULAR BONE CHANGES IN PATIENTS WITH PRIMARY HYPOTHYROIDISM TREATED WITH LEVOTHYROXINE SODIUM

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.

Evaluation of bone changes on dental panoramic radiography using mandibular indexes and fractal dimension analysis in children with familial Mediterranean fever

AIM

It was aimed to evaluate the bone microarchitecture of children with FMF in the city of Tokat, where the disease is highly prevalent, in Turkey, one of the countries where familial Mediterranean Fever (FMF) disease is the most common, using mandibular indexes and fractal dimension analysis on panoramic radiography.

METHODS

In this retrospective study, the results were evaluated and compared using the mandibular cortical index (MCI), the mental index (MI), the panoramic mandibular index (PMI), and the fractal dimension analysis of six different regions (condyle, angulus, and interdental) on dental panoramic radiographs in 124 children with FMF and 124 healthy children. The data were analyzed using the IBM SPSS V23.

RESULTS

The distribution of MCI in children with FMF was similar to the control group (p > 0.05). The mean MI (3.59) values in FMF patients were statistically higher than the control group (p = 0.016). No statistically significant difference was found in PMI between the patients with FMF and the control group (p > 0.05). No statistically significant difference was found between the mean fractal dimension (FD) values according to the groups (p > 0.05).

CONCLUSION

Trabecular bone microarchitecture of children with FMF is similar to healthy children. There is no correlation between the duration of colchicine use and bone microarchitecture.

Magnetic resonance imaging and fractal analysis findings in temporomandibular joints with disk perforation

OBJECTIVE

This study compared magnetic resonance imaging (MRI) findings and fractal dimension (FD) values in the temporomandibular joints (TMJs) of study patients with disk perforation vs control patients.

STUDY DESIGN

Of 75 TMJs examined with MRI for characteristics of the disk and condyle, 45 were included in the study group and 30 in the control group. MRI findings and FD values were compared for significance of differences between the groups. The frequency of subclassifications was analyzed for differences between the two forms of disk configuration and grades of effusion. Mean FD values were analyzed for differences among subclassifications of MRI findings and between groups.

RESULTS

Examination of MRI variables revealed that the study group had significantly greater frequencies of flattened disks, disk displacement, flattening and combined defects in condylar morphology, and grade 2 effusion (P = .001) Joints with perforated disks had a large percentage of normal disk-condyle relationships (73.3%). Significant differences were discovered between biconcave and flattened disk configuration in the frequencies of internal disk status and condylar morphology. FD values of all patients varied significantly among the subclassifications of disk configuration, internal disk status, and effusion. Mean FD values were significantly lower in the study group with perforated disks (1.07) compared with the control group (1.20, P = .001).

CONCLUSIONS

MRI variables and FD can be useful in investigating intra-articular TMJ status.

The effects of vitamin D deficiency on mandibular bone structure: a retrospective radiological study

OBJECTIVE

The aim of the study was to evaluate the effects of vitamin D deficiency on the mandibular bone structure by fractal analysis and panoramic morphometric indices.

METHODS

Ninety participants were divided into three groups as 30 individuals with severe vitamin D deficiency, 30 individuals with vitamin D deficiency, and 30 individuals with vitamin D sufficiency. Fractal dimension analysis (FD), panoramic mandibular index (PMI), mandibular cortical index (MCI), and mandibular cortical thickness measurement (CTM) were evaluated on panoramic radiographs.

RESULTS

FD values of the patients with vitamin D deficiency were found to be statistically lower than the patients with vitamin D sufficiency (p < 0.05). FD value of supracortical area above the angulus mandible (FD2) in patients with severe vitamin D deficiency was significantly lower than FD values (p = 0.002). There was no statistically significant difference between the groups in the CTM (p > 0.05). PMI was significantly lower in patients with severe vitamin D deficiency (p < 0.001). There was a significant difference in MCI values between the groups (p < 0.05).

CONCLUSION

Vitamin D deficiency causes a decrease in bone mineral density in the mandible, and an increase in alveolar porosity. FD analysis and radiomorphometric indices in panoramic radiographs can be used to assess osteoporotic changes in patients with vitamin D deficiency.

Evaluation of mandibular trabecular bone by fractal analysis on panoramic radiograph in paediatric patients with sleep bruxism

OBJECTIVE

To evaluate the trabecular bone density in the mandible of paediatric patients diagnosed with sleep bruxism (SB) using the fractal analysis method on panoramic radiographs.

METHODS

A total of 37 patients whose anamnesis and clinical signs were compatible with SB were diagnosed with SB using BiteStrip^® . Three areas were identified on the panoramic radiographs of the patients: the geometric center of the condyle, the angulus region under the mandibular canal, and the distal region of the mental foramen. Regions of interest (ROIs) of 60 × 60 pixels were selected in these three locations, and fractal dimensions (FDs) were calculated. Results were compared with the control group.

RESULTS

There was no statistically significant difference between the right and left FD values, and male and female FD values in all regions and both groups (p > .05). In the angulus (p = .03) and condyle (p = .03) regions, the SB group had a significantly higher FD value than the control group. There was no statistically significant difference between the SB and control groups in the corpus region (p = .98). A moderate negative correlation arose between age and condyle FD values among controls (r = -0.38, p = .02).

CONCLUSION

Fractal dimension values evaluating trabeculation of the mandibular bone are affected by SB in the angulus and condyle regions.

Evaluation of mandibular bone changes in multiple myeloma patients on dental panoramic radiographs

OBJECTIVE

The aim of this study is to assess the mandibular bone structures of multiple myeloma (MM) patients on panoramic radiographs using fractal analysis (FA) and radio-morphometric indices.

METHODS

The study group consisted of 67 MM patients, and the control group consisted of 67 individuals without any systemic disease. The mandibular cortical index (MCI) classification, antegonial index (AGI), gonial index (GI), mandibular cortical width (MCW), panoramic mandibular index (PMI) and fractal dimensions (FD) were evaluated on panoramic radiographs. FD measurements were made by identifying 4 related areas. Shapiro-Wilk test was used to determine the normal distribution of the data. Chi-square and independent t tests were used to compare the findings between the two groups.

RESULTS

The FD values of the study group in ROI1, ROI2, ROI3, ROI4 regions and GI values were found to be statistically significantly lower than the control group (p < 0.001). There was no statistically significant difference between the two groups in terms of AGI, MCW and PMI values (p > 0.05). While C1 was the most common type in the control group, C2 was the most common type in the study group. C2 and C3 were detected more in the study group than in the control group (p < 0.001).

CONCLUSION

Our study showed a consensus with the studies advocating that fractal analysis and radio-morphometric indices are methods that can be used to determine mandibular bone density. The low bone density of MM patients is a condition that physicians should be aware of for interventional dental procedures.

Fractal properties and radiomorphometric indices of the trabecular structure of the mandible in patients using systemic glucocorticoids

OBJECTIVES

The aim of this study is to evaluate the mandibular trabecular and cortical bone structure of patients using systemic glucocorticoid (GC) and compare to control group with the fractal analysis (FA) and radiomorphometric indices.

METHODS

Two researchers retrospectively investigated 192 dental panoramic radiographs to compare individuals using systemic GCs to healthy controls. FA was performed in 4 different regions; geometrical center of the mandibular ramus (ROI1), cancellous bone on supracortical mandibular angle area inferior to the mandibular canal (ROI2), cancellous bone on mesial to the mental foramen (ROI3), basal cortical bone extending mental foramen to the first molars' distal root in the mandibular corpus (ROI4). Panoramic mandibular index (PMI), mandibular cortical width (MCW) and mandibular cortical index (MCI) were performed for evaluate cortical thickness and porosity. The Shapiro-Wilk test was used to determine the normal distribution of the data, the independent t test for comparison of values and the chi-square test for descriptive statistics.

RESULTS

There were statistically significant differences in ROI4 and MCW. The fractal dimension (FD) values in ROI4 and MCW were significantly lower in study group. There were no significant differences in FD values in ROI1, ROI2, ROI3 and PMI and MCI measurements between both groups.

CONCLUSIONS

FA and radiomorphometric measurements is an efficient method to detect early changes in bone mass. In our study, ROI4 and MCW were significantly lower in study group. Osteoporosis prevention should be considered in patients using systemic GCs.

Effects of hyperlipidemia on trabecular and cortical structures of the mandible

OBJECTIVES

To evaluate the mandibular bone structure of patients with hyperlipidemia by fractal dimension (FD) analysis and panoramic radiomorphometric indices including mandibular cortical thickness measurement, panoramic mandibular index (PMI), mandibular cortical index (MCI) and to compare with the healthy group.

METHODS

In total, 60 panoramic radiographs were included, including panoramic radiographs of 30 individuals with hyperlipidemia and 30 individuals with systemically healthy. FD analysis in the mandibular condyle, angle of the mandible, the distal side of the second premolar and anterior to mental foramen, PMI, MCI, and mandibular cortical thickness measurements were evaluated on radiographs. Independent samples t-test was used for differences between healthy and hyperlipidemia groups with regard to age and PMI. Repeated measurement of variance with one within and one between factors in the comparison of four regions and two groups in terms of FD and cortical thickness measurements. Following this analysis, significant differences were detected by post-hoc Sidak test. Fisher-Freeman-Halton analysis was applied to determine the relationship between categorical variables.

RESULTS

FD values of the hyperlipidemic patients were found to be lower than the healthy group. Between the hyperlipidemic and healthy groups, there was a difference in the angle of the mandible FD values (p = 0.020). There were no differences in the cortical thickness measurements and PMI between the groups (p > 0.05). There was a difference in MCI values between the groups (p < 0.05).

CONCLUSION

The trabecular structure of the angle of the mandible and the cortical bone structure of the mandible were found to be negatively affected by hyperlipidemia.

Structural complexity of the craniofacial trabecular bone in multiple myeloma assessed by fractal analysis

Purpose

This study aimed to evaluate the structural complexity of craniofacial trabecular bone in multiple myeloma by fractal analysis of panoramic and lateral skull radiography, and to compare the fractal dimension values of healthy patients (HPs), pre-treatment patients (PTPs), and patients during bisphosphonate treatment (DTPs).

Materials and Methods

Pairs of digital panoramic and lateral skull radiographs of 84 PTPs and 72 DTPs were selected. After application of exclusion criteria, 43 panoramic and 84 lateral skull radiographs of PTPs, 56 panoramic and 72 lateral skull radiographs of DTPs, and 99 panoramic radiographs of age- and sex-matched HPs were selected. The fractal dimension values from panoramic radiographs were compared among HPs, PTPs, and DTPs and between anatomical locations within patient groups using analysis of variance with the Tukey test. Fractal dimension values from lateral skull radiographs were compared between PTPs and DTPs using the Student t-test. Pearson correlation coefficients were used to assess the relationship between the mandible from panoramic radiographs and the skull from lateral skull radiographs. Intra-examiner agreement was assessed using intraclass correlation coefficients (α=0.05).

Results

The fractal dimension values were not significantly different among HPs, PTPs, and DTPs on panoramic radiographs or between PTPs and DTPs on lateral skull radiographs (P>0.05). The mandibular body presented the highest fractal dimension values (P≤0.05). The fractal dimension values of the mandible and skull in PTPs and DTPs were not correlated.

Conclusion

Fractal analysis was not sensitive for distinguishing craniofacial trabecular bone complexity in multiple myeloma patients using panoramic and lateral skull radiography.

The Investigation of Radiographic Findings of Mandibles on Panoramic Radiographs of Patients with Primary Hyperparathyroidism Using Fractal Analysis

OBJECTIVE

The basis of the research is the application of fractal analysis (FA) to panoramic radiographs of patients with primary hyperparathyroidism (PHPT). In addition, the relationship between the relevant biochemistry parameters and fractal values of healthy controls and patients with PHPT will be evaluated.

MATERIALS AND METHODS

In the current study, FA was performed with ImageJ program on panoramic radiographs of 48 patients diagnosed with PHPT. Fractal dimension (FD) values of the patients and 48 healthy subjects were compared. In addition, biochemical [parathyroid hormone (PTH), serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and vitamin D] parameters and FD values of both groups were analyzed with Mann-Whitney U-tests and Pearson correlation coefficient (P < .05).

RESULTS

FD values of four different angular areas were significantly lower in the patient group than in the healthy group (P < .05). There was no statistically significant difference between the patient and control groups in the measurements between the apexes of the right and left premolar and molar teeth. The mean PTH, Ca, P, and vitamin D values of the patients with PHPT and control group were highly significant, and all the parameters of the patient group showed higher values than the control group except for the P values (P < .001). In the patient group and control group, there was no significant difference between mean ALP values (P = .48). No correlation was found between the two groups.

CONCLUSION

Bone biopsy is the gold standard method for the diagnosis of bone structure changes in patients with PHPT. However, it is not used routinely because it is an invasive method. The FA method applied to panoramic radiographs may be used as a noninvasive, easy-to-apply method to reveal the changes in the trabecular structure of the jaw bones of the patients.

Evaluation of mandibular condyle trabecular structure in patients with rheumatoid arthritis using fractal analysis

OBJECTIVES

The aim of this study was to compare the fractal dimension (FD) of trabecular structure of the mandibular condyles in patients with rheumatoid arthritis (RA) to patients without RA. Correlations between condylar FD and bone mineral density T-scores in the femoral neck and lumbar spine were also examined.

STUDY DESIGN

The RA study group patients were divided into 3 categories (33 normal, 33 osteopenic, and 34 osteoporotic) according to T-scores. The control group without RA was sex- and age-matched with the study group. FD was calculated from panoramic radiographs and compared between the study and control groups. The relationships between FD values and femoral neck and L1-L4 lumbar spine T-scores were investigated for study and control groups. Significance was established at P < .05.

RESULTS

The mean FD values of the entire study group and of each category in the study group were significantly lower than those of the control group (P < .001). There were no significant differences in FD values among the 3 RA categories (P > .05). No significant correlations appeared between FD and femoral neck or lumbar spine T-scores (P ≥ .063).

CONCLUSIONS

Fractal analysis of the condyles on panoramic radiographs can distinguish RA from healthy condyles, even if the patients with RA have normal bone mineral density T-scores.

Measurement of the trabecular bone structure of the TMJ region in patients with transverse maxillary deficiency: a CBCT fractal analysis study

OBJECTIVE

This study aimed to evaluate the effect of transverse maxillary deficiency on condylar morphology via visual examination and fractal analysis of cone beam computed tomography (CBCT) scans.

STUDY DESIGN

In total, 97 patients with posterior crossbite or maxillary narrowness and 36 control patients were included. The presence of degenerative changes in the bilateral condyles was evaluated with CBCT. Fractal dimension (FD) was calculated on the condylar images using ImageJ.

RESULTS

Degenerative bone changes were discovered in 38 of the 133 scans (28.6%). There was no significant difference between the groups in terms of the incidence of degenerative changes for either the right or left sides (P ≥ .670). In coronal sections and in mean measurements, FD was significantly lower in the control group compared with the other groups in the right condyle (P ≤ .031). No significant differences were found between the mean FD values of the condyles with degenerative bone changes or the mean FD values of the normal condyles (P ≥ .256).

CONCLUSIONS

In the presence of maxillary transverse deficiencies, degenerative bone changes in the mandibular condyle were not significantly different, but the FD of the right condyle was found to be higher compared with the control group.

Fractal dimension and lacunarity analysis of mandibular bone on digital panoramic radiographs of tobacco users

Background. This study aimed to evaluate and compare changes in the mandibular trabecular bone pattern using the fractal dimension (FD) and lacunarity analysis in tobacco users with healthy controls.

Methods. This study was carried out on digital panoramic radiographs of 225 subjects divided into three groups: smokeless tobacco users (SLTs), smokers, and control (n=75). ImageJ program with FracLac plugin was used to assess the FD and lacunarity of mandibular trabecular bone on the digital panoramic radiographs.

Results. The differences in the mean FD values of the study and control groups were statistically significant (P < 0.001). Mean FD was lower in the case groups than the control group, with SLTs having the least FD value. A significant difference in lacunarity was noted between SLTs and controls (P < 0.001). On the contrary, there was no significant difference in lacunarity between smokers and controls.

Conclusions. FD values were lower in tobacco users, suggesting that tobacco users have a less complex trabecular bone pattern than healthy controls. Higher lacunarity values in SLTs indicated a more heterogeneous bone pattern. These findings signify that FD and lacunarity analysis on digital panoramic radiographs can serve as promising predictive tools to assess bone quality for osteoporotic changes in tobacco users, thereby facilitating prompt referral for further management.

Trabecular and cortical mandibular bone investigation in familial adenomatous polyposis patients

Mandibular cortical and trabecular bone abnormalities in patients with familial adenomatous polyposis (FAP) were evaluated using dental panoramic radiographs (DPR) radiomorphometric indices and fractal dimension (FD). Sixty DPRs from 15 FAP patients and 45 healthy controls were evaluated. FAP group was composed of 33.3% females and 66.6% males, age_mean = 37.2 years (SD 15.79). The non-FAP group was paired by gender and sex. The parameters analyzed were: FD of the trabecular bone in four regions of interest (ROI), mandibular cortical index (MCI) and width (MCW). FD values were lower for the FAP group. Statistically significance differences were shown by ROI 2 and 3 anteriorly to the mental foramen bilaterally, p = 0.001, and p = 0.006. The ROI 1 and 4, at the mandibular angle trabeculae, indicated statistical significances on the right side (p = 0.036) and no differences on the left side (p = 0.091). There was no significant difference in MCI and MCW when the groups were compared, MCW (L) p = 0.247, and MCW (R) p = 0.070. Fractal values of FAP patients' mandibular trabecular bone were lower than healthy controls. The radiomorphometric indices MCI and MCW were not useful for analyzing the cortical bone pattern. Therefore, FD is a promising tool for detection of abnormal bone structure in DPRs and for supporting the appropriate referral of FAP patients.

Investigation of mandibular fractal dimension on digital panoramic radiographs in bruxist individuals

OBJECTIVE

This study aimed to evaluate changes in mandibular trabecular bone structure in bruxism using fractal analysis on digital panoramic radiographs obtained with automatic dosing.

STUDY DESIGN

In this prospective study, fractal analysis was performed on radiographs of 126 bruxists and 126 non-bruxists. Eight paired mandibular regions of interest were selected: the bilateral condylar and gonial regions, and the bilateral dentate regions between the apical areas of the first molar and second premolar and between the first premolar and canine. Fractal dimensions (FDs) were calculated at each site.

RESULTS

Mean FD values in the bilateral gonial regions of the bruxists were significantly lower than those of controls (P ≤ .049). In both groups, FD values of the right dentate region anterior to the mental foramen were significantly lower than those on the left side (P ≤ .042). Females exhibited significantly lower FD values in both condylar regions in both groups (P ≤ .039) and in the right dentate regions in the controls (P ≤ .022). Correlations between age and FD in all regions were positive but nonsignificant in both groups (P > .05).

CONCLUSIONS

FD values of mandibular trabecular bone are affected by bruxism in the gonial region and by laterality and sex differences in the condylar and dentate regions.

Evaluation of different Apexification treatments of teeth with immature apices and apical periodontitis on the fractal dimensions of trabecular bone

The aim of the present study was to investigate in the fractal dimension (FD) time-dependent changes of periapical bone after two different apexification treatments in teeth with immature apices and apical periodontitis. This study included 55 cases treated with apexification. Cases were divided into two groups: a calcium hydroxide group and a mineral trioxide aggregate group. In each case, the lesion area was evaluated by fractal analysis on periapical radiographs obtained before and 1-year after treatment via Image-J program. The FD of each region of interest on the radiographs was calculated using the fractal analysis method. The data were statistically analysed. In both groups, the FD values increased compare to initial at 1-year follow-up after treatment (P < .05). There was no statistically significant difference between the groups in terms of the time-dependent increase in FD values (P = 0.118). In the present study, time-dependent changes in FD were independent of the apexification method.

Comparison of dental and skeletal indices between patients under haemodialysis and peritoneal dialysis with healthy individuals in digital panoramic radiography

OBJECTIVE

The aim was to compare dental and skeletal indices in panoramic radiography between patients undergoing haemodialysis, peritoneal dialysis and age- and sex-matched control group.

METHODS

In this comparative cross-sectional study, quantitative Indices including Antegonial Index (AI), Mental Index (MI), Panoramic Mandibular Index (PMI) and qualitative indices including Mandibular Cortical Index (MCI) and Trabecular Pattern (TP) were evaluated in panoramic images of 32 haemodialysis patients, 14 patients under peritoneal dialysis and 52 healthy individuals. The images were also investigated for pulp canal calcification, pulp stones, soft tissue calcification, changes in or loss of lamina dura, radiolucencies associated with brown tumour and ridge resorption. The indices were compared between the three groups and were investigated for association with the patients' blood test parameters and their diseases causing chronic renal failure (CRF). Intraobserver agreement for the 2-week interval of assessment was calculated for the indices.

RESULTS

MI (p = 0.574) and PMI (p = 0.100) were not significantly different, but AI (p = 0.01), MCI (p < 0.001) and TP (p = 0.002) were significantly different between the two case groups and the control group. The prevalence of pulp calcification (p = 0.03) and ridge resorption (p = 0.005) was higher in the haemodialysis group. Soft tissue calcification (p = 0.85) and lamina dura changes (p = 0.9) showed no significant difference. Brown tumours were observed in only one case in the haemodialysis group.

CONCLUSIONS

AI, MCI and TP showed a reduction in mineral density of the cortical and trabecular bone in CRF patients and more severely in patients under haemodialysis than those under peritoneal dialysis.

Mandibular radiomorphometric parameters of women with cemento-osseous dysplasia

OBJECTIVE

To compare the radiomorphometric parameters of mandibular trabecular and cortical bone of females with and without cemento-osseous dysplasia (COD).

METHODS

A retrospective cross-sectional paired study was conducted. Digital panoramic radiographs were obtained from females diagnosed in a public service of Oral Medicine. The participants were divided into two groups of 50 subjects each: females with a diagnosis of COD (COD group) and females without a diagnosis of COD (non-COD group), randomly chosen from the image database and paired for age. The radiomorphometric parameters analyzed were: mandibular cortical width (MCW), fractal dimension (FD) and mandibular cortical index (MCI). The paired t-test and Wilcoxon test were used to compare MCW and FD values and the McNemar-Bowker test compared the MCI.

RESULTS

The mean age of both groups was 46.84 ± 11.38 years. The median MCW index was 3.12 mm (2.15-4.55) for the COD group and 3.52 mm (1.90-4.70) for the non-COD group (p = 0.034). The mean FD value of the COD group (1.2039 ± 0.0926) was lower than that of the non-COD group (1.2472 ± 0.0894) in the anatomical region of the interest of mandibular cortical bone (p = 0.031), while no difference was detected in alveolar trabecular bone. The C3 degree of MCI was more frequent in the COD group (p = 0.009).

CONCLUSION

Females with COD had lower values of radiomorphometric parameters in mandibular cortical bone than females of the same age without COD. These results suggest that, in addition to the dental care recommended in the literature, COD females also require more attention and screening for low bone mineral density.

Evaluation of the mandibular trabecular bone in patients with bruxism using fractal analysis

OBJECTIVE

The aims of this study were (1) to investigate the effect of bruxism on the fractal dimension (FD) of the mandibular trabecular bone through digital panoramic radiographs, and (2) to evaluate the effectiveness of fractal analysis as a diagnostic test for bruxism.

METHODS

One hundred and six bruxer and 106 non-bruxer patients were included in the study. Three bilateral regions of interest (ROI) were selected: ROI-1, the mandibular condyle; ROI-2, the mandibular angle; ROI-3, the-area between the apical regions of the mandibular second premolar and the first molar teeth. FD values for the bruxer and non-bruxer groups were compared for each ROI.

RESULTS

Only the FD measurements for the right mandibular condyle (ROI-1) showed a statistically significant difference (p = 0.041) between the bruxer and non-bruxer individuals. FD values measured in the bruxers (1.40 ± 0.09) were lower than in the non-bruxers (1.42 ± 0.08).

CONCLUSION

Fractal analysis may be a useful method for discerning trabecular differences in the condylar areas of bruxer individuals. In future studies, the unilateral mastication habits, the characteristics of dental wear, and the occlusal bite forces of individuals should be documented.

Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan's syndrome: a STROBE-compliant case-control study

Sheehan's syndrome (SHS) is a rare condition related to the risk of osteoporosis and evaluation of bone texture imaging features on panoramic radiographs would be suitable for this condition, which was the aim of the present study. Fractal dimension, lacunarity, and trabecular morphologic aspects were significantly altered in these patients.

INTRODUCTION

SHS is an important public health problem particularly in developing countries. It is characterized as postpartum hypopituitarism secondary to obstetric complications-related ischemic pituitary necrosis that shows significant systemic metabolic repercussions. Thus, this study aimed to evaluate bone texture parameters in digital panoramic radiographs of patients with SHS.

METHODS

A case-control study was conducted with 30 SHS patients from an Endocrinology and Diabetology Service of reference in Brazil, and 30 age- and sex-matched healthy controls. A custom computer program measured fractal dimension, lacunarity, and some morphologic features in the following mandibular regions of interest (50 × 50 pixels): below the mental foramen (F1), between the first and second molars (M1), and at the center of the mandibular ramus (R1).

RESULTS

The fractal analysis showed a statistically significant difference between the studied groups in all regions of interest. The fractal dimension in F1 (p = 0.016), M1 (p = 0.043), and R1 (p = 0.028) was significantly lower in SHS group, as well as lacunarity in R1 (p = 0.008). Additionally, several morphologic features were statistically significant in the SHS group (p < 0.05).

CONCLUSION

Therefore, individuals with SHS showed altered imaging texture parameters on panoramic radiographs, which reflect a smaller spatial organization of the bone trabeculae and, possibly, a state of reduced mineral bone density.

Comparison of skeletal changes related to patients with chronic kidney disease and healthy individuals in digital panoramic radiography

Background

Chronic kidney disease (CKD) is a prevalent condition affecting bone metabolism. Bone changes in CKD patients also known as renal osteodystrophy happen due to disorders in the regulation of water and electrolytes caused by the disease. The aim of this study is to investigate the bone changes of CKD stages 3-5 patients without dialysis using digital panoramic radiography.

Materials and Methods

In this cross-sectional study, panoramic radiographs were obtained from 30 patients with CKD stages 3-5 and 30 age and gender matched healthy individuals. The mean values of quantitative parameters such as mental index (MI), panoramic mandibular index (PMI), and antegonial index (AI) were measured and qualitative parameters such as mandibular cortical index (MCI) and trabecular bone pattern (TP) were recorded based on Kelemetti and Lindh calcifications, respectively. Statistical analysis was performed using t-test, Chi-square, and Mann-Whitney test (α = 0.05).

Results

The mean values of MI, PMI, and AI in the two groups were not statistically significant (P > 0.05). MCI and TP were significantly different between the two groups. MCI showed more defects in mandibular cortex of CKD patients (6.7% of patients vs. 0% of control group were C₃, P = 0.038), and TP showed more porosity in mandibular bone of CKD patients (10% of patients vs. 0% of control group were sparse, P = 0.001).

Conclusion

The amount of MI, PMI, and AI were not related to CKD. While MCI and TP were significant parameters that showed mandibular cortical situation and trabecular bone pattern, they assess osteoporosis level in a more reliable manner in CKD stages 3-5 patients without dialysis.

Use of fractal analysis in dental images: a systematic review

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.

Alendronate improves bone density and type I collagen accumulation but increases the amount of pentosidine in the healing dental alveolus of ovariectomized rabbits

BACKGROUND

It has been shown that the oral aminobisphosphonate sodium alendronate (ALN) therapy reduces the risk of main fractures in osteoporotic women, but its effect on the jaw bones is poorly known. Here, we hypothesized that ALN affects the newly formed alveolar bone, particularly the quality of the type I collagen cross-linking.

METHODS

Osteoporosis was induced by ovariectomy (OVX) in 6-month old rabbits. Six weeks following surgery, eight animals were treated by oral gavage with ALN (OVX + ALN) and ten received placebo (OVX + Pbo). Another six rabbits which were sham operated also received placebo (SHAM + Pbo). One month following the beginning of treatment, the upper and lower left first premolars were removed. Six weeks later, the upper and the lower right first premolars were also extracted. One month after the second extraction, biopsies were collected from the maxillary extraction sites and collagen crosslinks were analyzed in the newly formed bone tissue by HPLC. Also, at this time, mandibular bone segments were subjected to μCT.

RESULTS

Animals treated with ALN achieved a roughly 2-time greater bone volume fraction value at a late healing period than animals in the other groups (p < 0.05). Collagen mean results were 2- to 4-times superior in the OVX + ALN group than in the control groups (p < 0.05). ALN-treated animals presented higher amounts of the non-enzymatic collagen cross-link pentosidine (PEN) than the sham-operated rabbits (p < 0.05), whereas the OVX + Pbo group presented the highest amount of PEN (p < 0.05).

CONCLUSION

Alendronate increases bone volume and collagen accumulation, but does not fully rescue the non-osteoporotic alveolar tissue quality as is evident from the increased quantity of pentosidine.

Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis

OBJECTIVE

This study aimed to evaluate the radiomorphometric indexes and fractal dimension (FD) on dental panoramic radiography (DPR) of Thalassemia Major (TM) patients.

METHODS

In 59 TM patients and in 59 healthy control subjects, mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), and FD of four different regions (FD1-4) were evaluated and compared using DPRs.

RESULTS

The distribution of MCI in TM patients was similar to control subjects (p > 0.05). The mean MCW was significantly lower in TM patients (p = 0.001). There was no significant difference in PMI between TM patients and control subjects. The mean of FD measured in the supracortical area above the angle of mandible (FD2), in the anterior to the mental foramen (FD4) and mean FD of four different regions was significantly lower in TM patients (p = 0.003, p = 0.001, and p = 0.014, respectively).

CONCLUSIONS

The radiomorphometric indices and fractal dimensions evaluated in the panoramic radiograph are capable of identifying thalassemia patients' jaw bone, and the results of DPR scanning can be used to refer these patients to appropriate medical investigation.

Effect of a Papain-based Chemomechanical Agent on Structure of Dentin and Bond Strength: An in vitro Study

Aim

To evaluate the microtensile bond strength of teeth restored with packable composite after removing caries with three chemomechanical caries removal agents (Carisolv, Papacarie and Carie-care) and also to analyze its effect on chemical composition of dentin using energy-dispersive X-ray (EDX) analysis.

Design

A total of 40 carious molars with 1 to 1.5 mm of remaining dentin were selected and divided into four groups of 20 each. Group I (control)—bur, group II—Carisolv, group III—Papacarie, group IV—Carie-care. A total of 15 samples from each group were restored with composite; 1 mm thick sections were made and were debonded under tensile load. Remaining five samples from each group were subjected to EDX for elemental analysis of dentin surface.

Results

No statistically significant difference in the bond strength values and Ca/P ratio was observed between control group and three chemomechanical agents tested in the study.

Conclusion

None of the chemomechanical agents tested in the study adversely affected the bond strength of composite resin to caries-affected dentin. Therefore, newer papain-based chemomechanical agent Carie-care can be considered as an equally effective economical alternative to commonly used agents Carisolv and Papacarie.

How to cite this article: Nair S, Nadig RR, Pai VS, Gowda Y. Effect of a Papain-based Chemomechanical Agent on Structure of Dentin and Bond Strength: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):161-166.

Prevalence of Deleterious Oral Habits among 3- to 5-year-old Preschool Children in Bhubaneswar, Odisha, India

Aim

Oral habits during and beyond preschool age are one of the important etiological factors in developing malocclusion and other ill effects on orofacial structures. The objective of the present study was to know the prevalence of deleterious oral habits among 3- to 5-year-old preschool children in Bhubaneswar, Odisha, India.

Materials and methods

This cross-sectional study was conducted among preschool children, in the age group of 3 to 5 years in the city of Bhubaneswar, Odisha, India. To carry out this study, six private schools, two from each of the three electoral constituency, were selected using cluster sampling technique. A total of 500 students, studying in LKG and UKG and their respective mothers/caregivers were selected for the study as per the inclusion/exclusion criteria. Prevalence of different oral habits in children was calculated from the data obtained. Using Statistical Package for the Social Sciences (SPSS), version 17.0 software, Chi-square test was applied to compare the differences present between boys and girls and their significant values (p < 0.05).

Results

The result of this study showed a high prevalence of oral habits (36%) among preschool children in Bhubaneswar, Odisha, India. Lip biting was found to be the most prevalent habit (13.4%), followed closely by thumb sucking (12.8%), bruxism (12.8%), and mouth breathing (11%).

Conclusion

The study revealed a great dearth of a well-established dental education program for preschool children as well as their parents, caretakers, teachers, and pediatricians in order to provide an effective and timely care to the children.

How to cite this article: Dhull KS, Verma T, Dutta B. Prevalence of Deleterious Oral Habits among 3- to 5-year-old Preschool Children in Bhubaneswar, Odisha, India. Int J Clin Pediatr Dent 2018;11(3):210-213.

A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study

Objectives

The objective of this in vitro study was to assess the surface hardness through Vickers hardness (VH) test of one conventional hybrid resin composites (Filtek Z350), compared with that of two bulk cure resin composites (SDR™, Tetric N Ceram®).

Materials and methods

Twenty specimens of each material were prepared in cylindrical aluminum molds with an internal diameter of 5 mm and depth of 4 mm, 10 (incremental curing) and 10 (bulk curing).

The surface of each specimen was covered with a transparent plastic matrix strip before light curing with conventional visible light for 40 seconds. The specimens thus obtained were stored in deionized water and transferred to an incubator at 37°C for 24 hours to simulate clinical conditions. After 24 hours, the microhardness of each specimen was measured using a Vickers indenter, with a load of 100 gm and dwell time of 15 seconds (HV 0.2/40).

The specimens were further subjected to VH test in an interval of 7, 30, and 90 days. The data were subjected to statistical analysis—Student’s t test, analysis of variance, and post hoc Tukey’s test.

Results

The present study showed that SDR™ in bulk curing showed consistently greater value of hardness and was comparable to traditional incremental cured Filtek Z350, highlighting the advantages of the new SDR technology.

How to cite this article: Sarma A, Nagar P. A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):183-187.

A Comparative Study to evaluate Parent's Ability to assess Dental Fear in their 6- to 10-year-old Children using Children's Fear Survey Schedule-Dental Subscale

Aim

Parental presence often provides unique challenge in dental operatory and is directly related to the quality dental treatment. The present study was done to investigate parent's ability to assess dental anxiety of their 6- to 10-year-old child and to determine how parent's and children's fear assessments correlate with each other.

Materials and methods

Prior to dental treatment, 94 child-parent combinations were included to complete Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire, and Frankl score was assigned to children during treatment by operator.

Results

Mean dental anxiety score reported by the children was 27.74, whereas by their parents was 39.64. There was a poor consistency of parents to predict their child dental fear (p < 0.05). Parents reported higher dental fear for their children.

Conclusion

Parents assessment of their child's fear may vary in accordance to factors, including their own dental fear. Such input may prevent dentists from establishing an accurate association with the child's patient.How to cite this article: Malhotra R, Gandhi K, Kumar D, Ahuja S, Kapoor R, Sahni A. A Comparative Study to evaluate Parent's Ability to assess Dental Fear in their 6- to 10-year-old Children using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 2018;11(3):205-209.

Mandibular indexes and fractal properties on the panoramic radiographs of the patients using aromatase inhibitors

OBJECTIVE:

This study was conducted to evaluate fractal dimension (FD), mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI) on panoramic radiographs to determine the mandibular cortical and trabecular bone changes in females with breast cancer undergoing aromatase inhibitors (AIs) treatment.

METHODS:

In this retrospective study, FD analysis, PMI, MCI, and MCW were assessed over panoramic radiographs of 34 females under AI therapy as a patient group and 34 healthy age-gender matched individuals as a control group.

RESULTS:

Mean FD values and MCW were slightly but not significantly lower in the patient group (1.47 ± 0.06 and 4.1 ± 1.2 respectively). FDs measured onthe supracortical area above the angulus mandibula (FD2) and anterior to the mental foramen (FD4) were significantly lower in patients (p = 0.037 and p = 0.046 respectively). Among the measured regions in patients, FD2 was significantly lower (p = 0.001). PMI was also significantly lower in patients (p = 0.001) and MCI were similar in both groups (p = 0.604).

CONCLUSION:

AI use affects bone quality and evaluating FD, PMI, and MCW in panoramic radiography can be used to determine the effect of this drug on the jaw bones in the early period.

ADVANCES IN KNOWLEDGE:

Aromatase inhibitors are the most commonly used drugs in breast cancer patients. This drug is thought to have osteoporotic effects on the jawbone. This study is the first study to evaluate osteoporotic changes with measurements made on panoramic radiographs and the results of the study are significant. We think this study will shed light on the studies that will investigate the effects of the drug on the jaw bones.

Accelerating Treatment of Skeletal Class II Malocclusion using Fixed Twin Block Appliances

Background

Patients with class II malocclusion generally seek orthodontic treatment for esthetic concern. Various myo-functionl appliances can be used for the treatment of skeletal as well as the dental malocclusion in a growing patient. Among various functional appliances, twin block appliance is most commonly used due to better patient compliances. It redirects the mandibular growth to correct the maxillomandibular relationship, enhancing facial esthet ics. This article presents a modified design of the twin block appliance which is less bulky, more esthetic, can be used concurrently with fixed orthodontic appliance, and is easily accepted by uncooperative patients.

Case summary

An 11-year-old-boy, who presented himself with a skeletal class II malocclusion, was treated with simultaneous use of fixed twin block along with fixed orthodontic appliance to correct both the skeletal and dental malocclusion. The twin block design was modified to have a better compatibility with the fixed orthodontic appliance.

How to cite this article: Pattanaik S, Puvvula N, Mohammad N. Accelerating Treatment of Skeletal Class II Malocclusion using Fixed Twin Block Appliances. Int J Clin Pediatr Dent 2018;11(2):146-150.

A Case of Painless Excision

Soft tissue lesions of the oral cavity are seen in children at the dental office. This case report aims to showcase the ability of laser to treat recurrent soft tissue lesions in the oral cavity in a painless manner. This painless procedure provides relief to the child and parent who suffer from anxiety toward dental treatment.

How to cite this article: Suyash IA, Bhatia R. A Case of Painless Excision. Int J Clin Pediatr Dent 2018;11(2):135-140.

Customized Hybrid Bluegrass Appliance: An Innovative Technique

Oral habits in the form of thumb sucking and tongue thrusting are commonly learned patterns of behavior seen in preschool children and they are associated with anxiety, fear, hunger, oral pressure, and sleep. Chronic practice can cause dentoalveolar, perioral problems, and atypical root resorption (ARR) of anterior primary teeth. The ARR is provoked by the thumb sucking habit, and leads to early loss of anterior primary teeth. The early loss of anterior tooth may result in speech and masticatory problems, and psychological disturbance to the child. Hence, pediatric dentists play a crucial role in giving necessary information to parents and guardians. Starting from counseling to appliance therapy, various treatment modalities have been reported in the literature. One of them is bluegrass appliance; it is a nonpunitive habit reminder therapy. The present case report describes a customized hybrid bluegrass appliance designed to eliminate thumb sucking and tongue thrusting habit, and to perform as an esthetic functional space maintainer. How to cite this article: Mohammad Z, Bagalkotkar A, Mishra A, Veerala G. Customized Hybrid Bluegrass Appliance: An Innovative Technique. Int J Clin Pediatr Dent 2018;11(2):141-145.

Salivary Cortisol and Alpha-amylase-Biomarkers of Stress in Children undergoing Extraction: An in vivo Study

Aim

The anxiety of dental procedure evokes physiological response in the human body similar to fear. The level of cortisol and alpha-amylase in saliva can be considered as one of the major biomarkers of stress and anxiety. Our study was aimed to correlate the stress and anxiety with the levels of salivary cortisol (SC) and salivary alpha-amylase (SAA) in patients undergoing routine dental extraction.

Materials and methods

The levels of SC and SAA were assessed pre- and postextraction in the salivary samples of 20 children.

Results

The values of cortisol and alpha-amylase showed a significant increase postextraction.

Conclusion

Salivary cortisol and SAA can be considered an important and noninvasive tool for assessment of anxiety, such as dental extraction, in children.

Clinical significance

Increase in the stress levels of a child in the dental operatory procedures like tooth extraction suggests the use of some behavior modification and shaping techniques by dentists to overcome the anxiety of the child before commencement of the procedure. This can aid in better cooperation of the child during treatment as well as helps in internal motivation toward future dental treatment.

How to cite this article: Chaturvedi Y, Chaturvedy S, Marwah N, Chaturvedi S, Agarwal S, Agarwal N. Salivary Cortisol and Alpha-amylase—Biomarkers of Stress in Children undergoing Extraction: An in vivo Study. Int J Clin Pediatr Dent 2018; 11(3):214-218.

Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis

Introduction

The principal goal of dentistry is to maintain and improve the quality of life of the dental patients. As many of these objectives require the replacement or alterations of the existing tooth structure, the main challenge for centuries has been the development and selection of biocompatible materials that can withstand the unique conditions of the oral environment.

Finite element analysis (FEA) is a modern technique of numerical stress analysis that has become a solution to the task of predicting failure due to unknown stresses by showing problem areas in a material and allowing designers to see all of theoretical stresses within.

Aims and objectives

To evaluate and compare the effect of various temperature changes on the stress distribution, in class II mesial-occlusal-distal (MOD) cavity when restored with different restorative materials, using the finite element method (FEM).

Materials and methods

Using FEA, various thermal stresses generated in class II MOD lesion using different restorative materials were studied.

Results

The computer-generated models of intact tooth and teeth restored with the different restorative materials were designed, and thermal stress at different temperatures was observed when subjected to the thermal loads of 5°C, 20°C, 36°C, and 55°C. From the results of the study, it can be concluded that glass ionomer cement (GIC) performed best, followed by intact tooth, composite resin, silver amalgam, and zinc oxide eugenol cement.

Conclusion

Restoration of class II MOD lesions with materials of lower modulus of elasticity and lower coefficient of thermal expansion will enable better stress distribution.

How to cite this article: Srivastava B, Devi NN, Gupta N, Singh R. Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis. Int J Clin Pediatr Dent 2018;11(3):167-170.

Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals

Introduction

Dissolution of the enamel in the form of erosion has increased due to shift in eating habits toward carbonated drinks like soft drink and chocolates.

Aim

The purpose of this study was to evaluate changes in the salivary pH after intake of different eatables and beverages in children at different time intervals.

Study design

Using standard salivary tests, this study was conducted as a case-control study. Fifty children between ages of 8 and 12 years having strict vegetarian diet were included in the study.

Materials and methods

Oral prophylaxis was done and salivary buffer capacity for stimulated saliva was measured. Before the saliva collection, each of the children was informed not to eat or drink anything for up to 2 hours just before the appointment.

Results

On pairwise evaluation, all the differences were found to be significant statistically except between baseline vs 30 minutes. Maximum mean difference was calculated and observed between baseline and immediately after intake of fruit juice and immediate after 30 minutes, 0.953 and 0.963 respectively, while minimum difference was calculated and observed between baseline and 30 minutes after intake of fruit juice (0.010).

Conclusion

Maximum drop was seen in cold drink when compared with fruit juice. The maximum pH increase was observed in cream biscuits with 7.63 ± 0.20. It was observed that in all the groups, the pH gradually got back to near normal levels due to the buffering mechanism of saliva.How to cite this article: Pachori A, Kambalimath H, Maran S, Niranjan B, Bhambhani G, Malhotra G. Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals. Int J Clin Pediatr Dent 2018;11(3):177-182.