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Gaudin R, Otto W, Ghanad I, Kewenig S, Rendenbach C, Alevizakos V, Grün P, Kofler F, Heiland M, von See C. Enhanced Osteoporosis Detection Using Artificial Intelligence: A Deep Learning Approach to Panoramic Radiographs with an Emphasis on the Mental Foramen. Med Sci (Basel) 2024; 12:49. [PMID: 39311162 PMCID: PMC11417815 DOI: 10.3390/medsci12030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 09/01/2024] [Accepted: 09/18/2024] [Indexed: 09/26/2024] Open
Abstract
Osteoporosis, a skeletal disorder, is expected to affect 60% of women aged over 50 years. Dual-energy X-ray absorptiometry (DXA) scans, the current gold standard, are typically used post-fracture, highlighting the need for early detection tools. Panoramic radiographs (PRs), common in annual dental evaluations, have been explored for osteoporosis detection using deep learning, but methodological flaws have cast doubt on otherwise optimistic results. This study aims to develop a robust artificial intelligence (AI) application for accurate osteoporosis identification in PRs, contributing to early and reliable diagnostics. A total of 250 PRs from three groups (A: osteoporosis group, B: non-osteoporosis group matching A in age and gender, C: non-osteoporosis group differing from A in age and gender) were cropped to the mental foramen region. A pretrained convolutional neural network (CNN) classifier was used for training, testing, and validation with a random split of the dataset into subsets (A vs. B, A vs. C). Detection accuracy and area under the curve (AUC) were calculated. The method achieved an F1 score of 0.74 and an AUC of 0.8401 (A vs. B). For young patients (A vs. C), it performed with 98% accuracy and an AUC of 0.9812. This study presents a proof-of-concept algorithm, demonstrating the potential of deep learning to identify osteoporosis in dental radiographs. It also highlights the importance of methodological rigor, as not all optimistic results are credible.
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Affiliation(s)
- Robert Gaudin
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (R.G.); (W.O.); (I.G.); (S.K.); (C.R.); (M.H.)
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Wolfram Otto
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (R.G.); (W.O.); (I.G.); (S.K.); (C.R.); (M.H.)
| | - Iman Ghanad
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (R.G.); (W.O.); (I.G.); (S.K.); (C.R.); (M.H.)
| | - Stephan Kewenig
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (R.G.); (W.O.); (I.G.); (S.K.); (C.R.); (M.H.)
| | - Carsten Rendenbach
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (R.G.); (W.O.); (I.G.); (S.K.); (C.R.); (M.H.)
| | - Vasilios Alevizakos
- Center for Digital Technologies in Dentistry and CAD/CAM, Danube Private University, 3500 Krems an der Donau, Austria;
| | - Pascal Grün
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, 3500 Krems an der Donau, Austria;
| | - Florian Kofler
- Helmholtz AI, Helmholtz Zentrum München, Ingostaedter Landstrasse 1, 85764 Oberschleissheim, Germany;
- TUM—Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Max Heiland
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (R.G.); (W.O.); (I.G.); (S.K.); (C.R.); (M.H.)
| | - Constantin von See
- Center for Digital Technologies in Dentistry and CAD/CAM, Danube Private University, 3500 Krems an der Donau, Austria;
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Möst T, Winter L, Ballheimer YE, Kappler C, Schmid M, Adler W, Weber M, Kesting MR, Lutz R. Prevalence of carotid artery calcification detected by different dental imaging techniques and their relationship with cardiovascular risk factors, age and gender. BMC Oral Health 2023; 23:949. [PMID: 38037004 PMCID: PMC10691106 DOI: 10.1186/s12903-023-03564-0] [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: 07/10/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Atherosclerosis and its secondary diseases display a major threat to patient's health. Sequelae, like carotid artery calcification (CAC), usually develop over decades and remain asymptomatic for a long time, making preventive measures to reduce mortality and morbidity extremely important. Through panoramic radiography (PR) and cone beam computed tomography (CBCT), dentists may have helpful tools in aiding the holistic care of patients. In this context, the correlation of atherosclerotic risk factors and CAC development have not yet been sufficiently investigated. Thus, the aim of this observational radiological study was to evaluate the diagnostic value of PR compared with CBCT for the detection of CAC in patients older than 60 years. The radiological findings were correlated with gender, age, and cardiac risk factors. METHODS PRs and CBCTs of N = 607 patients were used for the qualitative analysis and compared. Basic patient information such as age, gender, body mass index (BMI), smoking history as well as patient's detailed medical history, including heart disease and cardiovascular risk factors such as hypercholesterolemia, arterial hypertension and diabetes mellitus type II were documented and their relation to CAC provided by radiological data was estimated in the form of odds ratios (OR), which were calculated using logistic regression models. Proportions of CAC in different risk groups were compared using Fisher's exact test, the significance level was set to α ≤ 0.05. The interrater reliability of two physicians was estimated using Cohen's kappa. RESULTS With an accuracy of 90.6%, a sensitivity of 67.5% and a specificity of 99.5% compared to CBCT, PR was a reliable method for the diagnosis of CAC. The overall detection rate for CAC was 27.8% across all age groups. Age (OR: 1.351; p = 0.021), the male sex (OR: 1.645; p = 0.006), arterial hypertension (OR: 2.217; p = < 0.001), heart disease (OR: 1.675; p = 0.006), hypercholesterolemia (OR: 1.904; p = 0.003) and chronic obstructive pulmonary disease (OR: 2.016; p = 0.036) were statistically significant risk factors. When correlated, neither history of stroke nor nicotine abuse showed any statistical significance. CONCLUSIONS Due to the capabilities of PR in the diagnosis of CAC, dentists can play a vital role in the early diagnosis of vascular disease. Awareness should therefore be raised among dentists regarding the detection of CAC in patients over 60 years of age, with a particular focus on those with arterial hypertension and hypercholesterolaemia.
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Affiliation(s)
- Tobias Möst
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.
| | - Linus Winter
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Yili Elisabeth Ballheimer
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Christian Kappler
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Magdalena Schmid
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology (IMBE), University of Erlangen- Nuremberg, Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
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Teterina A, Niratisairak S, Morseth B, Bolstad N. General and local predictors of mandibular cortical bone morphology in adult females and males: the seventh survey of the Tromsø Study. Clin Oral Investig 2023; 27:6577-6587. [PMID: 37735212 PMCID: PMC10630240 DOI: 10.1007/s00784-023-05263-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES To analyze factors predicting mandibular cortical width (MCW) and mandibular cortical index (MCI) in adult females and males. MATERIAL AND METHODS Data on 427 females and 335 males aged 40-84 from The Tromsø study: Tromsø7 were used. T-score, age, menopausal status (for females), remaining teeth, and periodontal status were analyzed in linear and logistic regression analyses as predictors of MCW and MCI, respectively. RESULTS T-score, age, and the number of remaining teeth significantly predicted MCW in females but not males. Standardized β coefficients were 0.286, -0.231, and 0.131, respectively. The linear regression model explained 24% of MCW variation in females. MCI in females was significantly predicted by T-score, age, and remaining teeth with the Wald values of 9.65, 6.17, and 5.83, respectively. The logistic regression model explained 16.3-23% of the variation in MCI in females. In males, T-score was the only significant predictor of the eroded cortex, and the logistic model explained only 4.3-5.8% of the variation in MCI. CONCLUSIONS The T-score demonstrated a stronger relationship with MCW and MCI than other factors in females, which supports the usefulness of those indices for osteoporosis screening. Conversely, the T-score exhibited no association with MCW and remained the only significant predictor of MCI in males, yet to a lesser extent than in females. CLINICAL RELEVANCE Understanding factors affecting mandibular cortical morphology is essential for further investigations of MCW and MCI usefulness for osteoporosis screening in females and males.
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Affiliation(s)
- Anna Teterina
- Department of Clinical Dentistry, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.
| | - Sanyalak Niratisairak
- Department of Orthopaedics, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Biomechanics Laboratory, Rikshospitalet, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Bente Morseth
- School of Sport Sciences, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Napat Bolstad
- Department of Clinical Dentistry, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
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Çitir M, Karslioglu H, Uzun C. Evaluation of mandibular trabecular and cortical bone by fractal analysis and radiomorphometric indices in bruxist and non-bruxist patients. BMC Oral Health 2023; 23:522. [PMID: 37491268 PMCID: PMC10369695 DOI: 10.1186/s12903-023-03245-y] [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: 03/14/2023] [Accepted: 07/20/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effect of bruxism on the cortical and trabecular bone of the mandible using the radiomorphometric indexes and fractal analysis (FA) additionally to examine the efficiency of FA as diagnostic test for bruxism. METHODS Evaluation was performed on panoramic radiographs of 94 bruxists and 94 non-bruxist individuals with the ImageJ program. Cortical bone was assessed with mandibular cortical index, mental index, and panoramic mental index. Trabecular bone in the condyle, gonial, and corpus region was evaluated by FA. An independent sample t and Mann-Whitney-U tests and Pearson and Spearman rank correlations were conducted for statistical analysis. RESULTS A total of 188 participants, 112 female, and 76 male, were included in the study. The sample age ranged from 18 to 43, with a mean of 27.55 (± 7.022) years. FA values of the angulus were significantly higher than those of the condyle and corpus, and the mean of the sample for the angulus, condyle, and corpus, respectively, were; 1.36 (± 10), 1.10 (± 0.9), 1.13 (± 0.8). There was a positive correlation between FA of the mandibular corpus and age (r = .163, p = .025). Females' values were smaller than males' in the FAs of three regions, and significant differences were found in FA of the condyle and angulus of the mandible, MCI, and PMI according to gender. There was no statistically significant difference between bruxist and non-bruxist patients in term of FAs of three regions, MCI, MI, and PMI values (p > .05). CONCLUSIONS FA of the condyle and angulus of the mandible, MCI, and PMI are significantly affected by gender. However bruxism doesn't cause a significant change in the fractal dimensions of the bone in the mandible and doesn't change substantially MCI, MI, and PMI.
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Affiliation(s)
- Mesude Çitir
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Tokat Gaziosmanpasa University, Tokat, Turkey.
| | - Hazal Karslioglu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, University of Baskent, Ankara, Turkey
| | - Canan Uzun
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, University of Health Sciences, İstanbul, Turkey
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Teterina A, Niratisairak S, Morseth B, Bolstad N. Diagnostic efficacy of radiomorphometric indices for predicting osteoporosis in a Norwegian population in the Tromsø Study: Tromsø7. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:444-455. [PMID: 36517373 DOI: 10.1016/j.oooo.2022.10.039] [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: 04/08/2022] [Revised: 09/22/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the diagnostic efficacy of the radiomorphometric indices of mandibular cortical width (MCW) and mandibular cortical index (MCI) of cortical erosion for osteoporosis screening in adults (≥40 years) and older adults (≥65 years) to determine whether adding a fracture risk assessment tool (FRAX) would improve efficacy. STUDY DESIGN One observer measured MCW and assessed MCI on dental panoramic radiographs acquired for patients in the Tromsø study. These indices, alone and with FRAX scores, were evaluated for efficacy in predicting osteoporosis, which was diagnosed by bone density measurement at the femoral necks with dual-energy X-ray absorptiometry. RESULTS MCW ≤3 mm and MCI indicating heavily eroded cortices (C3) had accuracies of 68.8% and 83.6%, respectively, in identifying osteoporosis. In females >65 years, MCW ≤3 mm and C3 produced higher sensitivities but lower specificities, with slightly lower accuracies (61.4% and 79.8%, respectively) compared with all females. The addition of FRAX scores >15% improved the accuracy of MCW ≤3 mm (81.7%) and C3 (87.9%), resulting in high specificity (86.6% and 95.4%). Combining MCW ≤3 mm or C3 with FRAX >15% increased the probabilities of detecting osteoporosis by increasing positive likelihood ratios. CONCLUSIONS MCW ≤3 mm or MCI C3, when combined with FRAX >15%, showed superior diagnostic efficacy, with high specificity in detecting females without osteoporosis.
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Affiliation(s)
- Anna Teterina
- Department of Clinical Dentistry, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Sanyalak Niratisairak
- Department of Orthopedics, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bente Morseth
- School of Sport Sciences, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Napat Bolstad
- Department of Clinical Dentistry, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.
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Triantafyllopoulos G, Mitsea A, Rontogianni A, Korres D. Osteoporosis Screening Using Dental Panoramic Radiographs and Age at Menarche. Diagnostics (Basel) 2023; 13:881. [PMID: 36900024 PMCID: PMC10000716 DOI: 10.3390/diagnostics13050881] [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: 02/08/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
Since early detection of osteoporosis is essential, the development of an efficient and cost-effective screening model would be incredibly beneficial. The aim of this study was to evaluate the diagnostic accuracy of MCW and MCI indices from dental panoramic radiographs in combination with a new variable, age at menarche, for the detection of osteoporosis. The study enrolled 150 Caucasian women (aged 45 to 86) who met the eligibility criteria, had DXA scans of the left hip and lumbar spine (L2 to L4), and were classified as osteoporotic, osteopenic, or normal based on T-score. Two observers evaluated MCW and MCI indexes on panoramic radiographs. There was a statistically significant correlation between the T-score and MCI and MCW. In addition, age at menarche had a statistically significant correlation with T-score (p = 0.006). In conclusion, in the current study, MCW proved to be more effective in detecting osteoporosis when combined with age at menarche. Individuals with MCW less than 3.0 mm and age at menarche later than 14 years old should be referred for DXA since they present high risk of osteoporosis.
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Affiliation(s)
| | - Anastasia Mitsea
- Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aliki Rontogianni
- Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Demitrios Korres
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Slaidina A, Springe B, Abeltins A, Uribe SE, Lejnieks A. The Effect of General Bone Mineral Density on the Quantity and Quality of the Edentulous Mandible: A Cross-Sectional Clinical Study. Dent J (Basel) 2023; 11:dj11010017. [PMID: 36661554 PMCID: PMC9858291 DOI: 10.3390/dj11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Osteoporosis is a disease which is characterized by a decrease in general bone mineral density (BMD), resulting in decreased bone strength and an increased risk of bone fractures. The effect of reduced BMD on the jawbones is still not fully understood. The purpose of the study was to evaluate the impact of BMD on the quality and quantity of the edentulous mandible. METHODS The present study included 127 edentulous postmenopausal women who underwent cone beam computed tomography (CBCT) examinations. BMD measurements of the lumbar spine and femoral necks were performed by dual-energy X-ray absorptiometry. In the cross-sectional CBCT images, three different areas of the mandible (lateral incisor, first premolar, and first molar) were selected. The complete mandibular, trabecular, and cortical bone volumes were measured. All measurements were performed on the total mandibular area, and the basal and alveolar parts of the mandible. RESULTS The volume of the cortical bone was reduced for females with reduced BMD in the lateral incisor and first premolar regions, both in the total mandibular area and in the basal part of the mandible. The trabecular bone volume statistically significantly increased when the BMD decreased in the complete mandibular area and the basal part of the mandible (linear regression). The total bone volume significantly decreased with a decrease in BMD in the basal part of the mandible. CONCLUSIONS Reduced BMD has a negative effect on the quantity and quality of bone in the basal part of the edentulous mandible.
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Affiliation(s)
- Anda Slaidina
- Department of Prosthodontics, Riga Stradins University, LV-1083 Riga, Latvia
- Correspondence: ; Tel.: +317-67456043
| | - Baiba Springe
- Department of Prosthodontics, Riga Stradins University, LV-1083 Riga, Latvia
| | - Andris Abeltins
- Department of Orthodontics, Riga Stradins University, LV-1083 Riga, Latvia
| | - Sergio E. Uribe
- Department of Conservative Dentistry and Oral Health, LV-1083 Riga, Latvia
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1083 Riga, Latvia
- School of Dentistry, Universidad Austral de Chile, Valdivia 5110566, Chile
| | - Aivars Lejnieks
- Clinics “Gailezers”, Riga East Clinical University Hospital, LV-1079 Riga, Latvia
- Department of Internal Diseases, Riga Stradins University, LV-1083 Riga, Latvia
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Peculiarities in the panoramic radiograph of patients with secondary hyperparathyroidism due to terminal renal disease: a radiologic controlled comparative study. Oral Radiol 2023; 39:125-132. [PMID: 35511337 PMCID: PMC9813191 DOI: 10.1007/s11282-022-00613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/06/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The present radiological observational controlled study aims to evaluate the impact of secondary hyperparathyroidism (SHPT) due to chronic kidney disease (CKD) as well as the duration of dialysis on the mineralization of the mandible by standardized qualitative evaluation of digital panoramic radiographs. METHODS Panoramic radiographs of CKD patients with SHPT and healthy controls were used for the qualitative analysis of the mandibular cortical index (MCI), the trabecular bone pattern (TBP), and calcification and resorption foci. Radiomorphometric indices were correlated to biochemical parameters and the duration of dialysis using the Spearman Rho test. Group comparisons were conducted using the Mann-Whitney U test and Fisher's exact test at a significance level of α ≤ 0.05. Interrater reliability of two physicians was estimated using Cohen's kappa. RESULTS Inclusion and exclusion criteria were fulfilled by N = 41 patients. Statistically significant differences in the MCI (p < 0.001) as well as the TBP (p = 0.002) could be detected for the experimental group in comparison to the healthy control group. Focusing on calcification and resorption foci, no statistically significant difference could be detected between the groups (p = 0.244). The level of the detected parathyroid hormone (PTH) significantly correlated with TBP (Rho = 0.338; p = 0.031), while no significant relationship between TBP and the duration of the dialysis could be found. CONCLUSIONS Patients with SHPT due to CKD show statistically significant bone changes in the panoramic radiograph, whereby the grade of trabecular bone change correlates to PTH values.
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Barra SG, Arruda JAAD, Souza AF, Brasileiro CB, Camargos BM, Lima EMD, Souza LN, Oliveira MCD, Macari S, Silva TA, Abreu LG, Mesquita RA. Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users. Braz Oral Res 2022; 36:e138. [PMID: 36477215 DOI: 10.1590/1807-3107bor-2022.vol36.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/04/2022] [Indexed: 12/05/2022] Open
Abstract
We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.
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Affiliation(s)
- Sâmila Gonçalves Barra
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery, Pathology and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | - José Alcides Almeida de Arruda
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery, Pathology and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | - Alessandra Figueiredo Souza
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery, Pathology and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | - Cláudia Borges Brasileiro
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery, Pathology and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | | | | | - Leandro Napier Souza
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery, Pathology and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | - Marina Chaves de Oliveira
- Universidade Federal de Minas Gerais - UFMG, Nursing School, Department of Nutrition, Belo Horizonte, MG, Brazil
| | - Soraia Macari
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Restorative Dentistry, Belo Horizonte, MG, Brazil
| | - Tarcília Aparecida Silva
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery, Pathology and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | - Lucas Guimaraes Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Child's and Adolescent's Oral Health, Belo Horizonte, MG, Brazil
| | - Ricardo Alves Mesquita
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery, Pathology and Clinical Dentistry, Belo Horizonte, MG, Brazil
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Santolia DD, Dahiya DS, Sharma DS, Khan DMA, Mohammed DN, Priya DH, Gupta DSR, Bhargava DS, Gupta DSR. Fractal Dimension and Radiomorphometric analysis of Orthopantomographs in patients with tobacco and areca nut associated oral mucosal lesions: a pilot in- vivo study in a North Indian cohort. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:627-638. [DOI: 10.1016/j.oooo.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
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PITOL GA, ALMEIDA RPD, COSER EV, ALBERGARIA BH, GRÃO-VELLOSO TR. Digital panoramic radiography as a tool for analyzing the quality of trabecular bone microarchitecture. REVISTA DE ODONTOLOGIA DA UNESP 2022. [DOI: 10.1590/1807-2577.05022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract Introduction Osteoporosis is a metabolic disease characterized by reduced bone mineral density, often accompanied by loss of quality of trabecular bone microarchitecture. Objective To assess the quality or degradation of trabecular bone microarchitecture in digital panoramic radiography to better predict the risk of fragility fractures. Material and method The sample included 68 female patients, age-matched, and divided into three groups according to densitometric results. Trabecular Bone Score values were measured and digital panoramic radiographs were taken. Fractal analysis with box counting was conducted in the region of premolars and angle of the mandible, with regions of interest measuring 64×64 and 80×120 pixels. In the statistical analysis, Pearson’s correlation was applied between the Trabecular Bone Score and fractal analysis results obtained in each group, using age as a control variable and assigning individualized age ranges within groups. Result A moderate correlation was identified in the regions of interest of 64×64 and 80×120 pixels at the angle of the mandible in the osteoporosis group and in the normal group. A moderate correlation was also obtained using age as a control variable in the 64x64 pixel regions of interest in the premolar region. Considering age range, the within-group analysis presented a strong correlation in the osteoporosis group and moderate correlation in the osteopenia and normal groups. Conclusion Fractal analysis in digital panoramic radiographs was shown to be a promising predictive instrument of bone microarchitecture quality.
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Gassama BC, Ndiaye ML, Lecor PA, Diop S, Toure B. Mandibular bone changes and dental status: A radiomorphometric study by the mandibular cortical index on a Senegalese female population aged 40 years and over. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Slaidina A, Nikitina E, Abeltins A, Soboleva U, Lejnieks A. Gray values of the cervical vertebrae detected by cone beam computed tomography for the identification of osteoporosis and osteopenia in postmenopausal women. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:100-109. [PMID: 34535433 DOI: 10.1016/j.oooo.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 05/18/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to determine whether the gray values (GVs) of the second and third cervical vertebrae in cone beam computed tomography (CBCT) are affected by general bone mineral density (BMD) in postmenopausal women and to evaluate whether CBCT can be used for predicting the risk of osteoporosis. STUDY DESIGN The present cross-sectional study included 127 edentulous postmenopausal women (average age, 70.4 ± 8.9 years) who underwent CBCT examinations. BMD measurements of the lumbar spine and both femoral necks were performed by dual-energy x-ray absorptiometry. The CBCT images were analyzed with OnDemand3D Dental software. GVs of the axial and sagittal sections of the cervical second and third vertebral bodies were obtained. RESULTS The GVs of the second and third cervical vertebrae decreased significantly with decreasing BMD. The axial GV of the second cervical vertebra showed the highest sensitivity (80.6%), highest negative predictive value (89.0%), lowest negative likelihood ratio (0.39), and highest area under the curve value (0.68) to predict osteoporosis. CONCLUSIONS Women with reduced BMD have lower GVs for the second and third cervical vertebrae. Changes in the GV of the second vertebra can potentially be used to determine the risk of osteoporosis in postmenopausal women.
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Affiliation(s)
- Anda Slaidina
- Leading Researcher, Department of Prosthodontics, Riga Stradins University, Riga Stradins University Institute of Stomatology, Riga, Latvia.
| | - Evija Nikitina
- Assistant, Department of Prosthodontics, Riga Stradins University, Riga Stradins University Institute of Stomatology, Riga, Latvia
| | - Andris Abeltins
- Associate Professor, Department of Orthodontics, Riga Stradins University, Riga Stradins University Institute of Stomatology, Riga, Latvia
| | - Una Soboleva
- Professor, Department of Prosthodontics, Riga Stradins University, Riga Stradins University Institute of Stomatology, Riga, Latvia
| | - Aivars Lejnieks
- Professor, Department of Internal Diseases, Riga Stradins University, Riga East Clinical University Hospital, Riga, Latvia
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Author’s response. J Am Dent Assoc 2020; 151:555. [DOI: 10.1016/j.adaj.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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