Mandibular radiomorphometric parameters of women with cemento-osseous dysplasia

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.

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.

Is there an association between proton pump inhibitors and radiomorphometric parameters of the mandible? A preliminary study

OBJECTIVES

This study aimed to analyze the association between the use of proton pump inhibitors (PPIs) and radiomorphometric parameters of trabecular and cortical bone of the mandible.

METHODS

A total of 64 patients (37 females and 27 males) using PPIs (PPI group) and 64 age- and gender-matched healthy individuals (control group) were included in this study. The analyzed radiomorphometric parameters were fractal dimension (FD), mandibular cortical width (MCW), and mandibular cortical index (MCI).

RESULTS

There were no significant differences in the mean FDs of selected regions and MCW between the two groups (p > 0.05). The mean MCW was 1.95 mm in the PPI group and 2 mm in the control group. The MCI C3 category, which represents the most porous state of the mandibular cortex, was 2.5 times more frequent in the PPI group (p = 0.002). PPI use duration did not correlate with FD or MCW. No significant differences were observed in FD, MCW, and MCI distribution according to PPI type (p > 0.05).

CONCLUSIONS

Although not all radiomorphometric parameters indicated osteoporotic effects of PPI use, the mandibular cortex of PPI users is prone to erosive defects.

Differentiation of osteosarcoma from osteomyelitis using microarchitectural analysis on panoramic radiographs

Diagnosing osteosarcoma (OS) is very challenging and OS is often misdiagnosed as osteomyelitis (OM) due to the nonspecificity of its symptoms upon initial presentation. This study investigated the possibility of detecting OS-induced trabecular bone changes on panoramic radiographs and differentiating OS from OM by analyzing fractal dimensions (FDs) and degrees of anisotropy (DAs). Panoramic radiographs of patients with histopathologically proven OS and OM of the jaw were obtained. A total of 23 patients with OS and 40 patients with OM were enrolled. To investigate whether there was a microarchitectural difference between OS lesions and normal trabecular areas in each patient, two regions of interest (ROIs) were located on the CT images. Three microarchitectural parameters (box-counting FD, fast Fourier transform-based FD, and DA) were calculated. For both OS and OM, significant differences were found for all three microarchitectural parameters. Compared to normal trabecular bone, trabecular bone affected by OS and OM became isotropic and more complex. When comparing OS and OM, a statistically significant difference was found only in DA. Trabecular bones affected by OS became more isotropic than those affected by OM. Microarchitectural analysis, especially DA, could be useful for detecting OS-induced trabecular alterations and differentiating OS from OM.

Cone beam computed tomography analysis of mandibular inferior cortical thickness and bone texture in cemento-osseous dysplasia

OBJECTIVE

This study compared mandibular cortical thickness (CTh) and fractal dimension (FD) in patients with cemento-osseous dysplasia (COD) and controls, as measured with cone beam computed tomography.

STUDY DESIGN

In total, 28 female patients with COD and 28 age-matched controls were selected retrospectively. Inferior cross-sectional CTh was measured at the symphysis (sCTh), anterior (aCTh), mental foramen (mfCTh), molar (mCTh), and posterior (pCTh) regions. The alternate measurement of mean CTh of the volume including buccal, lingual, and inferior cortices between the mental foramina (alternate CTh) was measured in ImageJ. FD was calculated in cortical and trabecular bone. Data were analyzed for significance of differences in CTh and FD between patient groups and for correlation of inferior and alternate CTh measurements.

RESULTS

Inferior CTh values were lower overall in the patients with COD than in the controls (P = .01), specifically at sCTh, mCTh, and pCTh (P ≤ .042). Alternate CTh was also significantly lower in the COD group (P = .005). There was a significant correlation between inferior and alternate CTh measurements (r = 0.636, P < .001). No significant differences were observed in cortical or trabecular FD between groups (P ≥ .072).

CONCLUSIONS

Female patients with COD had significantly lower inferior and alternate CTh than healthy controls. Both groups had similar cortical and trabecular bone textures.

Cemento-osseous dysplasia: clinical presentation and symptoms

Objectives

The purpose of this study was to evaluate risk factors and symptoms in cemento-osseous dysplasia (COD) patients.

Materials and Methods

In this study, 62 patients who were diagnosed histologically with COD were investigated from 2010 to 2020 at the author's institution. We compared clinical and radiological characteristics of symptomatic and asymptomatic patients. The factors were sex, age, lesion size, site, radiologic stage of lesion, apical involvement, sign of infection, and history of tooth extraction. Statistical analysis was performed using Fisher's exact test and the chi-square test.

Results

COD was more prevalent in female patients. With the exception of three cases, all were focal COD. The majority of patients presented with symptoms when the lesion was smaller than 1.5 cm in size. Symptoms were observed when the apex of the tooth was included in the lesion or there was a local infection around the lesion. The history of tooth extraction and previous endodontic treatment were evaluated, and history was not a significant predictor for the onset of symptoms.

Conclusion

In this study, risk factors associated with symptomatic patients were size of lesion, apical involvement, and local infection.

Evaluation of change in trabecular bone structure surrounding dental implants by fractal dimension analysis and comparison with radiomorphometric indicators: a retrospective study

Background

The trabecular bone surrounding dental implant show some structural changes during healing period. The purpose of this study is to observe the change in trabecular bone with fractal dimensional analysis from baseline to 3rd month of implant placement. It was also aimed to determine the correlation of fractal dimension (FD) change with morphometric indices, mandibular cortical index (MCI) and mandibular cortical width (MCW).

Methods

Digital panoramic radiographs taken from 14 patients were evaluated in this study. A total of 30 implants which were placed on mandibular premolar or molar region were included. MCI and MCW assessments were made on baseline radiograph and FD were analyzed on baseline and 3rd month radiograph. FD change by time was recorded separately for every ROI. A paired sample t-test was used to evaluate the change between FD-baseline and FD-3rdmonth values. One-way ANOVA was used to determine the relationship between FD change and MCI. FD change and MCW measurements correlation was calculated by Pearson correlation analysis.

Results

FD value increased in 75 of 90 implant-adjacent regions evaluated in the 3rd month and it was observed that the FD values were statistically significantly increased in the mesial, distal and apical regions at the 3rd month measurements. There was no statistically significant relationship between mean FD change and MCI, and there was no correlation between mean FD change and MCW value.

Discussion

There are many studies evaluating the resorptive changes in bone. However, there are few studies investigating whether there is a correlation between pre- and post-operative trabecular pattern with MCI and MCW. The results of this study indicate that the implants have an improving effect on bone trabeculation in the region where they are placed.

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.

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.