A Radiographic comparison of mandibular bone quality in pre- and post-menopausal women in Indian population

General and local predictors of mandibular cortical bone morphology in adult females and males: the seventh survey of the Tromsø Study

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.

Association between skull bone mineral density and periodontitis: Using the National Health and Nutrition Examination Survey (2011-2014)

BACKGROUND AND OBJECTIVE

Bone mineral density (BMD) and periodontitis have been the subject of many studies. However, the relationship between skull (including mandible) BMD and periodontitis has not been extensively studied. An objective of this cross-sectional study was to examine the relationship between skull BMD and periodontitis using data from the National Health and Nutrition Examination Surveys (NHANES) for 2011-2012 and 2013-2014.

MATERIALS AND METHODS

From NHANES 2011-2014, 3802 participants aged 30-59 were selected. We divided the skull BMD level into quartiles to check the distribution of variables. Periodontitis was defined by the Centers for Disease Control and Prevention (CDC) and the American Association of Periodontology (AAP) in 2012. Multivariate logical regression analysis was used to explore the independent relationship between skull BMD and periodontitis. The generalized additive model (GAM), smooth curve fitting (penalty spline) and threshold effect analysis was used to evaluate dose-response relationship between skull BMD and periodontitis and the potential nonlinear relationship between skull BMD and periodontitis. Finally, subgroup analysis and interaction test were conducted to determine the role of covariates between skull BMD and periodontitis.

RESULTS

The overall average skull BMD of 3802 participants was 2.24g/cm2, the average age was 43.94 years, and the prevalence of periodontitis was 41.03%. In the fully adjusted logistic regression model, skull BMD and periodontitis showed an independent negative correlation (OR 0.73, 95% CI 0.59-0.90, P = 0.0032) and a linear relationship. Compared with the lowest quartile array (Q1:1.22-1.98) of skull BMD, the highest quartile array(Q4: 2.47-3.79) had a significantly lower risk of periodontitis (OR 0.70,95% CI 0.56-0.87, P = 0.0014). Subgroup analysis showed a highly consistent negative correlation between skull BMD and periodontitis. In the interaction test, people with moderate poverty income ratio (1.57-3.62) and those who had more than 12 alcohol drinks in the past year had a lower risk of periodontitis.

CONCLUSIONS

This result suggested that periodontal disease can be related to low skull BMD, for those people, oral hygiene and health care should be more closely monitored. Validation of our findings will require further research.

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.

Mandibular cortical index in the screening of postmenopausal at low mineral density risk: a systematic review

OBJECTIVES

This systematic literature review addressed the use of mandibular cortical index (MCI), assessed by panoramic radiography, for the identification of postmenopausal women at risk of osteoporosis.

METHODS

Databases were searched for original research studies published from September 2010 to September 2020 using the following keywords: "postmenopausal osteoporosis" and synonyms combined with "panoramic radiography" and synonyms. Only English language manuscripts and studies pertaining to the MCI were selected.

RESULTS

A total of 24 studies were included. The publications were highly heterogeneous in terms of the subject of interest, i.e. the MCI, with some studies comparing the usefulness of the MCI using panoramic radiography and using cone beam computed tomography, and others comparing different radiomorphometric indexes developed for panoramic radiography.

CONCLUSIONS

Based on the literature included in this systematic review, we conclude that the MCI is useful as an auxiliary tool for identifying postmenopausal females at risk of low bone mineral density (BMD), as it correlates with skeletal BMD measured by dual X-ray absorptiometry. Nevertheless, other radiomorphometric indexes obtained from panoramic radiographs, such as panoramic mandibular index, mental index, and mandibular cortical width, are also valuable as auxiliary tools in the identification of postmenopausal females at risk, as they also correlate with BMD. Thus, it is not possible to affirm which index is the most reliable for the identification of postmenopausal females considering the literature screened. PROSPERO registration systematic review CRD42020208152.

Comparative Analysis of Linear and Angular Measurements on Digital Orthopantomogram with Calcaneus Bone Mineral Density

BACKGROUND

Bone remodeling is a continuous and complex process which occurs throughout life. Radiomorphometric and radioangular indices on the orthopantomogram are the predictors of bone remodeling associated with mandible. Bone mineral density is the amount of calcified tissue in a certain volume of the bone.

MATERIALS AND METHODS

Fifty normal healthy individuals within the age range of 25-55 years were included in the study. Linear measurements including mandibular cortical width (MCW) and panoramic mandibular index (PMI); and angular measurements including mandibular angle (MA) and antegonial angle (AGA) were recorded. Quantitative ultrasound bone mineral density (BMD) scan of the heel bone (calcaneus) of the same patient were also performed.

RESULTS

In our study, for both males and females, antegonial angle (AGA) had highest correlation with calcaneus bone mineral density. In the age group of less than 35 years, PMI in males, and AGA in females had highest correlation. In the age range of more than 35 years, MA in males and AGA in females had highest correlation.

CONCLUSION

There is a correlation between the mandibular bone remodelling changes and calcaneal bone mineral density in case of elder subjects and thus these parameters may be used as an inexpensive alternative screening method to assess the bone mineral density and identify individuals at risk for osteoporosis and fractures and also for dental treatment planning.

A Study to Assess and Correlate Osteoporosis and Periodontitis in Selected Population of Maharashtra

BACKGROUND

Osteoporosis is a systemic bone disorder characterized by decreased bone mass and increased risk for fracture. It has been proposed as a possible risk factor for periodontal disease progression. Recent literature has shown periodontitis to be a risk indicator for osteoporosis, suggesting a possible two way relationship. However the association between these two diseases still remains unclear leading to a scope of further research in this area.

AIM

The aim of the present study was to assess and Correlate the severity of osteoporosis and periodontitis by using variables like probing pocket depth, clinical attachment loss, plaque index, body mass index and bone mineral density.

MATERIALS AND METHODS

A total of 65 subjects aged between 45-75 years suffering from periodontitis were considered. All subjects were assessed for periodontal disease severity by plaque index (PI), probing pocket depth (PPD) and clinical attachment loss (CAL). The bone mineral density (BMD) of patients was assessed using dual energy X- ray absorptiometry (DXA) at lumbar spine (L1 - L4). The severity of periodontal disease was correlated with severity of osteoporosis. Descriptive statistics like frequency and percentage were calculated for all the variables. Chi-square test was performed to assess the association between the study variables.

RESULT

Among the entire group 78.46% had high plaque index score, and the severity of periodontitis increased with increase in plaque index score showing a statistical significance. Osteopenia was observed in 25.33% of the subjects, out of whom 63.15% suffered from severe periodontitis. Osteoporosis was observed in 17.33% of the subjects, and all the subjects (100%) suffered from severe periodontitis.

CONCLUSION

The results of the present study suggest that increasing severity of periodontitis increased the risk of osteoporosis and vice versa. We conclude that there is a definite association between periodontitis and osteoporosis.