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Suzuki S, Ohtani M, Matsuo Y, Fukuda M, Mimasaka S. Age estimation using postmortem computed tomography-based Hounsfield unit values of the palate and mandibular condyle and the Eichner classification. Leg Med (Tokyo) 2024; 69:102446. [PMID: 38640872 DOI: 10.1016/j.legalmed.2024.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
Age estimation is important in forensic investigations of unidentified human remains. This study assessed the correlation between age and Hounsfield unit (HU) values of the palate and mandibular condyle based on postmortem computed tomography (CT) and analyzed the influence of occlusal support in developing an age estimation method for Japanese individuals, including older adults. The sample consisted of a training dataset (357 cadavers) and a validation dataset (300 cadavers) that underwent postmortem CT. Three measurements were selected: the respective HU values of the palate and mandibular condyle and the Eichner classification. The correlation coefficients between age and HU values were also evaluated. Multiple stepwise regression analysis was performed to evaluate the significance of four parameters (sex, respective HU values of the palate and mandibular condyle, and the Eichner classification) for age estimation and to determine the best age estimation formula. In the validation tests, inaccuracy and bias were calculated for the groups aged ≥65 or <65 years. Significant correlations between age and HU values of the palate and mandibular condyle were observed, regardless of sex. In multiple stepwise regression analysis, all variables except sex were significantly correlated with age. The age estimation formula from the regression analysis was useful, and the validation test exhibited high accuracy, especially in older adults. The HU values of the palate and mandibular condyle and the Eichner classification are useful for age estimation in Japanese individuals.
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Affiliation(s)
- Shoken Suzuki
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan; Department of Dentistry and Oral Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Maki Ohtani
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan.
| | - Yuhei Matsuo
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan.
| | - Masayuki Fukuda
- Department of Dentistry and Oral Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Sohtaro Mimasaka
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan; Division of Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Poiana IR, Dobre R, Popescu RI, Pituru SM, Bucur A. Utility of Cone-Beam Computed Tomography in the Detection of Low Bone Mass-A Systematic Review. J Clin Med 2023; 12:5890. [PMID: 37762831 PMCID: PMC10531931 DOI: 10.3390/jcm12185890] [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: 08/21/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass density. MATERIALS AND METHODS A systematic review of the literature was performed using the PubMed and SCOPUS databases, with terms referring to low bone mass and cone-beam computed tomography (CBCT). RESULTS Sixteen studies were included in the review. The results show different perspectives, but the evidence favors the use of CBCT, combined with dual-energy X-ray absorptiometry bone density scan (DXA) evaluation, for the assessment of the osteoporosis status of the aging population and, more specifically, in postmenopausal women. Radiographic density (RD) values of the dens and the left part of the first cervical vertebra show the strongest correlation coefficients and the highest sensitivity, specificity, and accuracy for predicting osteoporosis (OP) in the lumbar vertebrae and the femoral neck. CONCLUSIONS Our review suggests the potential of CBCT as a screening tool for patients with low bone mass using different radiomorphometric indices. Linear measurements of the inferior mandibular cortex were lower in osteoporotic individuals, indicating the perspective of CBCT also as a diagnostic tool for this disease.
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Affiliation(s)
- Ioana Ruxandra Poiana
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
| | - Ramona Dobre
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
| | - Razvan-Ionut Popescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Silviu-Mirel Pituru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
| | - Alexandru Bucur
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
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Fakih KA, Edreva MS, Stoichkov BB. Removal of a Horizontally Displaced Dental Implant below the Mandibular Canal. Case Rep Dent 2023; 2023:6663874. [PMID: 37006703 PMCID: PMC10065860 DOI: 10.1155/2023/6663874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/12/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023] Open
Abstract
A clinical case of a horizontally displaced dental implant, which moved below the level of the mandibular canal during surgery is presented together with a brief review of the comparable published cases. The bone mineral density and the morphology of the alveolar ridge were analyzed at the site of osteotomy, and the low bone density of
Hounsfield Units was found in the area. The factors related to implant displacement were: the anatomical features of bone structure, and the applied mechanical pressure during the implant insertion. The displacement of the dental implant below the level of the mandibular canal during implantation can be a severe complication. Its removal requires the safest surgical approach to avoid damaging the inferior alveolar nerve. The description of one clinical case does not provide grounds for drawing definite conclusions. To avoid similar incidents, detailed radiographic assessment before implantation is necessary; it is also important to follow the surgical protocols of implant placement into soft bone and to create conditions for a good visibility and sufficient control of bleeding during surgery.
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Astuti ER, Arifin AZ, Indraswari R, Putra RH, Ramadhani NF, Pramatika B. Computer-Aided System of the Mandibular Cortical Bone Porosity Assessment on Digital Panoramic Radiographs. Eur J Dent 2022. [PMID: 36122586 DOI: 10.1055/s-0042-1749158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES The loss of bone mineral density (BMD) in various sites of the body, including the mandible, is the main sign of osteoporosis. Thus, the computer-aided diagnosis (CAD) system was developed for bone density assessment and patients were classified into normal, osteopenia, and osteoporosis groups using a digital panoramic radiograph. MATERIAL AND METHODS Data of dental panoramic radiographs and corresponding BMD assessments from 123 postmenopausal women were collected. For the proposed CAD system test, regions of interest (ROI) that were located below the left and right mental foramen on dental panoramic radiographs were determined. The width and texture of the mandibular cortical bone in each ROI were used to classify the data into normal, osteopenia, and osteoporosis classes. The width of the mandibular cortical was measured using the polynomial fitting method. The texture feature of the cortical bone is obtained by calculating the average value of the grayscale intensity of cortical bone. The classification result was obtained by using a multiclass support vector machine. RESULTS The experimental results using 10-fold cross-validation showed that the proposed system achieved an average accuracy of 86.50% for osteoporosis classification on dental panoramic radiographs. The average misclassification error and relative foreground area error of the segmentation process were 5.21 and 12.98%, respectively. From the analysis of the cortical width measurement process, highest average mandibular cortical width (MCW) was found in the normal patient category compared with the other classes. CONCLUSION This research showed that the proposed computer-aided system can be used for osteoporosis and osteopenia assessment by measuring the MCW and texture on dental panoramic radiographs with the average system accuracy of 89.52%.
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Affiliation(s)
- Eha R Astuti
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
| | - Agus Z Arifin
- Department of Informatics, Faculty of Intelligent Electrical and Information Technology, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Rarasmaya Indraswari
- Department of Information Systems, Faculty of Intelligent Electrical and Information Technology, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Ramadhan H Putra
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
| | - Nastiti F Ramadhani
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia.,Graduate Student of Dental Health Sciene Program, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
| | - Berty Pramatika
- Universitas Brawijaya Hospital, Brawijaya University, Malang, Indonesia
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Carvalho BF, de Castro JGK, de Melo NS, de Souza Figueiredo PT, Moreira-Mesquita CR, de Paula AP, Sindeaux R, Leite AF. Fractal dimension analysis on CBCT scans for detecting low bone mineral density in postmenopausal women. Imaging Sci Dent 2022; 52:53-60. [PMID: 35387102 PMCID: PMC8967487 DOI: 10.5624/isd.20210172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to compare the fractal dimension (FD) measured at 2 bone sites (second cervical vertebra and mandible) on cone-beam computed tomography (CBCT). The research question was whether FD could serve as an accessory tool to refer postmenopausal women for densitometric analysis. Therefore, the reliability and accuracy of FD were evaluated. Materials and Methods In total, 103 postmenopausal women were evaluated, of whom 52 had normal bone mineral density and 51 had osteoporosis, according to dual X-ray absorptiometry of the lumbar spine and hip. On the CBCT scans, 2 regions of interest were selected for FD analysis: 1 at the second cervical vertebra and 1 located at the mandible. The correlations between both measurements, intra- and inter-observer agreement, and the accuracy of the measurements were calculated. A P value less than 0.05 was considered to indicate statistical significance for all tests. Results The mean FD values were significantly lower at the mandibular region of interest in osteoporotic patients than in individuals with normal bone mineral density. The areas under the curve were 0.644 (P=0.008) and 0.531 (P=0.720) for the mandibular and vertebral sites, respectively. Conclusion FD at the vertebral site could not be used as an adjuvant tool to refer women for osteoporosis investigation. Although FD differed between women with normal BMD and osteoporosis at the mandibular site, it demonstrated low accuracy and reliability.
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Affiliation(s)
| | | | | | | | - Carla Ruffeil Moreira-Mesquita
- Division of Oral Radiology, Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | | | - Rafael Sindeaux
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - André Ferreira Leite
- Division of Oral Radiology, Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
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Hendrijantini N, Hartono CK, Daniati RP, Hong G, Sitalaksmi RM, Kuntjoro M, Ari MDA. Human Umbilical Cord Mesenchymal Stem Cell-induced Osterix, Bone Morphogenetic Protein-2, and Tartrate-resistant Acid Phosphatase Expression in Osteoporotic Mandibular Bone. Eur J Dent 2020; 15:84-89. [PMID: 32898872 PMCID: PMC7902117 DOI: 10.1055/s-0040-1715987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to prove that human umbilical cord mesenchymal stem cell (hUCMSC) therapy conducted according to the mandibular osteoporotic model will increase Osterix (Osx) and bone morphogenetic protein-2 (BMP-2) expression, while reducing tartrate-resistant acid phosphatase (TRAP) expression. PKH26 labeling proves that mandibular bone regeneration is produced by hUCMSCs induction. MATERIALS AND METHODS This study incorporated a true posttest only control group design. Twenty-five female Wistar rats were randomly divided into five groups consisting of the sham surgery (N) group, osteoporotic groups injected with gelatin for 4 weeks (G4) and 8 weeks (G8), and osteoporotic groups injected with hUCMSC-gelatin for 4weeks (SC4) and 8 weeks (SC8). All subjects were provided for BMP-2, Osx, and TRAP on immunohistochemistry examination and PKH-26 labeling. STATISTICAL ANALYSIS All data were analyzed using ANOVA and Tukey HSD tests with p < 0.05 being considered as statistically significant. RESULTS Compared with other groups, the highest level of BMP-2 and Osx occurred in the sham surgery (N) and osteoporotic groups injected with hUCMSCs-gelatin (SC), while the lowest level of TRAP was found in SC4. During 4- and 8-week observation periods, the PKH 26 appeared green (fluorescent). CONCLUSIONS hUCMSC demonstrates high-osteogenic activity and increased osteoporotic mandibular bone regeneration, as shown by increased expression of Osx and BMP-2 and decreased TRAP expression. From the labeling, PKH-26 proved that viable hUCMSCs in gelatin solvent can be present in the mandibular bone and be capable of promoting osteogenic differentiation and increasing mineralization and bone formation in the osteoporotic mandibular bone.
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Affiliation(s)
- Nike Hendrijantini
- Department of Prosthodontic, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Cindy Karina Hartono
- Department of Prosthodontic, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Reni Puspa Daniati
- Department of Prosthodontic, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Guang Hong
- Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Aoba-ku, Sendai, Japan
| | - Ratri Maya Sitalaksmi
- Department of Prosthodontic, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Mefina Kuntjoro
- Department of Prosthodontic, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
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Aliaga I, Vera V, Vera M, García E, Pedrera M, Pajares G. Automatic computation of mandibular indices in dental panoramic radiographs for early osteoporosis detection. Artif Intell Med 2020; 103:101816. [PMID: 32143810 DOI: 10.1016/j.artmed.2020.101816] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
AIM A new automatic method for detecting specific points and lines (straight and curves) in dental panoramic radiographies (orthopantomographies) is proposed, where the human knowledge is mapped to the automatic system. The goal is to compute relevant mandibular indices (Mandibular Cortical Width, Panoramic Mandibular Index, Mandibular Ratio, Mandibular Cortical Index) in order to detect the thinning and deterioration of the mandibular bone. Data can be stored for posterior massive analysis. METHODS Panoramic radiographies are intrinsically complex, including: artificial structures, unclear limits in bony structures, jawbones with irregular curvatures and intensity levels, irregular shapes and borders of the mental foramen, irregular teeth alignments or missing dental pieces. An intelligent sequence of linked imaging segmentation processes is proposed to cope with the above situations towards the design of the automatic segmentation, making the following contributions: (i) Fuzzy K-means classification for identifying artificial structures; (ii) adjust a tangent line to the lower border of the lower jawbone (lower cortex), based on texture analysis, grey scale dilation, binarization and labelling; (iii) identification of the mental foramen region and its centre, based on multi-thresholding, binarization, morphological operations and labelling; (iv) tracing a perpendicular line to the tangent passing through the centre of the mental foramen region and two parallel lines to the tangent, passing through borders on the mental foramen intersected by the perpendicular; (v) following the perpendicular line, a sweep is made moving up the tangent for detecting accumulation of binary points after applying adaptive filtering; (vi) detection of the lower mandible alveolar crest line based on the identification of inter-teeth gaps by saliency and interest points feature description. RESULTS The performance of the proposed approach was quantitatively compared against the criteria of expert dentists, verifying also its validity with statistical studies based on the analysis of deterioration of bone structures with different levels of osteoporosis. All indices are computed inside two regions of interest, which tolerate flexibility in sizes and locations, making this process robust enough. CONCLUSIONS The proposed approach provides an automatic procedure able to process with efficiency and reliability panoramic X-Ray images for early osteoporosis detection.
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Affiliation(s)
- Ignacio Aliaga
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - Vicente Vera
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - María Vera
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - Enrique García
- Dept. of Conservative Dentistry and Prostheses. Faculty of Dentistry. Complutense University, Madrid, Spain.
| | - María Pedrera
- Hospital Clínico San Carlos, Complutense University, Madrid, Spain.
| | - Gonzalo Pajares
- Instituto del Conocimiento (Knowledge Institute). Complutense University, Madrid, Spain.
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Yalcin ED, Bozan C. Relationship between mandibular condyle and articular eminence cortication with mandibular cortical index on cone-beam CT. Surg Radiol Anat 2019; 42:515-522. [PMID: 31768698 DOI: 10.1007/s00276-019-02385-7] [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: 08/19/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Mandibular condyle development can be evaluated with radiographic evaluation of subchondral cortical bone. The aim of this study is to investigate mandibular condyle cortication (MCC), articular eminence cortication (AEC) and mandibular cortical index (MCI) according to age and gender on CBCT, and relationship between each other. METHODS CBCT scans of 520 patients (312 male and 208 female, age range 7-84) were retrospectively investigated to evaluate MCC, AEC and MCI. MCC and AEC were examined in sagittal section and MCI in panoramic reformatted image. MCC and AEC were classified as Type I, Type II and Type III according to density difference between the cortical bone enclosing condyle and articular eminence. Categorical variables were tested by Chi square. RESULTS When MCC, AEC and MCI were compared, a significant relationship was detected (p < 0.05). According to age, there was a significant difference between MCC, MCI and AEC types with each other (p < 0.05). No significant discrepancy was found between gender and MCC, AEC and MCI (p > 0.05). CONCLUSIONS This study evaluated the distribution of MCC, AEC, MCI according to age and gender and detected that these cortications were correlated. This result may be caused by anatomical proximity bone components and functional stimuli. Knowledge of these cortications can be important for accurate diagnosis of TMJ disorders and may also be helpful for prediction of osteoporotic changes.
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Affiliation(s)
- Eda Didem Yalcin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gaziantep University, Sehitkamil, 27410, Gaziantep, Turkey.
| | - Cigdem Bozan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gaziantep University, Sehitkamil, 27410, Gaziantep, Turkey
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