Assessment of panoramic radiomorphometric indices of the mandible in a brazilian population

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.

Mandibular Cortical Bone Evaluation in a Healthy Paediatric Population

BACKGROUND

Changes in mandibular cortical bone have been documented in children with chronic diseases but not in healthy populations.

AIM

We aimed to qualitatively and quantitatively evaluate the mandibular cortical bone of a healthy paediatric population using dental panoramic radiographs (DPTs). The secondary objective was to assess the effect of dental status on cortical bone.

DESIGN

The DPTs of 660 individuals, aged 6-18 years, were evaluated by two blinded examiners. Bone was qualitatively categorized according to the Mandibular Cortical Index (MCI), and its width was calculated using the Mandibular Cortical Width Index (MCW). Differences between gender and age were tested using Fisher's exact and correlation with dental status with the chi-square test.

RESULTS

A significant correlation was observed between bone morphology and gender, with girls having more frequent even and sharp endosteal margins than boys, who showed semilunar defects. The degree of erosion increased with age, as did bone thickness. A positive correlation between thickness and type of dentition was recorded, with normal bone predominating in children in the mixed dentition stage. Νο correlation was found between bone morphology or thickness and the factors associated with dental status.

CONCLUSIONS

Bone quality and quantity vary significantly between different genders and age groups. Dental needs and treatment characteristics did not seem to affect the above parameters.

Investigation of the effect of oral and internal bisphosphonate use on bone density in the jaws in patients with osteoporosis in panoramic radiography

OBJECTIVES

This study aims to quantitatively evaluate the effects of bisphosphonate use duration and route of administration on mandibular cortical and trabecular bone in postmenopausal women.

STUDY DESIGN

Ninety postmenopausal women over the age of 50 were included in this study. Trabecular bone density was specified numerically by fractal dimension (FD) in the region of interest selected on the panoramic radiograph. The width of the mandibular cortical (MCW) bone under the mental foramen of the mandible was measured. Mann-Whitney U test was used for parameters that did not show a normal distribution. Spearman rho correlation test was used to determine the relationship between continuous measurement parameters.

RESULTS

It was observed that FD and MCW of dentate and edentate individuals using bisphosphonate were statistically significantly lower than those of healthy individuals (P < .05). There was no significant correlation was found between the duration of use of bisphosphonates and the fractal values obtained from the relevant regions of the mandible (P > .05).

CONCLUSION

Fractal dimension was found to be lower in oral bisphosphonate use than in intravenous bisphosphonate use. The width of the mandibular cortical bone values was found to be lower in individuals using bisphosphonate than in healthy individuals. Fractal dimension and MCW may benefit clinicians as quantitative parameters in panoramic radiography in the diagnosis of osteoporosis.

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.

Deep learning for automatic mandible segmentation on dental panoramic x-ray images

Many studies in the last decades have correlated mandible bone structure with systemic diseases like osteoporosis. Mandible segmentation, as well as segmentation of other oral structures, is an essential step in studies that correlate oral structures' conditions with systemic diseases in general. However, manual mandible segmentation is a time-consuming and training-required task that suffers from inter and intra-user variability. Further, the dental panoramic x-ray image (PAN), the most used image in oral studies, contains overlapping of many structures and lacks contrast on structures' interface. Those facts make both manual and automatic mandible segmentation a challenge. In the present study, we propose a precise and robust set of deep learning-based algorithms for automatic mandible segmentation (AMS) on PAN images. Two datasets were considered. An in-house image dataset with 393 image/segmentation pairs was prepared using image data of 321 image patient data and the corresponding manual segmentation performed by an experienced specialist. Additionally, a publicly available third-party image dataset (TPD) composed of 116 image/segmentation pairs was used to train the models. Four deep learning models were trained using U-Net and HRNet architectures with and without data augmentation. An additional morphological refinement routine was proposed to enhance the models' prediction. An ensemble model was proposed combining the four best-trained segmentation models. The ensemble model with morphological refinement achieved the highest scores on the test set (98.27%, 97.60%, 97.18%, ACC, DICE, and IoU respectively), with the other models scoring above 95% in all performance metrics on the test set. The present study achieved the highest ranked performance considering all the previously published results on AMS for PAN images. Additionally, those are the most robust results achieved since it was performed over an image set with considerable gender representativeness, a wide age range, a large variety of oral conditions, and images from different imaging scans.

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.

Panoramic Indices: An Aid to Early Detection of Patients with Low Bone Mineral Density

Objective An early identification of patients who are at an obvious increased risk of osteoporosis and subsequent high risk of pathological bone fractures is important to prevent morbidity and its subsequent impact on the quality of life of the affected patients. Dental professionals have a chance of identifying such cases in their very initial stages through routinely prescribed dental radiographs. The aim of this study was to assess the influence of gender and age on different parameters of alveolar bone loss using orthopantomograph (OPG) as an aid to identify patients with low bone mineral density (BMD).

Materials and Methods This study included eighty subjects in whom after taking OPGs, mandibular cortical index (MCI), mandibular cortical width (MCW), and panoramic mandibular index were assessed, while the results obtained were subjected to statistical analysis. One-way analysis of variance followed by Tukey's test was used to compare the means, while p-value less than 0.05 was considered statistically significant.

Results The findings of this study revealed a significant association between MCI and age for females, with C2 and C3 categories being more common with advancing age. Also, a significant difference could be seen in relation to gender (p-value = 0.0315) for MCW with a concomitant decrease in the values of MCW in females over 60 years of age.

Conclusion Panoramic radiographic measurements could provide valuable information and help in screening patients with low BMD.

Radiomorphometric Indices and their Relation to Alveolar Bone Loss: A Panoramic Radiographic Study

Aim

To assess the influence of gender and age on different parameters of alveolar bone loss using specific radiomorphometric indices on panoramic radiographs to aid in identifying patients with possible low bone mineral density (BMD).

Materials and Methods

The present cross-sectional study included 80 subjects in whom mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), alveolar bone loss (ABL), and bone height in 1^st premolar (Hp) and 1^st molar (Hm) were assessed to evaluate the alveolar bone loss.

Results

The findings of the present study revealed a significant association between MCI and age for females with C2 and C3 categories being more common with advancing age. Also, a significant difference could be seen in relation to gender (p-value = 0.0315) for MCW with a concomitant decrease in values of MCW in females >60 years of age. The vertical bone height of the edentulous mandible at 1^st premolar (Hp) (p-value = 0.0071) and 1^st molar (Hm) (p-value = 0.0044) regions were also found to be more in males than females.

Conclusion

Panoramic radiographic measurements provided valuable information for alveolar bone loss in terms of gender and age based on specific radiomorphometric parameters.

Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies

OBJECTIVES

To summarize the evidence on the feasibility of maxillomandibular imaging exams-related fractal dimension (FD) in screening patients with osteoporosis.

METHODS

This registered systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy statement. High sensitivity search strategies were developed for six primary databases and grey literature. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) items evaluated the risk of bias, and the GRADE approach assessed the evidence certainty.

RESULTS

From 1034 records initially identified through database searching, four studies were included (total sample of 747 patients [osteoporosis, 136; control group, 611]). The meta-analysis showed that the overall sensitivity and specificity of the FD were 86.17 and 72.68%, respectively. In general, all studies showed low RoB and applicability concern. The certainty of the evidence was very low to moderate.

CONCLUSIONS

This systematic review showed that the jaw-related FD presented sensitivity and specificity values higher than 70%, and its sensitivity in osteoporosis screening was a better parameter than specificity.

Is panoramic mandibular index a reliable marker in the evaluation of bone mineral density and sexual dimorphism??

Introduction:

Osteoporosis is a silent, progressive, and chronic disease affecting bones of the adults, especially postmenopausal women. Its effect on mandibular bone quality has also been described by some authors in men inferring that gender and age are factors that may influence bone mineral density (BMD) and prognosis. The panoramic radiograph is used widely for the early detection of osteoporosis. The present study was undertaken to evaluate whether the panoramic mandibular index (PMI) is useful for BMD and sexual dimorphism.

Materials and Methods:

A total of 60 patients (30 males and 30 females) in the age group of 25–40 years were selected for the study. Orthopantomograph was taken and PMI determined with the help of Sidexis next-generation software. All the measurements were performed by four observers and data subjected to the statistical analysis.

Results:

The mean superior PMI was 0.22–0.27, and the inferior PMI was 0.28–0.34. The mean superior and inferior linear measurements from the mental foramen were higher in males than females and statistically significant. The mean mandibular cortical width was 3.8–4.7 mm but did not show much gender difference.

Conclusion:

PMI is a reliable indicator for determining BMD but is not much influenced by gender variation.

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.

Dental Panoramic Radiographic Indices as a Predictor of Osteoporosis in Postmenopausal Saudi Women

Background

Many oral presentations of osteoporosis-a bone metabolic disease-were recorded. Thus, we aimed to assess panoramic radiomorphometric indices with bone mineral density (BMD) values among Saudi postmenopausal women and its importance in the prediction of osteoporosis.

Methods

A total of 431 Saudi women were enrolled in this study. Panoramic radiographs were obtained at the time of BMD measurement. Subjects were fatherly classified into; normal BMD, osteopenia, and osteoporosis groups. Serum follicle-stimulating hormone, luteinizing hormone (LH), estradiol (E2), 25-hydroxy-vitamin D (25[OH]D) and intact-parathyroid hormone were measured. Moreover, serum creatinine, calcium, and phosphate, together with serum osteocalcin (s-OC), procollagen type I N-terminal propeptide (s-PINP) and cross-linked C-terminal telopeptide of type 1 collagen (s-CTX) were measured. Receiver-operator curve (ROC) curve analysis for use of mandibular cortical width (MCW), panoramic mandibular index (PMI), and maxillary-mandibular ratio (M/M ratio) to differentiate women with osteoporosis or osteopenia from normal subjects was calculated. Cut off values of 4.6 at T score <−1 and 4.1 at T score ≤−2.5 were used.

Results

Body mass index is significantly low in the osteoporotic group. There is no significant difference in serum levels of LH, E2, calcium, phosphate, and 25(OH)D between the studied groups. Moreover, s-OC, C-terminal propeptide of procollagen type I, s-PINP, s-CTX, and urinary-CTX are significantly higher in osteoporosis than normal and osteopenia groups. ROC curve analysis revealed that MCW and PMI showed significant data while M/M ratio is non-significant.

Conclusions

It could be concluded that MCW as an important panoramic radiographic parameter can be used for prediction and diagnosis of osteoporosis in postmenopausal Saudi women with low BMD.

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.

Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment

OBJECTIVES

To verify radiomorphometric indices and fractal dimension (FD) in dental panoramic radiographs (DPRs) of children with different types of osteogenesis imperfecta (OI) and also to verify the effect of pamidronate (PAM) treatment in such panoramic analyses.

METHODS

In this retrospective study, 197 DPRs of 62 children with OI Types I, III and IV who were in treatment with a comparable dosage of intravenous PAM were selected. The mandibular cortical width (MCW), mandibular cortical index, visual estimation of the cortical width and FD of three standardized trabecular and cortical mandibular regions of interest were obtained from the radiographs. Factorial analysis of variance and Fisher test were used to compare FD and MCW measurements in children with different types of OI for different PAM cycles.

RESULTS

Children with all types of OI have thinner and more porous mandibular cortices at the beginning of treatment. There were significant differences between MCW and FD of the cortical bone, regarding different types of OI and number of PAM cycles (p = 0.037 and p = 0.044, respectively). FD measurements of the trabecular bone were not statistically different among OI types nor were PAM cycles (p > 0.05).

CONCLUSIONS

Children with OI presented cortical bone alterations after PAM treatment. Both MCW and the FD of the cortical bone were higher in children with OI after PAM treatment. It is argued that cortical bone should be considered for analyzing patients with OI, as well as to monitor the progress of PAM treatment.

Pamidronate affects the mandibular cortex of children with osteogenesis imperfecta

We hypothesized that mandibular cortical width (MCW) is smaller in children with osteogenesis imperfecta (OI) than in healthy children and that pamidronate can improve the cortical mandibular thickness. The aim of this study was to assess changes in the MCW on dental panoramic radiographs (DPRs) of children with normal bone mineral density (BMD) and with OI. We also compared the MCW of children with different types of OI regarding the number of pamidronate cycles and age at the beginning of treatment. MCW measurements were retrospectively obtained from 197 DPRs of 66 children with OI types I, III, and IV who were in treatment with a comparable dosage of cyclical intravenous pamidronate between 2007 and 2013. The control group had 92 DPRs from normal BMD children. Factorial analysis of variance was used to compare MCW measurements among different age groups and between sexes and also to compare MCW measurements of children with different types of OI among different pamidronate cycles and age at the beginning of treatment. No significant differences in results were found between male and female subjects in both OI and healthy children, so they were evaluated altogether (P > 0.05). There was an increase of MCW values related to aging in all normal BMD and OI children but on a smaller scale in children with OI types I and III. Children with OI presented lower mean MCW values than did children with normal BMD at the beginning of treatment (P < 0.05). A linear model estimated the number of pamidronate cycles necessary to achieve mean MCW values equivalent to those of healthy children. The thinning of the mandibular cortex depended on the number of pamidronate cycles, the type of OI, and the age at the beginning of treatment. DPRs could thus provide a way to identify cyclic pamidronate treatment outcomes in patients with OI.

Radiomorphometric indices of the mandible - an indicator of osteoporosis

INTRODUCTION

Osteoporosis is a regressive change which occurs in the bone and it is seldom diagnosed before the occurrence of fractures. Hence, determination of mandibular bone density is of paramount importance for the detection of this silent disease.

AIMS AND OBJECTIVES

The purpose of this study was to evaluate the influences of gender and age on the radiomorphometric indices and to assess the differences in the various indices, if any, between digital and analog radiographs.

MATERIALS AND METHODS

Two hundred and fifty six panoramic radiographs (128 digital and 128 analog) were obtained and they were grouped into 8 age groups which were between 21 to 60 years with 5 year intervals between them, with equal sex distributions. The mandibular cortical index (MCI), mental index (MI) and panoramic mandibular index (PMI) were analyzed.

RESULTS

C2 and C3 categories of MCI increased as age advanced in females. MI showed a significant difference in genders and MI Values decreased from younger to older females. PMI (p<0.05) was significant for both the genders.

CONCLUSION

This study showed that MCI, MI and PMI indices were useful for identifying patients with low skeletal bone mineral densities (BMD) or osteoporosis and that digital panoramic radiographs were better than analog radiographs for measuring the indices.