Relationship between the mandibular inferior cortex and bone stiffness in elderly Japanese people

Correlations of the Osteoporosis Self-Assessment Tool for Asians (OSTA) and Three Panoramic Indices Using Quantitative Ultrasound (QUS) Bone Densitometry

This study aimed to evaluate the correlation between the Osteoporosis Self-Assessment Tool for Asians (OSTA) and three panoramic indices in relation to z-score and t-score values using quantitative ultrasound (QUS) bone densitometry. The sensitivity, specificity, and area under the curve (AUC) of the OSTA index were also measured using the QUS tool to evaluate the method's performance in identifying people at risk of osteoporosis. The study employed a cross-sectional design with 387 participants (190 men, 197 women). Patients' mandibular cortical indexes (MCI), mandibular cortical widths (MCW), and panoramic mandibular indexes (PMI) were measured from panoramic images. The sensitivity, specificity, and AUC were calculated using an OSTA index cutoff of ≤-1 and a t-score of ≤-1.0 for the QUS bone densitometry. The coefficient correlation of the OSTA index with the z-score (r = -0.563, p < 0.001) and t-score (r = -0.740, p < 0.001) shows a higher value than the MCI, MCW, and PMI, per the QUS. The sensitivity, specificity, and AUC values with a cutoff t-score of ≤-1.0 per the QUS in men was 90%, 50%, and 0.812, and in women, 96.8%, 30%, and 0.862. The OSTA index is a simple method that can be used in general dental practice.

Three panoramic indices for identification of healthy older people at a high risk of osteoporosis

•

Three panoramic indices could be used to detect the risk of osteoporosis.

•

Severely eroded mandibular cortex as a potent marker of osteoporosis.

•

Low bone density may occur in older people under 65 years.

Background

This study aimed to identify whether healthy older adults are at a high risk of osteoporosis based on the association between the T-score values of bone mineral density (BMD) and three panoramic indices.

Materials and methods

All participants (50–64 years old) underwent calcaneal quantitative ultrasound (QUS) bone densitometry. In total, 371 panoramic images were included in the analysis. The mandibular cortical width (MCW), mandibular cortical index (MCI), and panoramic mandibular index (PMI) were the three parameters assessed. The data were examined using one-way analysis of variance or Kruskal–Wallis H and post hoc tests. Spearman’s rho was used to measure correlation coefficients.

Results

T-score distributions in the normal, osteopenia, and osteoporosis categories were 80 (21.6%), 236 (63.6%), and 55 (14.8%), respectively. T-scores were significantly related to age, MCW, PMI, and MCI (p < 0.001). Participants with osteopenia and a risk of progression to osteoporosis had an average MCW value of < 3.38 mm, a PMI of < 0.31, and an MCI class 2 and 3 distribution in 211 (56.9%) participants. The highest to lowest correlation coefficients with a significant relationship to the T-score were for age (r = -0.844), MCI (r = 0.456), MCW (r = 0.359), sex (r = 0.354), and PMI value (r = 0.292).

Conclusions

This study found that healthy older people with Class 3 MCI, an MCW < 3 mm, and a PMI ratio < 0.3 had a significant association with lower BMD T-scores on QUS and were at higher risk of osteoporosis.

Evaluation of osseous changes in dental panoramic radiography using radiomorphometric indices in patients with hyperthyroidism

OBJECTIVE

The aim of the present study was to compare radiomorphometric measurements on panoramic images of patients with hyperthyroidism (HT) to those of a control population.

STUDY DESIGN

In this retrospective study, the mental index (MI), inferior panoramic mandibular index (PMI), antegonial index (AI), gonial index (GI), and mandibular cortical index (MCI) were evaluated on dental panoramic radiographs (DPRs) of 40 patients with HT and 40 healthy age- and sex-matched individuals and compared between the groups. Quantitative data (MI, PMI, AI, and GI) were analyzed with the Student t and Mann-Whitney U tests. Categorical data (MCI) were analyzed with the chi-square test.

RESULTS

Statistically significant differences between the patient and control groups were found for inferior PMI (P = .001) and AI (P = .017) values, with smaller mean values among the patients. However, the measurements of MI (P = .59) and GI (P = .164) and the MCI distribution (P = .13) were similar in both groups.

CONCLUSIONS

Evaluating the radiomorphometric indices of inferior PMI and AI on the DPRs of patients with HT who are at high risk of secondary osteoporosis could be helpful in the early diagnosis of osteoporotic changes and in formulating surgical treatment plans.

Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis

Osteoporotic fractures are associated with an increased risk of subsequent fractures, a higher rate of mortality, and incremental medical costs. Incidental findings, which include some measurements related to the mandibular inferior cortex and the alveolar trabecular bone pattern of the mandible determined on panoramic radiographs, are considered to be a useful tool for identifying asymptomatic individuals at risk of having osteoporosis and/or fragility fractures. We undertook a worldwide literature survey and present the following clinical recommendations. Postmenopausal female dental patients with a mandibular inferior cortical width of less than 3 mm on panoramic radiographs may be at risk of having low skeletal bone mineral density (BMD) or osteoporosis, but not fragility fractures. In addition, those with a severely eroded mandibular inferior cortex may have an increased risk of having low skeletal BMD, osteoporosis, and fragility fractures. The alveolar trabecular bone pattern of the mandible might be useful for identifying female dental patients at risk of having fragility fractures, although further investigation is necessary to confirm this possibility. These incidental findings on panoramic radiographs, when used for identifying asymptomatic postmenopausal female patients at risk of having osteoporosis in general dental practice, may be helpful in reducing the incidence of first fractures, with a consequent reduction in the secondary fractures, medical costs, and mortality associated with osteoporotic fragility fractures, without incurring any additional cost.

Comparison of skeletal changes related to patients with chronic kidney disease and healthy individuals in digital panoramic radiography

Background

Chronic kidney disease (CKD) is a prevalent condition affecting bone metabolism. Bone changes in CKD patients also known as renal osteodystrophy happen due to disorders in the regulation of water and electrolytes caused by the disease. The aim of this study is to investigate the bone changes of CKD stages 3-5 patients without dialysis using digital panoramic radiography.

Materials and Methods

In this cross-sectional study, panoramic radiographs were obtained from 30 patients with CKD stages 3-5 and 30 age and gender matched healthy individuals. The mean values of quantitative parameters such as mental index (MI), panoramic mandibular index (PMI), and antegonial index (AI) were measured and qualitative parameters such as mandibular cortical index (MCI) and trabecular bone pattern (TP) were recorded based on Kelemetti and Lindh calcifications, respectively. Statistical analysis was performed using t-test, Chi-square, and Mann-Whitney test (α = 0.05).

Results

The mean values of MI, PMI, and AI in the two groups were not statistically significant (P > 0.05). MCI and TP were significantly different between the two groups. MCI showed more defects in mandibular cortex of CKD patients (6.7% of patients vs. 0% of control group were C₃, P = 0.038), and TP showed more porosity in mandibular bone of CKD patients (10% of patients vs. 0% of control group were sparse, P = 0.001).

Conclusion

The amount of MI, PMI, and AI were not related to CKD. While MCI and TP were significant parameters that showed mandibular cortical situation and trabecular bone pattern, they assess osteoporosis level in a more reliable manner in CKD stages 3-5 patients without dialysis.

Comparison of mandibular index values determined from standard panoramic versus cone beam computed tomography reconstructed images

OBJECTIVE

The aim of this study was to compare mandibular index values, including the mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI), determined on the basis of cone beam computed tomography (CBCT) and panoramic reconstructed (PR) images.

STUDY DESIGN

PR and CBCT images of 182 patients were retrospectively analyzed. Cross-sectional (CS) and PR images were obtained from CBCT data. The MCI, MI, and PMI were assessed on CS, PR, and panoramic images and evaluated for intra- and interobserver agreements by κ-value or intraclass correlation coefficient (ICC) analysis. Agreement among measurement methods was assessed by using the Bland-Altman method, with CS images as the gold standard for linear measurements.

RESULTS

Measurements from PR and CS images agreed with those from panoramic images in 66.7% and 53.8% of C3 classifications of MCI (porous cortices forming many endosteal residues), respectively. Panoramic and CBCT images exhibited good agreement in MI findings (ICC 0.91) and moderate (PR and panoramic images: ICC 0.79) to good (CS and panoramic images: ICC 0.87) agreement in PMI findings.

CONCLUSIONS

Because of the overlapping of buccal and lingual cortices, panoramic images are especially inadequate for determining the C3 category of MCI. However, CS images obtained from available CBCT data provide better visibility compared with panoramic images and, therefore, can be used for evaluating mandibular indices.

IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices

Purpose

The goal of this study was to develop a new index as an objective reference for evaluating current and newly developed indices used for osteoporosis screening based on dental images. Its name; IDIOS, stands for Index of Dental-imaging Indices of Osteoporosis Screening.

Materials and Methods

A comprehensive PubMed search was conducted to retrieve studies on dental imaging-based indices for osteoporosis screening. The results of the eligible studies, along with other relevant criteria, were used to develop IDIOS, which has scores ranging from 0 (0%) to 15 (100%). The indices presented in the studies we included were then evaluated using IDIOS.

Results

The 104 studies that were included utilized 24, 4, and 9 indices derived from panoramic, periapical, and computed tomographic/cone-beam computed tomographic techniques, respectively. The IDIOS scores for these indices ranged from 0 (0%) to 11.75 (78.32%).

Conclusion

IDIOS is a valuable reference index that facilitates the evaluation of other dental imaging-based osteoporosis screening indices. Furthermore, IDIOS can be utilized to evaluate the accuracy of newly developed indices.

Evaluation of Radiomorphometric Indices in Panoramic Radiograph - A Screening Tool

Background : Mandibular cortical indices, like the mandibular cortical index (MCI), panoramic mandibular index (PMI), mental index (MI), antegonial index (AI) and gonial index (GI) have been developed to assess and quantify the quality of mandibular bone mass. Aim and Objectives : The aim of this pilot study was to measure the radiomorphometric indices in a digital panoramic radiograph and find the inter-relationship of the indices with age and sex of the patients. Materials and Method : A total of 23 randomly selected patients were included in the study. Panoramic radiograph of each patient was taken and radiomorphometric indices were determined. Results : There was 69.57% agreement between MI and PMI which was significant. Similarly 78.26% agreement was seen between AI and MI which was significant. In contrast 30.43%, 52.17% and 56.52% agreement was observed while comparing GI with PMI, MI and AI respectively. Conclusion : MCI, PMI, AI and MI can be effectively measured on a panoramic radiograph, hence could be used as a screening tool for determining osteoporosis. All indices have a negative correlation with age and a significant difference between the younger and older age groups. All indices were significantly lower in females when compared to males of the same age group.

Mandibular inferior cortex erosion as a sign of elevated total serum calcium in elderly people: a 9-year follow-up study

OBJECTIVES

The mandibular inferior cortex (MIC) classification that was determined by observing the mandible distally from the mental foramen in panoramic radiography can be considered to reflect bone loss in the jaws. The purpose of this 9-year study was to investigate whether there is a relationship between MIC condition and total serum calcium (TSC) in elderly Japanese people.

METHODS

A total of 280 subjects aged 70 years at baseline (137 males and 143 females) took part in this longitudinal study design. TSC and dental panoramic radiographs were carried out at the baseline in 1998 and the final year in 2007.

RESULTS

The results of the MIC measurement were divided into two groups according to changes in MIC after the 9-year study period, namely no change group and change group. A significant relationship was found in females but not in males between the MIC condition and the TSC. The regression showed that female subjects are 3.26 times more likely to have increased erosion of the inferior border of the mandible than male subjects after the 9-year study period.

CONCLUSIONS

These results suggest that an increase in erosion of the inferior border of the mandible was significantly associated with an elevated TSC after 9 years and only in females.

Evaluation of panoramic radiomorphometric indices related to low bone density in sickle cell disease

SUMMARY

In sickle cell disease, erythroid hyperplasia causes trabecular destruction leading to low bone density. This condition could be suspected by the radiomorphometric indices and your diagnosis becomes relevant in a multidisciplinary context of health care for sickle cell subjects, providing prognostics and contributing to determine adequate therapeutic and preventive actions.

INTRODUCTION

The aim of this study was to assess the risk of low bone density in subjects with sickle cell disease (SCD) through analysis of panoramic radiographic exams by radiomorphometric indices.

METHODS

Seventy-eight Brazilian subjects with SCD took part in this study and were subdivided into four groups: (I) 31 SCD subjects aged under 40 years; (II) 13 SCD subjects aged 40 years or more; (III) 12 normal subjects aged under 40 years; and (IV) 22 normal subjects aged 40 years or more. In the panoramic radiographs, the mandibular cortical index (MCI) classification, increased spacing of the trabecular bone, panoramic mandibular index (PMI), and mental index (MI) were evaluated. Exact Fisher's test was used to compare age between the different groups. Descriptive analysis of the data was performed to evaluate the simple visual estimation of low bone density (increased bone trabecular space and MCI), and a one-way analysis of variance (Bonferroni criteria) was used to compare the means of the quantitative indices (PMI and MI). The significance level was p < 0.05.

RESULTS

In the MCI classification, C2 was more prevalent, especially in groups I and IV. Increased spacing of the trabecular bone was more frequent in groups I and II. MI did not show a statistically significant difference among the groups. PMI showed a statistically significant difference only between groups III and IV.

CONCLUSIONS

The radiomorphometric indices applied in the present study can be used on panoramic radiographs to detect the presence of low bone density in SCD subjects.

Osteoporosis and periodontitis in older subjects participating in the Swedish National Survey on Aging and Care (SNAC-Blekinge)

Abstract Objective. We assessed the relationships between (I) ultrasonography calcaneus T-scores (PIXI) and mandibular cortex characteristics on oral panoramic radiographs in older subjects; and (II) osteoporosis and periodontitis. Material and methods. We examined 778 subjects (53% women) aged 59-96 years. Periodontitis was defined by alveolar bone loss assessed from panoramic radiographs. Results. PIXI calcaneus T-values ≤-2.5 (osteoporosis) were found in 16.3% of women and in 8.1% of men. PIXI calcaneus T-values <-1.6 (osteoporosis, adjusted) were found in 34.2% of women and in 21.4% of men. The age of the subjects and PIXI T-values were significantly correlated in women (Pearson's r = 0.37, P < 0.001) and men (Pearson's r = 0.19, P < 0.001). Periodontitis was found in 18.7% of subjects defined by alveolar bone level ≥5 mm. Subjects with osteoporosis defined by adjusted PIXI T-values had fewer remaining teeth [mean difference 4.1, 95% confidence interval (CI) -1.1 to -6.5, P < 0.001]. The crude odds ratio (OR) of an association between the panoramic assessment of mandibular cortex erosions as a sign of osteoporosis and the adjusted T-value (T-value cut-off <-1.6) was 4.8 (95% CI 3.1-7.2, P < 0.001; Pearson χ(2) = 60.1, P < 0.001). A significant OR between osteoporosis and periodontitis was only found in women for the T-value cut-off ≤-2.5 (crude OR 1.8, 95% CI 1.1-3.3, P < 0.03). Conclusions. An association between osteoporosis and periodontitis was only confirmed in women. The likelihood that the mandibular cortex index agrees with adjusted PIXI T-values is significant.