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Camargo AJ, Rodrigues GA, Munhoz L, Lourenço AG, Watanabe PCA. Are Radiographic Changes in the Mandibular Canal Associated With Bone Mineral Density? J Oral Maxillofac Surg 2024; 82:1257-1265. [PMID: 39002553 DOI: 10.1016/j.joms.2024.06.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Osteoporosis, highly prevalent among postmenopausal women, significantly reduces bone density and increases the risk of fractures. Cortical bone, which constitutes the largest calcium deposit in the human skeleton, is primarily affected in various conditions, including osteoporosis. Due to its visibility in panoramic radiography, the cortical area of the mandibular canal could be valuable in assessing decreases in bone mineral density (BMD). PURPOSE The study aimed to characterize and compare changes in the cortices of the mandibular canal between normal, osteopenic, and osteoporotic postmenopausal women. STUDY DESIGN, SETTING, SAMPLE Our cross-sectional study analyzed postmenopausal patients. We included only patients with panoramic radiographs with good quality and who underwent osteoporosis risk assessment by dual-energy x-ray absorptiometry (DXA). INDEPENDENT VARIABLE BMD was measured by DXA at 3 sites (spine, femur, and forearm) and used to classify the patients into normal, osteopenic, or osteoporotic. This classification remained consistent across all measurement sites. MAIN OUTCOME VARIABLE The main outcome variable was BMD of the mandibular canal cortices measured using black pixel intensity. COVARIATES Demographic covariates, including age, weight, height, and BMD, were assessed. ANALYSES One-way analysis of variance between groups considering a P < .05. The relationship between covariates and dependent variables was assessed using the Pearson correlation test. RESULTS The sample comprised 52 postmenopausal women aged more than 40 years (mean age 61 ± 10 years), 26 (50%) normal, 18 (35%) osteopenic, and 8 (15%) osteoporotic. Significant differences were observed in the percentage of black pixels in the mandibular ramus between the groups. In this region, the average percentage of black pixels was 3.19% (± 0.65) for the normal group, 2.78% (± 0.65) for the osteopenia group, and 2.35% (± 0.65) for the osteoporosis group (P = .015). No significant differences were found in other mandibular regions. CONCLUSION AND RELEVANCE Our findings demonstrate an association between BMD assessed in the mandibular canal cortex and the presence of osteoporosis as determined by DXA. While the observed differences in black pixel percentages in the mandibular ramus are minor, they are statistically significant, suggesting that panoramic radiography may serve as an adjunctive tool for osteoporosis screening.
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Affiliation(s)
- Angela Jordão Camargo
- Postdoctoral Student, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Giovani Antonio Rodrigues
- Postdoctoral Student, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Luciana Munhoz
- Postdoctoral Student, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Alan Grupioni Lourenço
- Professor, Department of Morphology, Physiology, and Basic Pathology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Plauto Christopher Aranha Watanabe
- Full Professor, Department of Stomatology, Public Health and Forensic Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Suzuki T, Katsumata A, Mastumoto Y, Komatu M, Oomura Y, Okamura M, Mizuno S, Anazawa U, Nomura T. Features of mandibular cortical bone morphology in osteoporotic fracture patients. Oral Radiol 2022; 38:550-557. [PMID: 35124765 DOI: 10.1007/s11282-022-00596-0] [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: 06/27/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The diagnostic criteria for osteoporosis are based on the bone mineral density (BMD) level in the lumbar spine and femur bone. Patients with osteoporotic fractures were diagnosed with osteoporosis. While systemic BMD and mandibular cortical bone morphology are correlated, this has not been studied in patients with a history of osteoporotic fractures. Therefore, purpose of this study was researching the mandibular cortical bone morphology in patients with osteoporotic fractures. METHODS The subjects were 55 female and 20 male patients with osteoporotic fractures. Patients were divided into 30 primary osteoporosis patients and 45 secondary osteoporosis patients according to the medical history. Patients underwent BMD and panoramic radiography examinations during orthopedic treatment for fractures. A dual-energy X-ray absorptiometry system was used to measure BMD. Mandibular cortex index (MCI) and mandibular cortex width (MCW) were evaluated using machine-learning measurement software. RESULTS In the analysis of MCI, the ratio of class 2 and 3 was 73% of both primary osteoporosis and secondary osteoporosis. The average MCW was 2.19 mm for primary osteoporosis and 2.30 mm for secondary osteoporosis. The sensitivity values by MCI and MCW were 73% and 76% for both primary and secondary osteoporosis, which were similar detection powers. In addition, the false-negative rates by MCI and MCW were 27% and 24%. CONCLUSION We suggested that MCI and MCW are indicators of osteoporotic conditions in patients with primary and secondary osteoporosis. Our results show that MCI and MCW are non-inferior to the sensitivity values for lumbar BMD in patients with osteoporotic fractures.
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Affiliation(s)
- Taiki Suzuki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, Tokyo, 272-8513, Japan. .,Oral Cancer Center, Tokyo Dental College, Chiba, Japan.
| | - Akitoshi Katsumata
- Department of Oral Radiology, Asahi University School of Dentistry, Gifu, Japan
| | - Yusuke Mastumoto
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, Tokyo, 272-8513, Japan
| | - Masumi Komatu
- Department of Oral Medicine, Hospital Dentistry, Tokyo Dental College, Chiba, Japan
| | - Yusuke Oomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, Tokyo, 272-8513, Japan
| | - Masahiro Okamura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, Tokyo, 272-8513, Japan
| | - Sakiko Mizuno
- Department of Orthopedic Surgery, Ichikawa General Hospital Tokyo Dental College, Chiba, Japan
| | - Ukei Anazawa
- Department of Orthopedic Surgery, Ichikawa General Hospital Tokyo Dental College, Chiba, Japan
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, Tokyo, 272-8513, Japan.,Oral Cancer Center, Tokyo Dental College, Chiba, Japan
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Genc E, Buyuk SK. Evaluation of mandibular indices and cephalometric parameters in adolescents with impacted maxillary canines. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_38_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
Maxillary impacted canines have an important place in orthodontics for the reason of being a common anomaly and its treatment is time consuming and difficult. The aim of this study was to investigate the mandibular indexes and cephalometric parameters in adolescents with impacted maxillary canines.
Materials and Methods:
The radiographs of 4026 patients aged 12–19 years old were scanned and a total of 155 patients were included in the study. Subjects were divided into three groups according to the permanent maxillary canines: Bilateral impacted canine (BIC) (52 subjects; mean age 15.02 ± 1.74 years), unilaterally impacted canine (UIC) (51 subjects; mean age 14.89 ± 1.39 years), and the control (52 subjects; mean age 14.84 ± 1.65 years) groups. Skeletal, soft tissue and dental measurements were performed on cephalometric radiographs. Mandibular index analyzes including the panoramic mandibular index (PMI), mental index (MI), antegonial index (AI), and gonial index (GI) measurements and also angular measurements of impacted maxillary canines were performed on panoramic radiographs. Data were analyzed statistically and P < 0.05 was considered significant.
Results:
Maxillary skeletal and dental measurements showed retrusive positioned maxillary dental arch in the sagittal direction in the impacted canine groups (P < 0.05). PMI and MI values were greater in the BIC and UIC groups than in control group (P < 0.05). There was no statistically significant difference in AI value among groups (P < 0.05). GI value of BIC group was found statistically lower than other groups (P < 0.05).
Conclusion:
Individuals with impacted maxillary canines have more retrusive maxillary dental arch and soft-tissue components. Furthermore, mandibular cortex was thicker in subjects with impacted maxillary canine than individuals with not and clinicians should keep in mind this when examine the panoramic radiographs in terms of early diagnosis of impacted maxillary canine teeth.
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Affiliation(s)
- Esra Genc
- Department of Orthodontics, Ordu University, Ordu, Turkey,
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The Innovative and Sustainable Use of Dental Panoramic Radiographs for the Detection of Osteoporosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072449. [PMID: 32260243 PMCID: PMC7178244 DOI: 10.3390/ijerph17072449] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and CitNetExplorer for analyzing semantic contents, cited references, and temporal citation network. The 280 relevant papers identified were cited 4874 times, having an h-index of 38 and 17.4 citations per paper. The top five major contributing countries were Japan (n = 54, 19.3%), USA (n = 43, 15.4%), Brazil (n = 38, 13.6%), Turkey (n = 38, 13.6%), and the UK (n = 32, 11.4%). Citation per paper correlated with publication count among the authors and institutions. Mandibular cortical width was the most frequently used and most cited measurement index. References published during the 1970s and 1980s have built the foundation for the development of research that investigates the potential associations between osteoporosis and radiographic measurements on panoramic radiographs. Osteoporosis detection by dental panoramic radiographs is a perennially investigated research topic with global contributions. Panoramic radiographs are considered early detection and screening tools for osteoporosis by worldwide research.
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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: 17] [Impact Index Per Article: 3.4] [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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Secgin CK, Kulah CK, Gulsahi A. Analysis of mandibular changes using panoramic-based indices in patients with chronic renal failure. Int J Artif Organs 2017; 41:0. [PMID: 28967087 DOI: 10.5301/ijao.5000649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Chronic renal failure (CRF) is a progressive disease affecting many systems and causing dental and periodontal problems, in particular a decrease or loss in the amount of cortical bone that is visible on radiographs. Panoramic radiography is useful for determining these changes. The aim of this study was to evaluate cortical parts of the mandible using panoramic-based indices in patients with CRF. METHODS 70 subjects with CRF were included in the study. The measurements of panoramic indices were made according to the visibility (mandibular cortical index, MCI) and thickness (mental index, MI) of the inferior cortex of the mandible. Then, these indices, obtained from 70 healthy controls of the same age and gender, were assessed and the results were compared. The effects of dental status and hemodialysis duration on MCI and MI were also investigated. RESULTS The frequency of an eroded cortex was significantly elevated in patients with CRF (p<0.05). The mean MI was lower in patients with CRF than in healthy subjects (5.53 ± 1.62 and 5.73 ± 1.31 mm, respectively), but the difference was not statistically significant (p>0.05). No correlation was found between hemodialysis duration and mandibular indices (p>0.05). Dental status was not associated with mandibular indices (p>0.05). CONCLUSIONS These results suggest that MCI might be a useful radiographic parameter for evaluating changes occurring in the cortical parts of the mandible in CRF patients. Clinicians should be aware of these changes while planning invasive dental treatments in CRF patients.
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Affiliation(s)
- Cansu K Secgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara - Turkey
| | - Cemal K Kulah
- Department of Dentomaxillofacial Radiology, Antalya - Turkey
| | - Ayşe Gulsahi
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara - Turkey
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Kwon AY, Huh KH, Yi WJ, Lee SS, Choi SC, Heo MS. Is the panoramic mandibular index useful for bone quality evaluation? Imaging Sci Dent 2017; 47:87-92. [PMID: 28680844 PMCID: PMC5489673 DOI: 10.5624/isd.2017.47.2.87] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study was to determine whether the panoramic mandibular index (PMI) is useful for assessing bone mineral density. We also analyzed the potential correlations between PMI parameters and patient age. Materials and Methods Four observers measured the PMI of both sides of the mental foramen using a picture archiving and communication system and images in the Digital Imaging and Communications in Medicine format. They studied 300 panoramic radiographic images of patients belonging to the following age groups: 40–49 years, 50–59 years, 60–69 years, 70–79 years, and 80–89 years. The observers were allowed to zoom in or out and to adjust the contrast of the images. Further, they were instructed to record the reasons for any measurements that could not be made. Then, we conducted a reliability analysis of the measured PMI and assessed the correlations between different patient age groups and the 3 parameters used for determining the PMI from the available data. Results Among the 600 data items collected, 23 items were considered unmeasurable by at least 1 observer for the following 4 reasons: postoperative state, lesion, unidentified mental foramen, and alveolar bone loss. The intraobserver reproducibility of the measurable data was 0.611-0.752. The mandibular cortical width (MCW) decreased significantly as patient age increased. Conclusion PMI had limited usability when the margin of the mental foramen was not clear. In contrast, MCW, a parameter used for determining the PMI, had fewer drawbacks than the PMI with respect to bone mineral density measurements and exhibited a significant correlation with patient age.
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Affiliation(s)
- Ah-Young Kwon
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Panoramic radiographic features that predict the development of bisphosphonate-related osteonecrosis of the jaw. Oral Radiol 2017; 34:151-160. [DOI: 10.1007/s11282-017-0293-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/20/2017] [Indexed: 11/26/2022]
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