Alternative cone-beam computed tomography method for the analysis of bone density around impacted maxillary canines

A Comparative Evaluation of Bone Density Surrounding Buccally and Palatally Impacted Canines Utilizing Fractal Analysis: A Retrospective Cone-Beam Computed Tomography (CBCT) Study

INTRODUCTION

Previous studies have identified environmental and genetic causes of impaction; however, none of these studies have considered bone density as a factor. The study aimed to determine the bone density surrounding buccally and palatally impacted canines and to determine whether bone density is a contributing factor to the higher occurrence of palatal impaction.

METHODS

The study sample included 20 pretreatment cone-beam computed tomography (CBCT) scans with either unilateral or bilateral impacted canines. The fractal dimension (FD) was determined using ImageJ software (National Institutes of Health, Bethesda, MD), with a focus on the interproximal region between the first and second premolars, adjacent to the impacted canine. To assess significant differences between the groups, intergroup comparisons were performed using independent samples t-tests and unpaired t-tests.

RESULTS

The mean FD of palatally impacted canines was 1.5563, which was greater than that of buccally impacted canines (1.3983). The overall changes in FD were significant (p = 0.001).

CONCLUSION

 Our analysis of the CBCT images revealed that bone density is higher around canines that are impacted palatally compared to those impacted buccally. Therefore, bone density is one of the local etiologic factors associated with the higher prevalence of palatal impactions.

Comparison of the Effects of Fixed and Removable Functional Orthodontic Treatment on the Mandibular Trabecular Bone in Fractal Analysis

Objective

The aim of this retrospective study was to compare the effects of the Twin block and Herbst appliances on the mandibular trabecular pattern using fractal dimension analysis (FDA) of panoramic radiographs (PRs).

Methods

The PRs of 50 subjects with skeletal Class II malocclusion who underwent the Twin block (T-group, average age: 11.63±0.87; 25 girls, 25 boys), 50 subjects with skeletal Class II malocclusion who underwent the Herbst (H-group, average age: 11.72±0.91; 27 girls, 23 boys), and 50 controls (C-group average age: 11.67±0.83; 24 girls, 26 boys) were selected. The condyle, corpus, and angulus regions of all groups in the mandible were examined using FDA.

Results

The condylar region (p≤0.001) and corpus mandible in the treatment groups (T-group: right, p≤0.05, left, p≤0.01; H-group: p≤0.05), as well as the left and right condylar region (p≤0.001) and left corpus mandible (p≤0.05) in the C-group, all indicated substantial increases in FDA between T0 and T1. Inter-group comparisons indicated that the T-group had greater variances in the condyle (p≤0.001) compared to the H group.

Conclusion

As the findings revealed both Twin block and Herbst appliances not only contributed to the dentoalveolar structure but also provided remodeling of the mandibular trabecular structure. Consequently, the null hypothesis was rejected.

Three-dimensional assessment of the skeletal characteristics accompanying unilateral maxillary canine impaction: a retrospective cone-beam computed tomography study

BACKGROUND

Environmental and genetic factors associated with canine impaction have been extensively researched, whereas the bone characteristics in the impaction area have not been thoroughly studied. Accordingly, the objective of this investigation was to provide a skeletal assessment in terms of bone density, bone microstructure, bone volume, and palatal volume in subjects with unilaterally impacted maxillary canines.

METHODS

A retrospective design has been employed to address the aim of this study, where the initial pre-treatment cone-beam computed tomography (CBCT) scans of 30 patients with unilateral maxillary canine impaction were assessed. The obtained patients' data were equally divided according to the location of the impaction into 2 groups, one with buccally impacted canines, and another with palatal impactions, with the contra-lateral sides in both groups serving as the controls. Skeletal measurements such as bone density (BD), bone microstructure in terms of fractal dimension (FD), maxillary bone volume (MBV), and palatal volume (PV) were evaluated from the acquired CBCTs in both groups and compared to the controls.

RESULTS

With buccal impactions, significantly greater BD and FD have been reported (p < 0.001), whereas non-significant differences were found regarding the PV when compared with controls (p = 0.56). MBV was significantly greater on the non-impaction side in comparison with buccal impaction sides (p < 0.001). For palatal impactions: BD, FD, and MBV were significantly greater on the impaction sides (p < 0.001), and conversely with PV which has been reported to be significantly greater on the non-impaction sides (p < 0.001).

CONCLUSIONS

As per the obtained results, buccally impacted canines are associated with greater BD and FD, and less MBV, whereas palatally impacted canines are accompanied with greater BD, FD, and MBV, in addition to less PV, when both conditions are compared with the non-impaction sides.

Assessment of the Trabecular Bone Microstructure Surrounding Impacted Maxillary Canines Using Fractal Analysis on Cone-Beam Computed Tomography Images

OBJECTIVES

To assess the impact of the presence or position (buccal/palatal) of impacted canines on trabecular bone density using fractal analysis (FA) on cone-beam computed tomography (CBCT) images, and to compare the results with a control group without impacted canines.

METHODS

This retrospective study included 41 patients with unilateral impacted canines (30 palatal, 11 buccal) and a control group of 39 patients who underwent surgically assisted rapid maxillary expansion. All patients had CBCT images recorded for diagnostic and treatment purposes. Cross-sectional CBCT images were obtained between the first and second premolars on both sides of the patients' maxilla. From these images, fractal dimension (FD) was measured in a 20 × 20 pixel region of interest in the trabecular bone using the ImageJ software.

RESULTS

The FD values were significantly higher on the impacted side in the impacted canine group (p = 0.02). Within the impacted canine group, a significant increase in FD was observed on the impacted side in the buccal-impacted subgroup (p = 0.02), while no significant difference was observed in the palatal-impacted subgroup (p > 0.05).

CONCLUSIONS

According to the results of our study, there is an association between the position of the impacted canine and trabecular bone density. An increased trabecular bone density may play a role in the etiology of buccally impacted canines. Clinicians should consider anchorage planning, and appropriate force level, during the forced eruption of buccally impacted canines with high surrounding bone density, to minimize undesirable movements and achieve optimal treatment outcomes.

Comparison of quantitative radiomorphometric predictors of healthy and MRONJ-affected bone using panoramic radiography and cone-beam CT

OBJECTIVES

To determine the most distinctive quantitative radiomorphometric parameter(s) for the detection of MRONJ-affected bone changes in panoramic radiography (PR) and cone-beam CT (CBCT).

METHODS

PR and sagittal CBCT slices of 24 MRONJ patients and 22 healthy controls were used for the measurements of mandibular cortical thickness (MCT), fractal dimension (FD), lacunarity, mean gray value (MGV), bone area fraction (BA/TA), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N). MCT was measured in the mental foramen region. While FD and lacunarity were measured on mandibular trabecular and cortical regions-of-interest (ROIs), the remaining parameters were measured on trabecular ROIs. The independent samples t-test was used to compare the measurements between the MRONJ and control groups for both imaging modalities (P = .05).

RESULTS

MCT was the only parameter that differentiated MRONJ-affected bone in both PR and CBCT (P < .05). None of the remaining parameters revealed any difference for MRONJ-affected bone in CBCT (P > .05). FD, lacunarity, MGV, BA/TA, and Tb.Sp could distinguish MRONJ-affected trabecular bone in PR (P < .05). The correspondent ROI for both imaging methods that was reliable for detecting MRONJ-affected bone was the trabecular bone distal to the mental foramen above the inferior alveolar canal (ROI-3).

CONCLUSIONS

MCT is a reliable parameter for the discrimination of MRONJ-affected bone in both PR and CBCT images. PR may be used to detect MRONJ-affected trabecular bone using FD, lacunarity, MGV, BA/TA, and Tb.Sp measurements as well.

Morphological evaluation of maxillary arch in unilateral buccally and palatally impacted canines: a cone-beam computed tomography (CBCT)-based study in Northern Iran

Purpose

This study investigated the association between the maxillary impacted canines' position and the maxilla's morphological features in an Iranian population based on cone-beam computed tomography (CBCT) images.

Material and methods

In this cross-sectional descriptive-analytical study, 47 CBCT images of unilateral buccally impacted maxillary canines and 47 CBCT images of unilateral palatally impacted maxillary canines were examined. Several morphological variables were compared between the impacted and non-impacted sides, and between the buccal and palatal impaction types.

Results

Gender and age were not significantly associated with the canine impaction type. The alveolar bone height at the impacted side was significantly greater in the buccally impacted group than in the palatally impacted group (p = 0.016). In a comparison of the impacted and non-impacted sides, all variables of alveolar bone thickness at depth of 2 mm, maxillary arch width, and palatal volume had significantly smaller values in the impacted side in both buccally and palatally impacted groups (p < 0.05). The alveolar bone was significantly thicker at the depth of 10 mm in the impacted side of the buccal group (p = 0.024). The maxillary arch perimeter was significantly smaller in the impacted side of the buccal group (p = 0.008). The palatal depth did not significantly differ between the groups.

Conclusion

Among the studied variables, the alveolar bone thickness showed contrary results at different depths. The palatal volume and maxillary arch width were significantly smaller on the impacted side in both buccal and palatal groups, and the arch perimeter showed the same results only in the buccal group.

Channel-Boosted and Transfer Learning Convolutional Neural Network-Based Osteoporosis Detection from CT Scan, Dual X-Ray, and X-Ray Images

Osteoporosis is a word used to describe a condition in which bone density has been diminished as a result of inadequate bone tissue development to counteract the elimination of old bone tissue. Osteoporosis diagnosis is made possible by the use of medical imaging technologies such as CT scans, dual X-ray, and X-ray images. In practice, there are various osteoporosis diagnostic methods that may be performed with a single imaging modality to aid in the diagnosis of the disease. The proposed study is to develop a framework, that is, to aid in the diagnosis of osteoporosis which agrees to all of these CT scans, X-ray, and dual X-ray imaging modalities. The framework will be implemented in the near future. The proposed work, CBTCNNOD, is the integration of 3 functional modules. The functional modules are a bilinear filter, grey-level zone length matrix, and CB-CNN. It is constructed in a manner that can provide crisp osteoporosis diagnostic reports based on the images that are fed into the system. All 3 modules work together to improve the performance of the proposed approach, CBTCNNOD, in terms of accuracy by 10.38%, 10.16%, 7.86%, and 14.32%; precision by 11.09%, 9.08%, 10.01%, and 16.51%; sensitivity by 9.77%, 10.74%, 6.20%, and 12.78%; and specificity by 11.01%, 9.52%, 9.5%, and 15.84%, while requiring less processing time of 33.52%, 17.79%, 23.34%, and 10.86%, when compared to the existing techniques of RCETA, BMCOFA, BACBCT, and XSFCV, respectively.

Comparison of the effects of removable functional appliance therapy applied in pubertal and postpubertal periods: A retrospective cephalometric and fractal analyses study

INTRODUCTION

In this study, we compared the effects of functional treatment with Twin-block appliance on the bony architectures of the maxilla and mandible by fractal dimension (FD) analysis, and the skeletal and dentoalveolar effects by cephalometric analysis, in pubertal and postpubertal patients with Class II malocclusion.

METHODS

This study comprised 60 patients who underwent Twin-block treatment. Group 1 consisted of 30 patients in the pubertal period (6 boys and 24 girls; mean age 12.27 ± 1.35 years), whereas group 2 consisted of 30 patients in the postpubertal period (6 boys and 24 girls; mean age 13.73 ± 1.51 years). FD analysis was performed on the patients before and after Twin-block panoramic and lateral cephalometric radiographs. Cephalometric analysis was also conducted. Paired and Student t tests were used to compare the parametric data, and Wilcoxon signed rank and Mann-Whitney U tests were conducted to compare the nonparametric data.

RESULTS

SNB, Pg-N, N-Me, ANS-Me, IMPA, L1/NB, Co-Gn, Go-Gn, S-Go, Co-Go, and Go-Me significantly increased in both groups after treatment. FD values of tuber, condyle, and molar regions significantly decreased in group 1, whereas no significant differences were observed in group 2 after treatment.

CONCLUSIONS

In the pubertal period, the Twin-block appliance resulted in skeletal correction by causing bone remodeling and reshaping in both jaws along with the dentoalveolar correction. In the postpubertal period, Twin-block had no significant effect on the bone trabecular arrangement in the investigated areas but produced cephalometric improvement to a certain extent with lower skeletal and higher dental impact.

Qualitative and quantitative three-dimensional evaluation of maxillary basal and dentoalveolar dimensions in patients with and without maxillary impacted canines

Background

This study aimed to three-dimensionally evaluate the qualitative and quantitative maxillary basal, dentoalveolar, and dental dimensions in patients with unilateral or bilateral maxillary impacted canines relative to their normal peers.

Materials and methods

This is a retrospective comparative study. Cone-beam computed tomography images of one hundred and fifty adult patients were divided into three equal groups: unilateral, bilateral, and control groups. Each had 50 patients that were three-dimensionally analysed. The quantitative measurements involved three basal (molar basal width, premolar basal width, and arch depth), seven dentoalveolar (molar alveolar width, premolar alveolar width, inter-molar width, inter-premolar width, inter-canine width, arch length, and arch perimeter), and two dental (canine length and width) measurements. The qualitative measurements included four bone density areas (buccal, lingual, mesial, and distal) around the maxillary impacted canines.

Result

Differences between the three groups were statistically different for the quantitative measurements involving the two basal variables (molar basal width and premolar basal width) and all measured dentoalveolar variables; these were smaller in the unilateral and bilateral groups compared with the control group (p < 0.001). Unilateral and bilateral impacted canine groups showed significantly wider and shorter canines than the control group (p < 0.001). The qualitative measurements (the four bone density areas) around unilateral and bilateral impacted canine groups showed significantly greater density than the control group (p < 0.001). There was no significant qualitative or quantitative difference between the unilateral and bilateral impacted canines. The three groups had no significant variations in terms of arch depth.

Conclusion

Maxillary unilateral and bilateral canine impactions are associated with reduced basal and dentoalveolar dimensions as well as wider and shorter maxillary canines compared to normal peers. The quality of bone around unilateral and bilateral impacted maxillary canines is higher than in non-impacted cases. Unilateral and bilateral canine impactions have quite similar qualitative and quantitative parameters.

Evaluation of mandibular indices and cephalometric parameters in adolescents with impacted maxillary canines

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.

Gray value measurement for the evaluation of local alveolar bone density around impacted maxillary canine teeth using cone beam computed tomography

Background

To investigate whether any relationship between local alveolar bone density and maxillary canine impaction using gray values from cone beam computed tomography.

Material and Methods

The cone beam computed tomography images of 151 patients were retrospectively evaluated. Maxillary canine was defined as an impacted tooth when root formation was complete and the patient’s age older than 13 or the other side of the maxillary canine has completely erupted. Similarly, complete eruption was defined as the tooth in its expected occlusion and position. Using the cone beam computed tomography software, the region of interest which was 5 mm2 in area, was placed in the trabecular bone on cross sectional cone beam computed tomography images and the gray value measurements were recorded. After measuring the gray values of all the teeth, the images were grouped according to the field of view size. Comparison of the gray values of impacted and non-impacted teeth was made between images with the same field of view size.

Results

A total of 151 patients, 101 (66.9%) female and 50 (33.1%) male, were included in the study. The mean age of the patients was 24.94 ±13.9. In images with a 40X40 field of view, the gray values of the impacted canine teeth were higher than the gray values of the non-impacted ones and statistically significant difference was found between them (p=0.003). However no statistically significant difference was found between the gray values of impacted and non-impacted canine teeth in 60x60 and 100x50 field of view (p=0.197, p=0.170, respectively).

Conclusions

We suggest using the smallest field of view size when evaluating bone density using gray values from cone beam computed tomography images and we support the idea that the local increased bone density may influence on impaction.

Key words:Cone-beam computed tomography, tooth, impacted, bone density, maxilla, image processing, computer-assisted.

Evaluation of mandibular morphologic measurements and trabecular structure among subgroups of impacted mandibular third molars

OBJECTIVE

To investigate mandibular morphologic measurements and trabecular structures that may cause mandibular third molar (MM3) impaction according to MM3 subgroups.

METHODS

A total of 150 MM3 of 2175 panoramic radiographs (PRs) were reviewed. MM3s according to Winter (vertical), Pell & Gregory Class 1 and group: A, B, C on PRs were included in the study group. Fractal dimensions (FD) and mandibular morphologic measurements were evaluated. Statistical analysis for parametric values was performed using one-way analysis of variance (ANOVA). Statistical analysis for non-parametric values was performed using the Kruskal-Wallis H test.

RESULTS

Statistically, a significant difference was found only in terms of angle of impaction among the groups of MM3 (p < 0.05) [Winter (vertical), and Pell & Gregory Class 1 and group A, B, C]. There was no difference among groups A, B, C in mandibular morphology and trabecular structure, but group C showed different characteristics than the other groups only in terms of impaction angle.

CONCLUSION

The trabecular structure and morphometric properties except for the angle of impaction do not affect impacted MM3s with adequate retromolar space and vertical angle.

Aggregation of Region-based and Boundary-based Knowledge Biased Segmentation for Osteoporosis Detection from X-Ray, Dual X-Ray and CT Images

BACKGROUND

Osteoporosis is a term used to represent the reduced bone density, which is caused by insufficient bone tissue production to balance the old bone tissue removal. Medical Imaging procedures such as X-Ray, Dual X-Ray and Computed Tomography (CT) scans are used widely in osteoporosis diagnosis. There are several existing procedures in practice to assist osteoporosis diagnosis, which can operate using a single imaging method.

OBJECTIVE

The purpose of this proposed work is to introduce a framework to assist the diagnosis of osteoporosis based on consenting all these X-Ray, Dual X-Ray and CT scan imaging techniques. The proposed work named "Aggregation of Region-based and Boundary-based Knowledge biased Segmentation for Osteoporosis Detection from X-Ray, Dual X-Ray and CT images" (ARBKSOD) is the integration of three functional modules.

METHODS

Fuzzy Histogram Medical Image Classifier (FHMIC), Log-Gabor Transform based ANN Training for osteoporosis detection (LGTAT) and Knowledge biased Osteoporosis Analyzer (KOA).

RESULTS

Together, all these three modules make the proposed method ARBKSOD scored the maximum accuracy of 93.11%, the highest precision value of 93.91% while processing the 6th image batch, the highest sensitivity of 92.93%, the highest specificity of 93.79% is observed during the experiment by ARBKSOD while processing the 6th image batch. The best average processing time of 10244 mS is achieved by ARBKSOD while processing the 7th image batch.

CONCLUSION

Together, all these three modules make the proposed method ARBKSOD to produce a better result.

Three dimensional movement analysis of maxillary impacted canine using TADs: a pilot study

BACKGROUND

The aim of the present study was to compare two different anchorage systems efficiency to disinclude impacted maxillary canines using as evaluation tool superimposed Cone Beam Computed Tomography (CBCTs).

METHODS

The study has been conducted with two parallel groups with an allocation ratio of 1:1. Group test received treatment using as anchorage a miniscrew, control group was treated using an anchorage unit a trans palatal arch (TPA). Both groups received a calibrated traction force of 50 g. CBCT before treatment and 3 months after traction were superimposed and canine tip and root movement were evaluated in mm/month ratio.

RESULTS

No differences were observed between groups for apex displacement, tip displacement and observation timespan. Twenty-two patients (12 female, 10 male, mean age:13.4 years) undergoing orthodontic treatment for impacted maxillary canines were recruited for this study. No differences were observed between groups for apex displacement, tip displacement and observation timespan.

CONCLUSIONS

The present pilot study provided no evidence that indirect anchorage on miniscrews could make canine disimpaction faster than anchorage on a TPA. An apex root movement of 0.4-0.8 mm per month was found, while average canine tip movement ranged between 1.08 mm and 1.96 mm per month. No miniscrews failures were observed.

TRIAL REGISTRATION

The study reports the preliminary results of the randomized clinical trial registered at www.register.clinicaltrials.gov (registration number: NCT01717417 ).

Prediction of rapid palatal expansion success via fractal analysis in hand-wrist radiographs

INTRODUCTION

This study aimed to evaluate the efficacy of fractal analysis of hand-wrist radiography in the decision of conventional or surgery-assisted rapid palatal expansion (RPE).

METHODS

The study included 48 patients who underwent the RPE procedure. Study groups were as follows: group 1 (successful conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.85 ± 0.97 years]) and group 2 (failed conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.96 ± 1.08 years]). Fractal dimension (FD) analysis was conducted on hand-wrist radiographs of the patients for 4 different regions: the epiphysis-diaphysis line of the radius bone and the proximal, medial (MP3), and distal (DP3) phalanxes of the middle finger. A Student t test was performed to compare fractal values between the groups. A receiver operating characteristic analysis was applied to determine the optimal cutoff value of FDs. In addition, a Pearson correlation coefficient was calculated to evaluate the relationship between the fractal values and either age or hand-wrist stage in a second sample group (n = 90; age range, 8.7-18.7 years).

RESULTS

Fractal values of the radius, MP3, and DP3 were significantly increased in the failed conventional RPE group (P <0.05). The optimal cutoff value of the FD for predicting the success of conventional RPE was 1.16 in the radius, 1.18 in proximal phalanxes, 1.29 in MP3, and 1.08 in DP3. There was a positive correlation between fractal values of the radius and age or hand-wrist stages (P <0.05).

CONCLUSIONS

Within the limits of this study, results revealed that fractal analysis of hand-wrist radiographs might be considered a significant tool in the prediction of RPE success.

Analysis of Bone Density in a Group of Patients with Dental Inclusion

Background/Aim: Genetic and environmental etiologic factors have been described for maxillary canine impaction, except for the trabecular bone characteristics in the impacted area. The aim of this study was to evaluate the surface area and bone density using cone-beam computed tomography (CBCT) images of patients with maxillary impacted canines.

Material and Methods: The sample comprised preorthodontic treatment, CBCT images of 24 participants with unilateral maxillary impacted canines, using the impacted side as study group and the non-impacted side as control group. CBCT images were acquired in portrait mode (17 × 23 cm high field of view) at 120 kV, 5 mA, 8.9 seconds exposure time, and 0.3 mm voxel size. Each root was divided into three levels (cervical, intermediate, and apical) to determine whether the bone density change varied with the tooth level. Moreover, each level was divided into four regions (palatal, distal, mesial, and buccal sides). Bone density was measured using Hounsfield Units. Comparisons were made using paired t tests and linear regression. Repeated measurements were obtained randomly from about 20% of the sample.

Results: In subjects with unilateral impactions, the maxillary bone density was higher in the impacted side, with a mean difference of 350 HU. Bone density increases in the corono-apical direction of about 100 HU in the impaction site and about 50 HU in the site of the erupted canine. The repeated measurements showed similar results.

Conclusions: The maxillary alveolar bone area and bone density are increased in the impacted side compared with the nonimpacted side.

Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan's syndrome: a STROBE-compliant case-control study

Sheehan's syndrome (SHS) is a rare condition related to the risk of osteoporosis and evaluation of bone texture imaging features on panoramic radiographs would be suitable for this condition, which was the aim of the present study. Fractal dimension, lacunarity, and trabecular morphologic aspects were significantly altered in these patients.

INTRODUCTION

SHS is an important public health problem particularly in developing countries. It is characterized as postpartum hypopituitarism secondary to obstetric complications-related ischemic pituitary necrosis that shows significant systemic metabolic repercussions. Thus, this study aimed to evaluate bone texture parameters in digital panoramic radiographs of patients with SHS.

METHODS

A case-control study was conducted with 30 SHS patients from an Endocrinology and Diabetology Service of reference in Brazil, and 30 age- and sex-matched healthy controls. A custom computer program measured fractal dimension, lacunarity, and some morphologic features in the following mandibular regions of interest (50 × 50 pixels): below the mental foramen (F1), between the first and second molars (M1), and at the center of the mandibular ramus (R1).

RESULTS

The fractal analysis showed a statistically significant difference between the studied groups in all regions of interest. The fractal dimension in F1 (p = 0.016), M1 (p = 0.043), and R1 (p = 0.028) was significantly lower in SHS group, as well as lacunarity in R1 (p = 0.008). Additionally, several morphologic features were statistically significant in the SHS group (p < 0.05).

CONCLUSION

Therefore, individuals with SHS showed altered imaging texture parameters on panoramic radiographs, which reflect a smaller spatial organization of the bone trabeculae and, possibly, a state of reduced mineral bone density.

Use of fractal analysis in dental images: a systematic review

OBJECTIVES

This study reviewed the use of fractal analysis (FA) in dental images.

METHODS

A search was performed using PubMed, MEDLINE, LILACS, Web of Science and SCOPUS databases. The inclusion criteria were human studies in the English language, with no date restriction.

RESULTS

78 articles were found in which FA was applied to panoramic radiographs (34), periapical radiographs (21), bitewing radiographs (4), cephalometric radiograph (1), cone beam CT (15), micro-CT (3), sialography (2), and ultrasound (2). Low bone mineral density (21) and systemic or local diseases (22) around the bone of dental implants were the main subjects of the study of FA. Various sizes and sites of the regions of interest were used to evaluate the bone structure. Different ways were used to treat the image and to calculate FA. FA of 43 articles showed significant differences in the comparison of groups, mainly between healthy and sick patients.

CONCLUSIONS

FA in Dentistry has been widely applied to the study of images. Panoramic and periapical radiographs were those most frequently used. The Image J software and the box-counting method were extensively adopted in the studies reviewed herein. Further studies are encouraged to improve clarification of the parameters that directly influence FA.