The Investigation of Radiographic Findings of Mandibles on Panoramic Radiographs of Patients with Primary Hyperparathyroidism Using Fractal Analysis

OBJECTIVE

The basis of the research is the application of fractal analysis (FA) to panoramic radiographs of patients with primary hyperparathyroidism (PHPT). In addition, the relationship between the relevant biochemistry parameters and fractal values of healthy controls and patients with PHPT will be evaluated.

MATERIALS AND METHODS

In the current study, FA was performed with ImageJ program on panoramic radiographs of 48 patients diagnosed with PHPT. Fractal dimension (FD) values of the patients and 48 healthy subjects were compared. In addition, biochemical [parathyroid hormone (PTH), serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and vitamin D] parameters and FD values of both groups were analyzed with Mann-Whitney U-tests and Pearson correlation coefficient (P < .05).

RESULTS

FD values of four different angular areas were significantly lower in the patient group than in the healthy group (P < .05). There was no statistically significant difference between the patient and control groups in the measurements between the apexes of the right and left premolar and molar teeth. The mean PTH, Ca, P, and vitamin D values of the patients with PHPT and control group were highly significant, and all the parameters of the patient group showed higher values than the control group except for the P values (P < .001). In the patient group and control group, there was no significant difference between mean ALP values (P = .48). No correlation was found between the two groups.

CONCLUSION

Bone biopsy is the gold standard method for the diagnosis of bone structure changes in patients with PHPT. However, it is not used routinely because it is an invasive method. The FA method applied to panoramic radiographs may be used as a noninvasive, easy-to-apply method to reveal the changes in the trabecular structure of the jaw bones of the patients.

Morphometric analysis of occipital condyles using alternative imaging technique

PURPOSE

The occipital condyles (OCs) are crucial anatomical structures in the cranial base. To our knowledge, there is no cone beam computed tomography (CBCT)-based study on the morphometric analysis of OCs. The aim of this study was to evaluate the morphometric analysis of OCs using CBCT.

METHODS

CBCT images of 200 OCs from 100 patients of which 39 males and 61 females in the age group of 18-67 years were included in the study population. Linear and angular measurements of OCs were performed.

RESULTS

The average OC width, length, height, sagittal angle, and effective height were 10.3 ± 1.3 mm, 19.6 ± 2.0 mm, 9.1 ± 1.4 mm, 7.4 ± 1.7 mm, and 35.3 ± 5.2 mm. Condylar width and sagittal angle measurements were found significantly different between the right and left sides; and were not found significant difference between the right and left sides in the measurements of condylar height, length, and effective height. Also the average intercondylar anterior distance (ICAD), intercondylar posterior distance (ICPD), distance between the basion and the anterior apex of the occipital condyle (B-AAOC), distance between the basion and posterior apex of the occipital condyle (B-PAOC), distance between the opisthion and anterior apex of occipital condyle (O-AAOC), and distance between the opisthion and posterior apex of occipital condyle (O-PAOC) were 20.9 ± 1.5 mm, 44.0 ± 2.0 mm, 12.3 ± 1.9 mm, 34.5 ± 4.2 mm, 29.8 ± 1.7 mm, and 27.0 ± 2.1 mm. There was not significant difference in the morphometric measurements among age groups. All morphometric measurements showed a significant difference depending on gender.

CONCLUSIONS

The morphometric evaluation of OCs may be effectively examined using CBCT. Linear and angular measurements data of OCs in the present study may be used as a reference database for future morphometric and surgical investigations.

Evaluation of radix entomolaris in mandibular first and second molars using cone-beam computed tomography and review of the literature

OBJECTIVES

The aim of the present study is to identify the prevalence of radix entomolaris in mandibular first and second molars and to determine morphological classifications and associations with other root and canals.

METHODS

Mandibular first and second molar teeth of 850 Turkish patients were evaluated using cone-beam computed tomography. A total of 2800 mandibular first molars and second molars were screened. The CBCT examination was performed at five different axial levels. The prevalence of total radix entomolaris, unilateral-bilateral, right-left side and gender distributions, and the classification of radix entomolaris's canal configurations were measured.

RESULTS

Radix entomolaris was found in 2.9% (n = 25) of the patients and 1.2% (n = 34) of the teeth. The prevalence of radix entomolaris in mandibular first molars was higher than in mandibular second molars (p < 0.01), in males than in females (p < 0.05) and in right side than left side. An additional tubercle was found in 23% of the teeth with radix entomolaris. For buccolingual orientation, Type A canal variation was the highest and Type C canal variation was the lowest. Regarding locations of cervical parts, Type III canal variation was the highest while Type I canal variation was the lowest.

CONCLUSIONS

The prevalence of radix entomolaris was lower in the Turkish population than in other Asian populations but, in multiethnic societies, it needs attention. Before starting endodontic treatment, the clinician should examine the radiography thoroughly and apply advanced radiography methods when necessary. Cone-beam computed tomography is a valuable advanced radiography method for assessing such anatomical variations in vivo.

Alternative cone-beam CT method for the analysis of mandibular condylar bone in patients with degenerative joint disease

OBJECTIVE

The aim of this study was to investigate the use of 3D microstructural bone analysis in patients with degenerative joint disorder (DJD) to enhance the diagnostic capacity of cone beam computed tomography (CBCT) in the evaluation of bone tissue.

METHODS

147 TMJ CBCT images of 88 participants were assessed with regard to DJD in the mandibular condyle. We divided each condyle into 3 groups (0, 1, 2) according to diagnosis of DJD: 0 indicates normal condyles (control individuals), 1 indicates mild erosive osteoarthritic change (EOC) and 2 indicates severe EOC. 3D fractal dimension (FD) was calculated on CBCT images of mandibular condyle and were compared with the radiographic diagnosis of patients.

RESULTS

ANOVA test showed that there was statistically significant difference in FD values among each groups. The average FD value of group 0 was 1.971, group 1 was 1.918 and group 2 was 1.863. Lower FD values and more severe degenerative changes were seen in patient group 2. To evaluate the reliability of fractal analysis (FA) method, receiver operating characteristic (ROC) curve analysis was performed. Area under the curve (AUC) was 0.717 (p < 0.001).

CONCLUSION

This study provides a preliminary conclusion that fractal analysis may be a helpful tool to enhance the diagnostic capacity of CBCT in the evaluation of DJD.

Correction to: Cone beam computed tomography and ultrasonography imaging of benign intraosseous jaw lesion: a prospective radiopathological study

In the original version of this article, '123 lytic intraosseous jaw lesions diagnosed in 112 patients' was incorrectly presented as '123 lytic intraosseous jaw lesions diagnosed in 121 patients' and 'an average age of 31.7 ± 15.4 (range, 6-72)' was incorrectly presented as 'average age of 15.4 ± 31.7 (range, 6-72)'.

Fractal properties of the trabecular pattern of the mandible in chronic renal failure

OBJECTIVES

The purpose of this study was to evaluate fractal analysis as a tool to quantitatively determine the mandibular trabecular bone changes in patients with chronic renal failure (CRF).

METHODS

In the present study, fractal analysis was performed using ImageJ (National Institutes of Health, Bethesda, MD) program with box-counting method over panoramic radiographs of 25 patients (14 females and 11 males) with CRF and 26 healthy individuals (14 females and 12 males) as a control group. The fractal dimension (FD) values of the patients and healthy individuals were compared. In addition, average biochemical parameters [parathyroid hormone (PTH), calcium (Ca), phosphorus (P), product of Ca and P levels (CaxP), alkaline phosphatase (ALP), vitamin D] of the patients with CRF, as measured during the 3 months before the panoramic radiographs, were compared with FD values.

RESULTS

According to the results, FD values of the patients with CRF were found to be statistically lower than the control group (p < 0.05). The average PTH levels of the patients with CRF were 416.16 ± 310.3 pg ml(-1); average Ca levels were 8.94 ± 1.2 mg dl(-1); average P levels were 5.76 ± 1.7 mg dl(-1); average CaxP values were 51.12 ± 15.03; average ALP levels were 83.44 ± 36.8 U l(-1); and the average vitamin D values were 19.43 ± 9.7 ng ml(-1). In addition, there was no significant correlation between FD values and the biochemical parameters of the patients, and there was no correlation between age, gender and FD.

CONCLUSIONS

The FD values of the patients with CRF were lower than those of the controls. This finding suggests that FD analysis might be a promising simple and cost-effective tool for evaluating trabecular bone structure.

Ultrasonography in the evaluation of the mid-palatal suture in rapid palatal expansion

OBJECTIVES

Orthodontists usually evaluate the mid-palatal sutural opening with occlusal radiography. The purpose of this article is to evaluate the sutural opening with ultrasonography (USG) in a series of patients undergoing rapid palatal expansion (RPE).

METHODS

The study included 87 USG images and 87 occlusal radiographs from 29 healthy patients (mean age, 13.9 years; range, 11-20 years; boys, 12; girls, 17) who required RPE treatment. The sutural opening was assessed with USG, and the amount of sutural expansion as mesiodistal length was measured immediately after appliance practice (T0), 10 turns (T1) and 20 turns (T2) during the expansion period. Sutural expansion evaluated by occlusal radiographs was scored at every stage. Measurements obtained by USG and scores observed in the occlusal radiographs were compared by non-parametric Kendall's tau test.

RESULTS

Both USG and radiographic images revealed normal anatomical structure during pre-expansion (stage T0). On USG, sutural expansion was seen in 19 patients at stage T1. There was no expansion at this stage in ten patients. At stage T2, on USG and radiography, an increase in the amount of expansion was observed in 19 patients with sutural expansion at stage T1 and sutural expansion was observed in 5 patients without sutural expansion at stage T1. No expansion was observed at both stages T1 and T2 in five patients. USG measurements and occlusal scores in both T1 and T2 turns showed statistically significant correlation (p < 0.001).

CONCLUSIONS

The results indicate that USG might be a useful method to assess mid-palatal sutural opening in patients undergoing RPE.