TRABECULAR AND CORTICAL MANDIBULAR BONE STRUCTURE IN FAMILIAL ADENOMATOUS POLYPOSIS: A PANORAMIC RADIOGRAPHIC STUDY

Abstract

<h3>BACKGROUND</h3> Colorectal cancer (CRC) is the third leading cause of cancer-associated deaths worldwide and is responsible for almost 9% of all deaths. Familial adenomatous polyposis (FAP) is an autosomal dominant disorder presenting with dento-osseous manifestations. <h3>OBJECTIVE(S)</h3> To analyze the mandibular cortical and trabecular bone pattern in patients with FAP through dental panoramic radiomorphometric indices and fractal dimension (FD). <h3>STUDY DESIGN</h3> Dental panoramic radiographs (DPRs) were obtained from patients with FAP and paired controls. The parameters analyzed were FD of the trabecular bone in 4 different regions of interest (ROIs), mandibular cortical index (MCI), and mandibular cortical width (MCW). Blinded evaluators were trained until they reached an adequate intra- and interobserver reliability calculated via the intraclass correlation coefficient (ICC). FD for each area, MCI and MCW were compared between groups by parametric Student <i>t</i> tests and the chi-square statistic. <h3>RESULTS</h3> Sixty panoramic radiographs of dentate patients, including patients with FAP (n = 15) and matched controls (n = 45), were investigated. The ICC showed an excellent agreement, FD ICC = 100%, MCI = 0.967 (confidence interval [CI], 0.945-0.980), MCW(R) = 0.995 (CI, 0.991-0.997), and MCW(L) = 0.983 (CI, 0.972-0.990). The FD values were lower for the FAP group compared with the non-FAP controls. Statistically significant differences were shown in ROI-2 and ROI-3 anteriorly to the mental foramen bilaterally (<i>P</i> = .001 and <i>P</i> = .006, respectively). ROI-1 and ROI-4, at the mandibular angle trabecular bone region, indicated statistical significance on the right side (<i>P</i> = .036) and no difference on the left side (<i>P</i> = .091). There was no significant difference in MCI and MCW between the groups, with MCW (L) <i>P</i> = .247 and MCW (R) <i>P</i> = .070. <h3>DISCUSSION/CONCLUSIONS</h3> Fractal dimension values of mandibular trabecular bone of patients with FAP were lower than those in healthy controls. The radiomorphometric indices MCI and MCW were not useful for the analysis of the cortical bone pattern. Therefore, FD is a promising tool for bone structure evaluation in dental panoramic radiographs and for supporting the appropriate referral of patients with FAP.