Mandibular Cortical Width Research Articles

Diagnosis of osteoporosis in dental patients

Osteoporosis is a severe skeletal disease that leads to bone fractures, even disability, if it remains undetected. However, osteoporosis remains frequently unnoticed until a fracture occurs. It is possible for dental practitioners to screen patients at risk of osteoporosis and refer them for an osteoporosis evaluation. Screening can be achieved mainly through dental radiographs and especially panoramic x-rays, where several radiographic indices, such as Mandibular Cortical Width (MCW), Mandibular Cortical Index (MCI), Gonial Index (GI), Antigonial Index (AI), Panoramic Mandibular Index (PMI) and alveolar crest resorption degree (M/M ratio) can be assessed. Furthermore, patients with osteoporosis develop changes in the trabecular bone of their jaws and those alternations can be detected by dentists through periapical and panoramic x-rays. Moreover, periodontitis, which is a major reason for tooth loss, deteriorates when the patient also suffers from osteoporosis. Dentists can thus screen their patients who are possibly unaware of their osteoporosis, and refer them further for dual-energy X-ray absorptiometry (DXA) examination. However, all the above indices are merely indicative of low skeletal bone mineral density and the dentist must always take into account the medical history and clinical risk factors of osteoporosis before further referring to an osteoporosis specialist.

Diagnostic performance of fractal dimension and radiomorphometric indices from digital panoramic radiographs for screening low bone mineral density

A number of panoramic radiographic measurements have been associated with osteoporotic alterations. However, little is known about the differences in sensitivity and specificity among these measurements for screening low bone mineral density (BMD). Aim: To correlate and compare precision, sensitivity and specificity of panoramic radiomorphometric indices and fractal dimension (FD) for screening low BMD (i.e. osteopenia and osteoporosis). Methods: Sixty-eight female patients (42.78±15.59 years) were included in this study. Body mass index (BMI), mandibular cortical index (MCI), mandibular cortical width (MCW), FD and connectivity (C) were assessed. Low BMD was diagnosed by peripheral dual-energy X-ray absorptiometry (p-DXA). Non-parametric correlations were assessed among all variables. In addition, sensitivity and specificity of MCI, MCW and FD were estimated for screening low BMD. Results: Significant correlation was found between FD and BMI (p=0.013; r=0.269). In addition, FD was the most sensitive method for screening low BMD (70.8%, p=0.001). FD and MCI presented a significant and relatively high sensitivity, whereas MCW presented a high specificity for screening low systemic BMD Conclusions: Among the analyzed methods, FD and MCI offer a significant and relatively high sensitivity, whereas MCW offers a high specificity for screening low BMD.

Risk of osteoporosis in elderly individuals attending a dental clinic

Osteoporosis has become a critical public health problem with the rapidly aging population in Japan. It is necessary for dentists to know their patients' status because it influences dental treatment. The purpose of this study was to predict the risk of osteoporosis in elderly patients visiting a dental clinic by assessing mandibular cortical morphology on panoramic radiographs. Three-hundred and thirty patients were divided into three classes based on the morphology of their mandibular cortex on panoramic radiographs. Mandibular cortical bone width at the mental foramen was also measured. Bone mineral density (BMD) was determined at the calcaneus using a quantitative ultrasound device. The mandibular cortical width decreased significantly from Class 1 (normal cortex), to Class 2 (moderately eroded cortex) and to Class 3 (severely eroded cortex). BMD was negatively correlated with age in both female and male patients. Most (108/186) female patients had a class 3 cortex with a low BMD. Among women, mandibular cortical width was significantly correlated with BMD. Thirty-three percent of the female had received a previous diagnosis of osteoporosis. In contrast, only 13.9% (20/144) of the male had a Class 3 cortex. In men, mandibular cortical width did not significantly correlate with BMD. Only a few of the men had received a previous diagnosis of osteoporosis. The number of remaining teeth did not correlate with low BMD in either sex. Our findings reveal that most elderly female patients visiting the dental clinic had a high risk of osteoporosis and a low BMD.

Is the panoramic mandibular index useful for bone quality evaluation?

PurposeThe 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 MethodsFour 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.ResultsAmong 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.ConclusionPMI 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.

Distributional Variations in the Quantitative Cortical and Trabecular Bone Radiographic Measurements of Mandible, between Male and Female Populations of Korea, and its Utilization.

It is important to investigate the irregularities in aging-associated changes in bone, between men and women for bone strength and osteoporosis. The purpose of this study was to characterize the changes and associations of mandibular cortical and trabecular bone measures of men and women based on age and to the evaluation of cortical shape categories, in a large Korean population. Panoramic radiographs of 1047 subjects (603 women and 444 men) aged between 15 to 90 years were used. Mandibular cortical width (MCW), mandibular cortical index (MCI), and fractal dimensions (FD) of the molar, premolar, and anterior regions of the mandibular trabecular bone were measured. Study subjects were grouped into six 10-years age groups. A local linear regression smoothing with bootstrap resampling for robust fitting of data was used to estimate the relationship between radiographic mandibular variables and age groups as well as genders. The mean age of women (49.56 ± 19.5 years) was significantly higher than that of men (45.57 ± 19.6 years). The MCW of men and women (3.17mm and 2.91mm, respectively, p < 0.0001) was strongly associated with age and MCI. Indeed, trabecular measures also correlated with age in men (r > −0.140, p = 0.003), though not as strongly as in women (r > −0.210, p < 0.0001). In men aged over 55 years, only MCW was significantly associated (r = −0.412, p < 0.0001). Furthermore, by comparison of mandibular variables from different age groups and MCI categories, the results suggest that MCW was detected to be strongly associated in both men and women for the detection of bone strength and osteoporosis. The FD measures revealed relatively higher association with age among women than men, but not as strong as MCW.

Corrеlation bеtwееn Dual-Еnеrgy X-Ray Absorptiomеtry and Panoramic Mandibular Indicеs in Prеdiction of Bonе Minеral Dеnsity in Postmеnopausal Fеmalеs

Background: Ostеoporosis is a systеmic disеasе of thе bonе that is charactеrizеd by rеducеd bonе mass, which lеads to incrеasеd bonе fragility and fracturеparticularly in postmеnopausal womеn.Thе aims of study was toеvaluatе thе rеlationship bеtwееn mandibular radiomorphomеtric indicеs obtainеd on digital panoramic radiographswith thе bonе minеral dеnsitiеs of thе lumbar spinееvaluatеd using dual-еnеrgy X-ray absorptiomеtry (DXA) scan, in a population of ostеoporotic and non-ostеoporotic fеmalеs. Matеrials and mеthods: In panoramic imagеs obtainеd from 60 fеmalе individuals dividеd еqually into thrее groups: controls (20-30 yеars), non-ostеoporotic post-mеnopausal agеd 50 yеars and abovе and ostеoporotic post-mеnopausal agеd 50 yеars and abovе, thе mеan was calculatеd for mandibular cortical width (MCW), panoramic mandibular indеx (PMI), mandibular cortical indеx (MCI) and gonial anglе indеx (GAI) valuеs mеasurеd in thе right and lеft sidеs of thе mandiblе. Bonе minеral dеnsity (BMD) valuеs wеrе mеasurеd by dual еnеrgy X-ray absorptiomеtry (DXA) scan. Rеsults: Significant positivе corrеlation (r) was obsеrvеd bеtwееn bonе minеral dеnsity of lumbar vеrtеbraе and MCW (r=0.706) and PMI (r=0.668) of mandiblе, and a nеgativе corrеlation was obsеrvеd bеtwееn MCI and BMD of lumbar vеrtеbraе (r=-0.716). Whilе GAI did not show any significant diffеrеncе in rеlation to bonе minеral dеnsity. Conclusion: This study showеd that MCW, PMI and MCI indicеs wеrе usеful for idеntifying fеmalеs with low skеlеtal (BMD), whilе GAI was indеpеndablе in dеtеcting ostеoporosis.

Factors affecting observer agreement in morphological evaluation of mandibular cortical bone on panoramic radiographs

To assess intra- and inter-observer agreement in the morphological evaluation of mandibular cortical bone on panoramic radiographs, to examine factors affecting the diagnosis, and to determine causes of diagnostic discrepancy. Three experienced observers evaluated mandibular cortical shape on panoramic radiographs of 228 females, and divided the images into three classes. The intra- and inter-observer agreements were calculated. The effect of mandibular cortical width on shape classification was examined. Causes of diagnostic discrepancy were investigated. Overall intra- and inter-observer kappa values in diagnosing mandibular cortical shape were 0.58–0.76 and 0.62–0.69, respectively. The kappa values in diagnosing Class 2 were low. In radiographs diagnosed as Class 2 and Class 3, the ranges of mandibular cortical width overlapped. Discrepancies in diagnosis were caused by slight resorption at the endosteal margin of the cortical bone, endosteal cortical residues near the thinned smooth cortex, and superimposition of the hyoid bone over the mandible. Inter-observer agreement in evaluating mandibular cortical shape was moderate to substantial. Diagnostic discrepancies were mainly caused by differences in evaluation of the endosteum near the cortical bone.

Influence of N-methyl pyrrolidone on the activity of the pulp-dentine complex and bone integrity during osteoporosis.

To analyse the effect of systemic application of N-methyl pyrrolidone (NMP) on the pulp-dentine complex and on the jawbone of ovariectomized rats. Female Sprague Dawley rats were randomly divided into a Sham-operated group (Sham n=6) and an oestrogen depletion by ovariectomy (OVX n=12) group. In 6 of the ovariectomized animals, N-methyl pyrrolidone (NMP) in phosphate-buffered saline (PBS) was administered systemically weekly by intraperitoneal injection (i.p.); the other 6 were injected with PBS (Veh). After 15weeks of injections, the jaw bones were collected and pulps extracted from the incisors teeth. Histology was used to determine pre-dentine thickness in teeth and radiography to determine alveolar bone mass. Immunohistological staining and RT-PCR were performed to verify the presence and localization of the odontoblast-specific dentine sialoprotein and to quantify its expression in the dentine-pulp complex. Mandibular cortical width and mandibular height were evaluated by means of X-ray analysis. Statistical analysis was performed with analysis of variance (anova). Both pre-dentine (P=0.029) and alveolar bone structures (P=0.049) were significantly reduced due to oestrogen deficiency in OVX Veh and OVX. NMP treatment normalized these parameters to the Sham level. DSPP expression in OVX NMP animals was significantly higher (P=0.046) than in OVX Veh. X-ray analysis confirmed that ovariectomy significantly reduced the mandibular cortical width in the OVX Veh group compared to the Sham Veh and OVX NMP (P=0.020). N-methyl pyrrolidone (NMP) had a remarkable anti-osteoporotic ability preserving activity in the pulp-dentine complex and preventing jawbone loss. These effects make NMP a promising candidate for the preservation of the activity of the pulp-dentine complex and jawbone thickness in post-menopausal females.

Diagnostic value of panoramic indices to predict osteoporosis and osteopenia in postmenopausal women

Background: Osteoporosis is characterized by the progressive loss of bone density, which leads to severe fractures. This study conducted to evaluate the diagnostic value of the mandibular radiomorphometric indices of panoramic radiographs to predict the status of bone mineral density (BMD) in postmenopausal women. Materials and Methods: Panoramic radiographs of ninety postmenopausal women (thirty osteoporotic, thirty osteopenic, and thirty controls) with the mean age of 54.47 years were evaluated. Bone densitometry was performed by using the dual-energy X-ray absorptiometry method. Variables such as the mandibular cortical width (MCW), panoramic mandibular index (PMI), gonial angle, mandibular cortical index (MCI), and the number of teeth lost were assessed. Results: The average of MCW in normal, osteopenic, and osteoporotic groups were 4.56, 3.97, and 3.39 mm, respectively. The PMI in normal, osteopenic, and osteoporotic groups was calculated as 0.33, 0.28, and 0.24, respectively. The MCW, PMI, and the number of teeth lost in the three groups showed statistically significant differences (P = 0.0001). The MCI had a significant difference in the three groups (P = 0.0001). The optimal cutoff points for MCW and PMI to predict low BMD were 4.13 mm and 0.29, respectively. Conclusions: The MCW, PMI, and MCI have a high diagnostic value to predict low BMD. By increasing the age and the postmenopausal duration, MCW and PMI decrease, whereas C3 form of MCI and the number of teeth lost showed increase. About 1 mm decrease in MCW increased the odds of reduced BMD (osteoporosis, osteopenia) up to 3.22-fold.

Continuous Positive Airway Pressure Treatment Increases Serum Vitamin D Levels in Male Patients with Obstructive Sleep Apnea.

Recent studies report a link between obstructive sleep apnea (OSA) syndrome, low vitamin D levels, and high parathyroid hormone (PTH) concentrations. The aim of the current study is to evaluate the effect of 7-night continuous positive airway pressure (CPAP) therapy on serum vitamin D, PTH, and calcium levels in patients with severe OSA syndrome. Patients with severe OSA were enrolled into the study and compared to control subjects. Patients with OSA underwent CPAP therapy for 7 nights and were consequently divided into responders (OSA-R, mean residual AHI < 5/h) and nonresponders (OSA-nR, mean residual AHI > 5/h). Serum vitamin D, PTH, and calcium levels were measured at baseline in patients with severe OSA (apnea-hypopnea index > 30/h) and control subjects. Patients with OSA underwent a final morning blood sample after 7-night CPAP therapy. We enrolled 90 patients with OSA into the study (65 OSA-R and 25 OSA-nR) compared to 32 control subjects. At baseline, lower vitamin D and higher PTH levels were detected in the OSA group compared to controls. After 7-night CPAP therapy, male OSA-R patients showed a significant increase in vitamin D levels. Conversely, female OSA-R patients did not show the same increase in vitamin D levels. It was also observed that OSA-nR subjects did not show modifications of serum markers after nCPAP-therapy. The study demonstrates that short-term nCPAP treatment is able to promote the recovery of vitamin D homeostasis in male patients with OSA. The mediation of sexual hormones in regulating vitamin D is a possible explanation of the lack of recovery of vitamin D homeostasis in female patients with OSA as it often affects postmenopausal women.

Prediction of implant loss and marginal bone loss by analysis of dental panoramic radiographs.

One of the major factors governing implant success is the quantity and density of the host bone. The aim of this work was to determine whether mandibular bone texture and cortical width measurements on plain radiographs could be associated with implant failure and/or marginal bone loss. A statistical model was built to predict implant failure; it incorporated several radiographic features of cortical and cancellous bone texture, cortical width, and patient smoking habits. Cortical width measurements and texture measurements of cortical and cancellous bone were made on the panoramic radiographs of 460 subjects. These were used to predict implant failure and marginal bone loss after 5 years. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were used to determine the diagnostic accuracy of the variables in predicting implant failure and marginal bone loss. Additionally, for 91 of 460 subjects with periapical radiographs, marginal bone levels around implants were measured over a 5-year period. Of the 460 patients assessed for implant failure, 29 had failed implants (93.7% success rate). The ROC curve built from this model had a sensitivity of 62.1% and specificity of 67.5%. The AUC from the model was 0.690 (95% confidence interval [CI] 0.597 to 0.783). A model was also built to predict marginal bone loss. The ROC curve had 78.6% sensitivity and 74.6% specificity (AUC = 0.880, 95% CI = 0.810 to 0.953). Mandibular cortical width was not a significant predictor of either implant failure or bone loss. In a retrospective analysis 5 years after implant placement, features of cancellous and cortical bone of the mandible were significant in predicting implant failure and marginal bone loss in a sample of 460 patients.

Application of telemedicine to assess mandibular cortical width on panoramic images of dental patients in the Lao People’s Democratic Republic

Objectives Mandibular cortical width (MCW) reference standards for osteoporosis screening have not yet been established in Laos, where panoramic radiography has recently been introduced. The present study was designed to determine the average MCW in Laotian people using panoramic radiography via telemedicine.

Pamidronate Affects the Mandibular Cortex of Children with Osteogenesis Imperfecta

We hypothesized that mandibular cortical width (MCW) is smaller in children with osteogenesis imperfecta (OI) than in healthy children and that pamidronate can improve the cortical mandibular thickness. The aim of this study was to assess changes in the MCW on dental panoramic radiographs (DPRs) of children with normal bone mineral density (BMD) and with OI. We also compared the MCW of children with different types of OI regarding the number of pamidronate cycles and age at the beginning of treatment. MCW measurements were retrospectively obtained from 197 DPRs of 66 children with OI types I, III, and IV who were in treatment with a comparable dosage of cyclical intravenous pamidronate between 2007 and 2013. The control group had 92 DPRs from normal BMD children. Factorial analysis of variance was used to compare MCW measurements among different age groups and between sexes and also to compare MCW measurements of children with different types of OI among different pamidronate cycles and age at the beginning of treatment. No significant differences in results were found between male and female subjects in both OI and healthy children, so they were evaluated altogether (P > 0.05). There was an increase of MCW values related to aging in all normal BMD and OI children but on a smaller scale in children with OI types I and III. Children with OI presented lower mean MCW values than did children with normal BMD at the beginning of treatment (P < 0.05). A linear model estimated the number of pamidronate cycles necessary to achieve mean MCW values equivalent to those of healthy children. The thinning of the mandibular cortex depended on the number of pamidronate cycles, the type of OI, and the age at the beginning of treatment. DPRs could thus provide a way to identify cyclic pamidronate treatment outcomes in patients with OI.

Identifying risk groups for osteoporosis by digital panoramic radiography.

Background:Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to bone fragility, and enhanced susceptibility to fractures. Dental radiographs, especially panoramic images, have been used to predict bone mineral density. A number of indices, (mandibular cortical index [MCI], mandibular cortical width [MCW], and panoramic mandibular index [PMI]) have been developed to assess and quantify the quality of mandibular bone mass and to observe the signs of resorption.Objectives:The objectives of the study were to assess mental index (MI), MCW index, and PMI with bone density in identifying risk group for osteoporosis and also to investigate influence of age and gender on MI, MCI, and PMI.Materials and Methods:After obtaining consent, details regarding age, gender, systemic health status, and oral parafunctional habits were recorded in each patient. Then a digital panoramic radiograph was taken. The image thus obtained was subjected to calibrations and morphometric analysis using Digora version 2.7. The obtained values of indices were compared with the mean values of indices, to evaluate subjects whether they are prone to osteoporosis or not. The obtained information was subjected to statistical analysis for the significance of the parameters.Results:Data analysis showed that calibration indices were highly significant in the assessment of risk group for osteoporosis than noncalibration index. The subjects at a higher risk for development of osteoporosis were old-aged adults with higher prevalence being reported in women compared to male subjects.Conclusion:In conclusion, our results suggest that higher percentage of subjects with undetected decreased bone mineral density may be identified based on trained general dental practitioners analyses of their panoramic radiographs using simple screening analytical calibration MI and MCI.

Comparative Analysis of Linear and Angular Measurements on Digital Orthopantomogram with Calcaneus Bone Mineral Density.

Bone remodeling is a continuous and complex process which occurs throughout life. Radiomorphometric and radioangular indices on the orthopantomogram are the predictors of bone remodeling associated with mandible. Bone mineral density is the amount of calcified tissue in a certain volume of the bone. Fifty normal healthy individuals within the age range of 25-55 years were included in the study. Linear measurements including mandibular cortical width (MCW) and panoramic mandibular index (PMI); and angular measurements including mandibular angle (MA) and antegonial angle (AGA) were recorded. Quantitative ultrasound bone mineral density (BMD) scan of the heel bone (calcaneus) of the same patient were also performed. In our study, for both males and females, antegonial angle (AGA) had highest correlation with calcaneus bone mineral density. In the age group of less than 35 years, PMI in males, and AGA in females had highest correlation. In the age range of more than 35 years, MA in males and AGA in females had highest correlation. There is a correlation between the mandibular bone remodelling changes and calcaneal bone mineral density in case of elder subjects and thus these parameters may be used as an inexpensive alternative screening method to assess the bone mineral density and identify individuals at risk for osteoporosis and fractures and also for dental treatment planning.

Texture analysis of mandibular cortical bone on digital dental panoramic radiographs for the diagnosis of osteoporosis in Korean women

To determine whether individual measurements or a combination of textural features and mandibular cortical width (MCW) derived from digital dental panoramic radiographs (DPRs) are more useful in assessment of osteoporosis. Textural features were obtained by using fractal dimension (FD) and gray-level co-occurrence matrix (GLCM). Digital DPRs and bone mineral densities (BMDs) of the lumbar spine and the femoral neck were obtained from 141 female patients. A naïve Bayes classifier, a k-nearest neighbor (k-NN) algorithm, and a support vector machine were assessed for classifying osteoporosis. The combinations of FD plus MCW (95.3%, 92.1%, 96.8%) and GLCM plus MCW (93.7%, 89.5%, 94.2%) for femoral neck BMD showed the highest diagnostic accuracy with the use of the naïve Bayes, k-NN, and support vector machine classifiers, respectively. The combination of textural features and MCW contributed a better assessment of osteoporosis compared with the use of only individual measurements.

The impact of premature birth on the mandibular cortical bone of children.

Children born prematurely often have reduced skeletal mineralization. The aim in this study was to compare the cortical thickness of the lower jaw on radiographs of 8- to 10-year-old children with histories of preterm or full term births. There were no significant differences in cortical thickness between full term and preterm children at this age. The purpose of this study was to compare the cortical thickness of the mandible on panoramic radiographs of 8- to 10-year-old children with histories of preterm or full term births. Panoramic radiography was performed on 36 extremely preterm, 38 very preterm and 42 full term children at the age of 8 to 10 years. Five observers independently measured the mandibular cortical width on the panoramic radiographs at four defined sites bilaterally. Altogether, 928 sites were available. Measurements were performed twice on a random 24% of the sites by four observers. One-way analysis of variance with Tukey's post hoc test was used to test differences between groups. Intraclass correlation coefficient (ICC) was calculated for interobserver agreement while intra-observer agreement was expressed as measurement precision. Significant differences of mandibular cortical width were found between extremely preterm and very preterm children for five of the eight measurement sites with the very preterm showing the highest value. No significant differences were found between full term and either very preterm or extremely preterm except for one measurement site, with the extremely preterm showing the lowest value. ICC varied between 0.30 and 0.83 for the different sites (mean 0.62). The precision of a single measurement varied between 0.11 and 0.45 mm (mean 0.25 mm). From the evidence that very preterm children had significantly thicker mandibular cortices than extremely preterm children, we suggest that these findings may reflect the effect of mineral supplementation provided to premature infants, causing a 'shifting up' of bone mineral status relative to the full term peer group while maintaining the difference between very preterm and extremely preterm born children.

Mandibular cortical indices on cone‐beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates

To evaluate the mandibular cortical indices in osteoporotic women receiving oral bisphosphonates (oBPs). The study group included 46 Caucasian women aged over 55 years on treatment with oBPs for postmenopausal osteoporosis. Information recorded included age, weight, height, type of oBP, duration of treatment, comorbid conditions and coadjuvant medication. Forty-six age-matched Caucasian women with no known diagnosis of osteoporosis were selected as the control group. All participants underwent cone-beam computed tomography, and the mandibular cortical width (MCW) and the height from the inferior mandibular border to the mental foramen (MBMF) were measured. The MBMF was similar in the participants with osteoporosis and in controls. MCW was significantly greater in the participants with osteoporosis than in the controls (p < 0.001). Mandibular cortical width should not be used to predict the risk of bisphosphonate-associated osteonecrosis of the jaws.

Relationship between femur bone mineral density, body mass index and dental panoramic mandibular cortical width in diagnosis of elderly postmenopausal women with osteoporosis.

To measure and determine mandibular cortical width (MCW) on the panoramic radiographs, to evaluate the usefulness of the method in identifying postmenopausal women with low femoral bone mineral densities (f- BMD) and to correlate the radiographic findings on panoramic radiographs with the f-BMD assessed by dual X-ray absorptiometry (DXA) to predict the efficacy of the radiographic method in diagnosing osteoporosis. One hundred and twenty postmenopausal women (60 normal and 60 osteoporotic) in the age group of 50-75 y with f-BMD assessed by DXA had undergone panoramic radiographic examination. The patients were classified as normal (T-score ≥ -1.0) and osteoporotic (T-score ≤ -2.5). MCW on panoramic radiographs was measured bilaterally at the mental foramen region with a caliper and their mean was used as the exposure measure in the analysis. Student t-test showed that mean f-BMD, BMI and MCW was found be less in osteoporotic patients as compared to normal group with a statistically significant p-value < 0.001. Pearson correlation coefficient test revealed that MCW correlated positively with f-BMD and showed a significant decrease with age of the patient. Postmenopausal women with low f-BMD had thinner mandibular cortex at the mental foramen region when compared to normal subjects and are more susceptible to femoral neck fractures. Mandibular inferior cortical width at the mental foramen region could be used to identify postmenopausal women with low f- BMD. Hence, dental panoramic radiographs serve as a useful screening tool for early diagnosis of osteoporotic fractures.

Automated Measurement of Mandibular Cortical Width on Dental Panoramic Radiographs for Early Detection of Osteoporosis: Extraction of Linear Structures

Automated Measurement of Mandibular Cortical Width on Dental Panoramic Radiographs for Early Detection of Osteoporosis: Extraction of Linear Structures