Mandibular Inferior Cortex Research Articles

Osteoporosis detection in panoramic radiographs using a deep convolutional neural network-based computer-assisted diagnosis system: a preliminary study.

To evaluate the diagnostic performance of a deep convolutional neural network (DCNN)-based computer-assisted diagnosis (CAD) system in the detection of osteoporosis on panoramic radiographs, through a comparison with diagnoses made by oral and maxillofacial radiologists. Oral and maxillofacial radiologists with >10 years of experience reviewed the panoramic radiographs of 1268 females {mean [± standard deviation (SD)] age: 52.5 ± 22.3 years} and made a diagnosis of osteoporosis when cortical erosion of the mandibular inferior cortex was observed. Among the females, 635 had no osteoporosis [mean (± SD) age: 32.8 ± SD 12.1 years] and 633 had osteoporosis (72.2 ± 8.5 years). All panoramic radiographs were analysed using three CAD systems, single-column DCNN(SC-DCNN), single-column with data augmentation DCNN(SC-DCNN Augment) and multicolumnDCNN (MC-DCNN). Among the radiographs, 200 panoramic radiographs [mean (± SD) patient age: 63.9 ± 10.7 years] were used for testing the performance of the DCNN in detecting osteoporosis in this study. The diagnostic performance of the DCNN-based CAD system was assessed by receiver operating characteristic (ROC) analysis. The areaunderthecurve (AUC) values obtained using SC-DCNN, SC-DCNN (Augment) and MC-DCNN were 0.9763, 0.9991 and 0.9987, respectively. The DCNN-based CAD system showed high agreement with experienced oral and maxillofacial radiologists in detecting osteoporosis.A DCNN-based CAD system could provide information to dentists for the early detection of osteoporosis, and asymptomatic patients with osteoporosis can then be referred to the appropriate medical professionals.

Radiographic features of lingual mandibular bone depression using dental cone beam computed tomography.

To describe accurately the radiographic characteristics of lingual mandibular bone depression (LMBD) using CBCT images. This study included 30 cases of LMBD with CBCT images from 29 patients. Age, sex, location, shape, size, and the relationships of the LMBDs to adjacent anatomical structures such as the mandibular inferior cortex and mandibular canal were recorded. The correlation between age and size was evaluated using Pearson's correlation coefficient. The average age of the patients was 57 years. LMBDs occurred primarily in males (93%), occurrence in the right (n=14) and left (n=16) mandibles was approximately equal. The shapes were ovoid, round, peanut, triangular, or rectangular on panoramic radiographs. The occurrences in the molar, distal to the molar, and ramus regions were 63.3, 33.3, and 3.3% respectively. The mean size on CBCT was 15.4 mm in length, 11.2 mm in height, and 6.4 mm in depth. The relationship to the mandibular canal was categorized as separated (48.2%), contacted (31%), or go-through (20.7%). The relationship to the mandibular inferior cortex was classified as separated (20.7%), contacted (27.6%), or resorbed (51.7%). The Pearson's correlation coefficient showed a positive correlation between age and depth (r=0.38; p=0.038). The typical features of a LMBD were ovoid, round or mutilobated radiolucent shape, well-defined sclerotic border, and position in the posterior area of the mandible between the mandibular canal and inferior mandibular cortex. The buccolingual depth of LMBD was deeper with increasing age.

Evaluation of dental health and thickness of mandibular inferior cortex among menopaused Iraqi cigarette smokers sample by the aid of using digital panoramic radiography

Smoking is linked to osteoporosis through its anti-estrogenic effect in womenwhich results in premature menopause in smokers and increased bone resorption iscorrelated with estrogen loss in menopause women. The aim of this study is toevaluate the effects of smoking and hormonal changes on the thickness of mandibularinferior cortex and the dentition status in both maxilla and mandible (DMFT) inmenopausal females and to estimate the value of panoramic radiographic findings inassessing the possibility of latent osteoporosis. Panoramic images for 80 healthy,median stature, smokers and non-smokers Iraqi female subjects aged (20-35) yearspremenopausal and (45-60) years menopause was done, then the thickness ofmandibular inferior cortex and (DMFT) was evaluated. The results showed thatpanoramic radiographic measurements are considered as indicator of bone turnoverand the dentist is able to identify smokers and non-smokers postmenopausal femaleswith increase risk of osteopenia and osteoporosis by using dental panoramicradiography which is a simple valuable screening tool.

Investigating of Differences in the Mandibular Inferior Cortical Thickness on Digital Panoramic Image in women at Different Age Groups

Panoramic images provide the dental clinician with a survey of anatomy of the jaws. Recent studies suggest that mandibular cortical thickness on panoramic images may be useful in identifying women with low bone mineral density. Panoramic radiographic measurements are considered as indicator of bone turnover. Changes in the thickness of mandibular inferior cortex can be attributed to many factors.The most important aim was to correlate differences in the thickness of mandibular inferior cortex in women regarding , menopausal status and menopausal age, pregnancies, and history of backache using digital panoramic image.A total sample of 199 apparently healthy Iraqi women attending the Dental Teaching Hospital in Al- Mosul city were considered. Each woman was subjected to dental panoramic image. Their ages ranged between (20 – 72) years. The total sample were collected during the period from November 2006 to April 2007 .The information from each woman was recorded in special case sheet. Calibration of the image was done by using known length stainless steel wire fixed in bite piece to be within the center of focal trough anteriorly. The digital dental panoramic image was taken and the thickness of mandibular inferior cortex in the right and left sides were measured and recorded using digital panoramic image measurement tools. All results were obtained under the run of the statistical software MINITAB release 11.12 32 Bit with R-square and t- test.It has been found that age explains 38.4% of the total variability of the changes in mean thickness of mandibular inferior cortex. The results of the one-way analysis of variance test indicated that elder age groups have highly significantly lower mean thickness of mandibular inferior cortex than younger age groups, which emphasize the fact that this is an age related phenomenon (highly significant inverse relation), while pregnancies explains 10.2% of the total variability of the changes in mean thickness of mandibular inferior cortex (highly significant inverse relation). The results of the two-sample t-test indicated that women with history of backache are experience more changes in the mean thickness of mandibular inferior cortex than other women (highly significant relation). For the menopausal age our study show that 21.4% of the total variability of the changes in mean thickness of mandibular inferior cortex related to menopausal age (highly significant inverse relation). Postmenopausal women areto have highly significantly lower mean thickness of mandibular inferior cortex thanpremenopausal women.Because oral health is an integral part of general health, oral problems indigenousto the female population have to be addressed. Hormonal fluctuations affect more thana woman’s reproductive system. Puberty, menses, pregnancy, and menopause allinfluence a woman’s oral health and the way in which dental professionals shouldapproach her dental treatment. Therefore, factors like menopausal status and age,number of pregnancies, history of backache together with age, were considered in thisstudy which has direct effect on mean thickness of mandibular inferior cortex inwomen.

Mandibular Inferior Cortex Erosion on Dental Panoramic Radiograph as a Sign of Low Bone Mineral Density in Postmenopausal Women.

Objective To examine the role of the panoramic mandibular radiograph in the diagnosis of low bone mineral density (BMD) in postmenopausal women. Methods A cross-sectional study including volunteer women aged over 40 years in amenorrhea due to ovarian failure for at least 12 months, who were cared for at the climacteric outpatient clinic of a university hospital in the city of Cuiabá, in the state of Mato Grosso, Brazil. The panoramic radiographs were evaluated using a specific software. Two aspects were analyzed in the mandibular panoramic radiograph: a qualitative aspect regarding the shape of the mandibular cortical bone, and a quantitative aspect regarding the width of the mandibular cortical bone. The morphology of the mandibular cortical bone in the digital panoramic radiograph was determined bilaterally by the observation of the bone structure between the mental foramen and the base of the jaw. The mandibular cortical bone was categorized into three groups. The mental index (MI) was used to evaluate the thickness of the mandibular cortical bone through a perpendicular line drawn from the base of the mandible at the height of the center of the mental foramen, with another line drawn tangent to the inferior border of the mandible, and a third line parallel to the line at the superior border of the mandible. The MI data are expressed in millimeters, with a normal value of 3.0 mm. The densities of the lumbar spine and femur, expressed in g/cm2, were categorized as normal, osteopenia or osteoporosis. Results The agreement index between the MI and the BMD of the lumbar spine was good (Kappa = 0.718), but the same index between the MI and the BMD of the femoral neck was poor (Kappa = 0.443). An excellent agreement occurred when the mandibular cortical index (MCI) was compared with the BMD of the lumbar spine (Kappa = 0.912). The agreement between MCI and the BMD in the femur was moderated (Kappa = 0.579). Conclusion The radiomorphometric indices evaluated in the mandibular panoramic radiograph are capable of identifying postmenopausal women with low mineral density in the mandible, and the results can be used to refer these women to appropriate medical investigation and/or treatment.

Capability of CBCT to identify patients with low bone mineral density: a systematic review.

The aim of this study was to systematically review the literature about the capability of CBCT images to identify individuals with low bone mineral density (BMD). As the literature is scarce regarding this topic, the purpose of this systematic review is also to guide future research in this area. A detailed search was performed in five databases without restrictions of time or languages. Additionally, a grey literature search was conducted. The Quality Assessment Tool for Diagnostic Accuracy Studies-2 was applied to evaluate the methodological design of selected studies. With the inclusion of only six studies, the evidence is limited to endorse the use of CBCT assertively as a diagnostic tool for low BMD. All of the three studies that analyzed radiomorphometric indices found that the linear measurements of the mandibular inferior cortex were lower in osteoporotic individuals. CBCT-derived radiographic density vertebral and mandibular measurements were also capable for differentiating individuals with osteoporosis from individuals with normal BMD. The analysis of the cervical vertebrae showed high accuracy measurements. This systematic review indicates a scarcity of studies regarding the potential of CBCT for screening individuals with low BMD. However, the studies indicate that radiomorphometric indices and CBCT-derived radiographic density should be promising tools for differentiating individuals with osteoporosis from individuals with normal BMD.

Związek między wskaźnikami części korowej żuchwy oraz stężeniami wapnia i fosforu w surowicy

Związek między wskaźnikami części korowej żuchwy oraz stężeniami wapnia i fosforu w surowicy

Evaluation of mandibular inferior cortex changes in patients candidate for liver and kidney transplantation using panoramic view

Background: The number of patients with chronic liver failure (CLF) or chronic kidney disease (CKD) referred to dental clinics are increasing. However, there are few studies about the effect of these diseases on jaw bones. Objectives: The aim of this study was to evaluate the inferior mandibular cortex changes of the patients with CLF and CKD that are candidate for liver and kidney transplantation, in panoramic views. Patients and Methods: Panoramic radiographs were obtained from 83 patients with a history of CLF and 43 patients with CKD who were undergoing the assessment for transplantation and also 126 control cases. The mean was calculated for the width of inferior mandibular cortex. The relationship between the thicknesses of the inferior mandibular cortex with the duration of disease was determined using Pearson’s correlation coefficient test. T and chisquare tests were used for evaluating the inferior cortex of the mandible according to age and sex, respectively. Results: Compared with the control group, the means of the cortical thickness in CLF and CRF patients were significantly different (P < 0.001). There was a significant relationship between cortical thickness and gender in CLF (P = 0.007) and CRF patients (P = 0.029). Neither the duration of the disease and nor age was associated with mandibular thickness changes in CLF and CRF patients (P = 0.79). Thickness of the inferior mandibular cortex in premolar area was more than that in molar area and thickness of molar was greater than that of the mandibular angle in CKD and CLF patients. This latter was similar to that in normal subjects. Conclusion: Compared with normal population, a decrease in the thickness of inferior mandibular cortex is observed in CKD and CLF patients. This decrease is not affected by age and duration of the disease but is meaningfully related to sex, especially females.

Sensitivity and specificity of radiographic methods for predicting insertion torque of dental implants.

Subjective radiographic classifications of alveolar bone have been proposed and correlated with implant insertion torque (IT). The present diagnostic study aims to identify quantitative bone features influencing IT and to use these findings to develop an objective radiographic classification for predicting IT. Demographics, panoramic radiographs (taken at the beginning of dental treatment), and cone-beam computed tomographic scans (taken for implant surgical planning) of 25 patients receiving 31 implants were analyzed. Bone samples retrieved from implant sites were assessed with dual x-ray absorptiometry, microcomputed tomography, and histology. Odds ratio, sensitivity, and specificity of all variables to predict high peak IT were assessed. A ridge cortical thickness >0.75 mm and a normal appearance of the inferior mandibular cortex were the most sensitive variables for predicting high peak IT (87.5% and 75%, respectively). A classification based on the combination of both variables presented high sensitivity (90.9%) and specificity (100%) for predicting IT. Within the limitations of this study, the results suggest that it is possible to predict IT accurately based on radiographic findings of the patient. This could be useful in the treatment plan of immediate loading cases.

Angled Osteotomy Design Aimed to Influence the Lingual Fracture Line in Bilateral Sagittal Split Osteotomy: A Human Cadaveric Study

The traditional osteotomy design in the bilateral sagittal split osteotomy includes a horizontal lingual bone cut, a connecting sagittal bone cut, and a vertical buccal bone cut perpendicular to the inferior mandibular cortex. The buccal bone cut extends as an inferior border cut into the lingual cortex. This study investigated a modified osteotomy design including an angled oblique buccal bone cut that extended as a posteriorly aimed inferior border cut near the masseteric tuberosity. The authors implemented a randomized controlled study. The study sample was comprised of 28 cadaveric dentulous mandibles. The primary outcome variable was the pattern of lingual fracture induced using the conventional (n = 14) and modified (n = 14) osteotomy designs. The secondary outcome variables included the incidence of bad splits and the status of the inferior alveolar nerve (IAN). Descriptive and bivariate statistics were computed. The angled osteotomy design resulted in a significantly larger number of the lingual fractures originating from the inferior border cut (odds ratio [OR] = 1.54; 95% confidence interval [CI], 1.27-1.86; P < .01), with a significantly more posterior relation of the fracture line to the mandibular canal (OR = 2.11; 95% CI, 1.22-3.63; P < .01) and foramen (OR = 1.99; 95% CI, 1.28-3.08; P < .01). No bad splits occurred with the angled design, whereas 3 bad splits occurred with the conventional design, although this difference was not statistically significant (OR = 1.11; 95% CI, 0.99-1.25; P = .07). IAN status was comparable between designs, although the nerve more frequently required manipulation from the proximal mandibular segment when the conventional design was used (OR = 1.21; 95% CI, 0.99-1.47; P = .06). The results suggest that the angled osteotomy design promotes a more posterior lingual fracture originating from the inferior border cut and a trend was apparent that this also might decrease the incidence of bad splits and IAN entrapment. These results must be carefully extrapolated to the clinical setting, with future studies clarifying these findings.

Detecting low bone mineral density from dental radiographs: a mini-review.

Over a number of years researchers have reported associations between osteoporosis or low bone mineral density and signs that can be detected on dental radiographs, particularly in the width of the inferior mandibular cortex and the texture of the trabecular bone. As patients visit the dentist more regularly than they visit their doctor, there is the possibility that such signs could be used as a means of identifying individuals at risk of developing osteoporosis or suffering from consequent fracture. This paper reviews the historical background behind this research and the current status, including recent developments in automation of measurement using computer image analysis.

Mandibular inferior cortex erosion as a sign of elevated total serum calcium in elderly people: a 9-year follow-up study

The mandibular inferior cortex (MIC) classification that was determined by observing the mandible distally from the mental foramen in panoramic radiography can be considered to reflect bone loss in the jaws. The purpose of this 9-year study was to investigate whether there is a relationship between MIC condition and total serum calcium (TSC) in elderly Japanese people. A total of 280 subjects aged 70 years at baseline (137 males and 143 females) took part in this longitudinal study design. TSC and dental panoramic radiographs were carried out at the baseline in 1998 and the final year in 2007. The results of the MIC measurement were divided into two groups according to changes in MIC after the 9-year study period, namely no change group and change group. A significant relationship was found in females but not in males between the MIC condition and the TSC. The regression showed that female subjects are 3.26 times more likely to have increased erosion of the inferior border of the mandible than male subjects after the 9-year study period. These results suggest that an increase in erosion of the inferior border of the mandible was significantly associated with an elevated TSC after 9 years and only in females.

Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women

To correlate the radiomorphometric indices obtained using digital panoramic radiography (DPR) with bone mineral densities, evaluated by the dual-energy X-ray absorptiometry test, in a population of post-menopausal females to identify patients with asymptomatic low bone mineral densities. The morphology of the mandibular cortex was evaluated using the mandibular cortical index (MCI) and the inferior mandibular cortex width was evaluated using the mental index (MI) in 64 female patients who had undergone dual-energy X-ray absorptiometry assessment. Of these patients, 21 were diagnosed with osteopaenia and 20 with osteoporosis, and 23 were normal. Three new indices for evaluating the inferior mandibular cortex width were designed: the mental posterior index 1 (MPI1), MPI2 and MPI3. Statistical analyses were performed using the χ(2) and Kruskal-Wallis tests and the receiver operating characteristic curve. There were significant differences between the normal and lower bone mineral density groups (osteopaenia and osteoporosis) for MCI (p < 0.01). In the osteoporosis group, the MI, MPI1, MPI2 and MPI3 were significantly different from the normal and osteopaenia groups (p < 0.05). The MI, MPI1, MPI2 and MPI3 showed that there is an area in the mandibular cortex, located between the mental foramen and the antegonial region, which is valid for identifying females at high risk for osteoporosis. The MCI, MI, MPI1, MPI2, and MPI3 radiomorphometric indices evaluated using DPR can be used to identify post-menopausal females with low bone densities and to provide adequate medical treatment for them.

Diagnostic Efficacy of Panoramic Radiography in Detection of Osteoporosis in Post-Menopausal Women with Low Bone Mineral Density

Objective:The aim of the study was to evaluate panoramic radiograph, a commonly taken dental radiograph as a screening tool to detect early osseous changes (normal, mildly or severely eroded) of the mandibular inferior cortex and measure the mandibular cortical width (CW) in post-menopausal women and correlate it with the bone mineral density (BMD) measured by the ultrasound bone sonometer at the mid-shaft tibia region.Materials and Methods:The study included females between 45 years and 65 years of age in their post-menopausal stage (no menstruation for at least 6-12 months). Mandibular indices (mandibular CW and mandibular cortical shape) were evaluated from panoramic radiographs. The BMD assessment was carried out at the mid-shaft tibia region, exactly half-way between the heel and the knee joint perpendicular to the direction of the bone, using an ultrasound bone sonometer. It is a non-invasive device designed for quantitative measurement of the velocity of ultrasound waves as speed of sound in m/s, capable of measuring bone density at one or more skeletal sites. Using 1994 WHO criteria the study subjects were categorized as Group 1: Normal, Group 2: Osteopenia, Group 3: Osteoporosis. (WHO T score for tibia BMD can be used as a standard).Results:The diagnostic efficacy of the panoramic radiograph in detecting osseous changes in post-menopausal women with low BMD was shown to have 96% specificity and 60% sensitivity with mandibular cortical shape and 58% specificity and 73% sensitivity with mandibular CW measurement. Factorial ANOVA analysis carried out indicated a significant correlation of BMD classification with mandibular cortical shape (F = 29.0, P < 0.001, partial eta squared [η2] =0.85), a non-significant correlation with mandibular CW, (F = 1.6, P = 0.23, η2 = 0.86), and a more significant correlation with combined cortical shape and width (F = 3.3, P < 0.05, η2 = 0.70).Conclusion:The study concludes that the combined mandibular cortical findings (P < 0.05) and mandibular cortical shape erosion alone (P < 0.001) on panoramic radiograph are effective indicators of osteoporosis in post-menopausal women.

Radiographic evaluation of the symphysis menti as a donor site for an autologous bone graft in pre-implant surgery

PurposeThis study was performed to obtain a quantitative evaluation of the cortical and cancellous bone graft harvestable from the mental and canine regions, and to evaluate the cortical vestibular thickness.Materials and MethodsThis study collected cone-beam computed tomographic (CBCT) images of 100 Italian patients. The limits of the mental region were established: 5 mm in front of the medial margin of each mental foramen, 5 mm under the apex of each tooth present, and above the inferior mandibular cortex. Cortical and cancellous bone volumes were evaluated using SimPlant software (SimPlant 3-D Pro, Materialize, Leuven, Belgium) tools. In addition, the cortical vestibular thickness (minimal and maximal values) was evaluated in 3 cross-sections corresponding to the right canine tooth (3R), the median section (M), and the left canine tooth (3L).ResultsThe cortical volume was 0.71±0.23 mL (0.27-1.96 mL) and the cancellous volume was 2.16±0.76 mL (0.86-6.28 mL). The minimal cortical vestibular thickness was 1.54±0.41 mm (0.61-3.25 mm), and the maximal cortical vestibular thickness was 3.14±0.75mm(1.01-5.83 mm).ConclusionThe use of the imaging software allowed a patient-specific assessment of mental and canine region bone availability. The proposed evaluation method might help the surgeon in the selection of the donor site by the comparison between bone availability in the donor site and the reconstructive exigency of the recipient site.

Radiographic Evaluation of Osteoporosis through Detection of Jaw Bone Changes: A Simplified Early Osteoporosis Detection Effort

Osteoporosis has become a worldwide problem and has been known as a silence disease. Nowadays, there are a lot of diagnostic tools for detecting osteoporosis. Eighty eight postmenopausal were included and underwent digital panoramic, digital periapical, and conventional radiography. Ultrasound bone densitometry of os calcis used as gold standard. Correlation between stiffness index (SI) with a digital dental, digital panoramic and conventional dental radiography are 0.170 (p = 0.11), -0382 (p = 0.001) and 0.246 (p = 0.021) respectively. Significant relationship was found between the SI only with digital panoramic and conventional dental. The highest correlation was found between SI values with mandibular Inferior Cortex on digital panoramic (-0.382, Pearson Correlation Tests). Correlation between digital panoramic radiographs and the SI values was the highest of the three radiographic modalities in this study. This indicates that evaluation of cortical bone is more accurate than cancellous bone. Bone quality evaluation in patients at high risk for osteoporosis using panoramic and dental conventional radiograph by dentist, contributes in preventing further occurrence of osteoporosis which in turn could reduce mortality and morbidity of osteoporosis in Indonesia.

Relationship between the mandibular inferior cortex and bone stiffness in elderly Japanese people

SUMARRY: This study assessed the relationship between the mandibular inferior cortex (MIC) and bone stiffness in elderly Japanese subjects. Results suggest that MIC classification may be useful for screening patients for the possibility of osteoporosis by measuring bone stiffness with ultrasound bone densitometry. The prevention of fractures is a priority for patients with osteoporosis. Dental panoramic radiographs are frequently taken for the examination of teeth and jaws in general dental practice worldwide. This study assessed the relationship between the mandibular inferior cortex (MIC) and bone stiffness in elderly Japanese subjects. This study included 519 healthy subjects (263 men and 256 women) aged 70 years old. We evaluated the relationship between MIC classification and bone stiffness using Scheffe's multiple comparison test. Multiple linear regression analysis was used to assess the relationship between MIC classification and bone stiffness after controlling for confounding factors. A significant correlation was found between MIC classification and bone stiffness in men (C1 vs C2: p < 0.05) and women (C1 vs C2: p = NS, C1 vs C3: p < 0.01, C2 vs C3: p < 0.05). MIC classification was significantly associated with bone stiffness on multiple linear regression analysis after controlling for sex, body mass index, regular exercise, and smoking (beta = -0.11, p < 0.01, R(2) = 0.387, p < 0.001). Our study suggests that MIC classification may be useful for screening patients for the possibility of osteoporosis by measuring bone stiffness with ultrasound bone densitometry.

Dental and radiographic findings as predictors of osteoporosis in postmenopausal women

The objective of this study was to evaluate the relationship between dental findings and osteoporosis in postmenopausal women. One hundred and eight postmenopausal women were recruited for the study. All participants underwent dual X-ray absorptiometry (DXA). The number of remaining teeth, clinical attachment loss, pocket depth and mobility of each tooth were determined. Radiodensitometric analyses were performed on digital periapical radiographs utilizing an aluminum stepwedge technique. The appearance of inferior mandibular cortex posterior of the mental foramina region was scored according to the classification by Klemetti. The number of remaining teeth, attachment loss values, Klemetti Index scores and the radiodensitometric scores showed a significant relationship with skeletal bone density. Tooth loss, an increased clinical attachment level, reduced density on digital periapical radiographs and an eroded appearance of the inferior mandibular cortex in panoramic radiographs are associated with low-skeletal bone mineral density.

Relation of bone turnover markers to periodontal disease and jaw bone morphology in elderly Japanese subjects

The purpose of this study was to evaluate the relation of bone turnover markers such as bone formation and resorption to periodontal disease and jaw bone morphology in elderly Japanese subjects. We selected 148 subjects for participation in this study. All subjects were aged 77 years. The periodontal examination included the assessment of clinical attachment level (CAL). Biochemical parameters of bone turnover measured included urinary deoxypyridinoline, serum osteocalcin (S-OC), and serum bone-specific alkaline phosphatase. In addition, to evaluate the jawbone, we used the mandibular inferior cortex classification (MIC). Serum osteocalcin had significantly higher (males: P = 0.038, females: P = 0.041) tendency for MIC Class (ANOVA). Multiple linear regression results showed that the number of remaining teeth and S-OC were negatively associated with the percentage of sites with > or =6 mm CAL (R(2) = 0.322, P < 0.001). Coefficients and betas were -0.71, -0.46 (P < 0.001) and -1.11, -0.28 (P = 0.002), respectively. In conclusion, this study suggests that there is a significant relation of bone turnover markers to periodontal disease and jaw bone morphology in elderly Japanese subjects.

Assessment of panoramic radiomorphometric indices in Turkish patients of different age groups, gender and dental status

The aim of the study was to determine the distribution of the appearance of the inferior mandibular cortex (Mandibular Cortical Index (MCI)) in a large Turkish population group and to assess a range of values for cortical width at the mental foramen region (Mental Index (MI)) and the ratio of the thickness of the mandibular cortex to the distance between the inferior margin of the mental foramen and the inferior mandibular cortex (Panoramic Mandibular Index (PMI)) according to the MCI. In addition, we assess how age, sex and dental status affected the MCI. Panoramic radiographs of 1,863 patients, 698 (37.5%) men and 1,165 (62.5%) women over 20 years old, were assessed during 2005-2006 from the files of Baskent University. Gender, age and dental status were recorded for each patient. MCI classifications, MI and PMI values in the MCI groups were evaluated and comparisons were made using logistic regression analysis. Compared with patients aged 20-49 years, the likelihood of MCI C3 category in patients over 70 years of age and in patients aged 50-69 years of age was 79.14 and 9.17 times higher. The likelihood of the C3 category in edentulous and partially dentate patients was 27.30 and 2.68 times higher than in fully dentate patients, respectively. The likelihood of C3 category in patients with MI <3 mm was 14.86 times higher than in patients with MI >or=3 mm; also, in patients with a PMI of <0.30 this likelihood was 9.78 times higher than in patients with a PMI of >or=0.30. Without respect to gender, edentulous patients with C3 category, MI <3 mm and PMI <0.30 may be seen as high-risk patients for osteoporosis and therefore should be referred for further osteoporosis investigation.