Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.

OBJECTIVE: This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). METHODS: This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. RESULTS: Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). CONCLUSION: The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Marginal bone level changes and implant stability after loading are not influenced by baseline microstructural bone characteristics: 1-year follow-up.

OBJECTIVE: The aim of this study was to investigate the influence of different bone tissue characteristics of implant sites on changes in marginal bone level and implant stability over time. MATERIAL AND METHODS: One hundred and one implants were inserted in 41 patients. Cortical bone thickness of the alveolar ridge was measured on computed tomography (CT) images. Histomorphometric and microtomographic analyses (microCT) were performed in bone specimens obtained by using a trephine bur, at first drilling. Implant stability quotient (ISQ) measured by resonance frequency analysis (RFA) was registered at implant insertion. Implant stability quotient was measured also at the stages of uncovering, loading and at the 1-year follow-up, when standardized periapical radiographs were taken to measure the marginal bone level (MBL). Descriptive statistics, Spearman's rho correlation and multiple linear regression were used for data analysis (P < 0.05). RESULTS: Comparison between groups of higher and lower values of ISQ changes and between groups of higher and lower values of MBL changes revealed no differences in histomorphometric and microtomographic parameters, according to non-parametric comparison tests, (P > 0.05). Bivariate correlation also showed no association among these microstructural parameters and the outcomes evaluated. There was no correlation between cortical thickness and MBL changes (r = -0.029; P = 0.832) and between cortical thickness and ISQ changes (r = 0.145; P = 0.292). CONCLUSION: Microstructural bone characteristics of implant sites have no effect on changes in marginal bone level and implant stability as measured by RFA. Bone morphology cannot predict implant treatment success over time.

Bone tissue microarchitectural characteristics at dental implant sites part 2: correlation with bone classification and primary stability.

OBJECTIVE: To investigate in vivo the correlation between the bone microarchitecture of implant bone sites, bone tissue classification subjectively assessed in radiographs and primary implant stability. MATERIAL AND METHODS: Periapical and panoramic radiographs were obtained from 32 partially edentulous patients. Three surgeons classified bone quality at implant sites using two different methods: assessments in periapical and panoramic radiographs (PP) and according to the classification proposed by Lekholm and Zarb (L&Z). During the implant insertion, bone biopsies were taken, and three-dimensional parameters were measured by microcomputed tomography (microCT). Insertion torque value (ITV) and initial implant stability quotient (ISQ) were recorded at the moment of the implantation. ISQ was also recorded at the uncovering stage of a traditional implant protocol. RESULTS: Bone types 2 and 3 were the most prevalent classifications according to PP (54.3%) and L&Z (58.7%). The mean and standard deviation values of primary stability variables were 38.7(16.7) for ITV, 75.3 (7.7) for initial ISQ and 79.3 (6.8) for uncovering ISQ. Several microCT original and factor variables were found to correlate with bone tissue classifications and primary stability variables. L&Z correlated with architecture (r = 0.31; P < 0.05), density (r = -0.43; P < 0.01) and bulk (r = -0.35; P < 0.05), whereas ITV correlated with architecture (r = -0.40; P < 0.01) and density (r = 0.51; P < 0.01). Multiple linear regression analysis revealed that density and bulk explained 32% of the variability of L&Z bone classification, while density and architecture explained 42% of the variability of ITV. CONCLUSIONS: This study demonstrates the first step in validating L&Z classification. MicroCT provides objective and detailed quantitative data on bone microarchitecture. Intraosseous implant stability is mainly determined by the density of the bone. ITVs could be a good indicator of primary implant stability, whereas ISQs measurements have some limitations and should not be used alone.

Histomorphometrical and molecular evaluation of endosseous dental implants sites in humans: correlation with clinical and radiographic aspects.

OBJECTIVE: To evaluate the correlations between clinical-radiographical aspects and histomorphometric-molecular parameters of endosseous dental implant sites in humans. MATERIAL AND METHODS: The study sample consisted of bone implant sites from the jawbones of 32 volunteers, which were classified according to two different systems: (1) based only on periapical and panoramic images (PP); (2) as proposed by Lekholm & Zarb (L&Z). Bone biopsies were removed using trephine during the first drilling for implant placement. Samples were stained with haematoxylin-eosin (HE), and histomorphometric analysis was performed to obtain the following parameters: trabecular thickness (Tb.Th), trabecular number, bone volume density (BV/TV), bone specific surface (BS/BV), bone surface density and trabecular separation (Tb.Sp). In addition, immunohistochemistry analysis was performed on bone tissue samples for the proteins, Receptor activator of nuclear factor kappa-B (RANK), RANK ligand (RANKL), osteoprotegerin (OPG) and Osteocalcin (OC). Also, the determination of the relative levels of gene expression was performed using Reverse transcription-real-time Polymerase Chain Reaction (RT-PCR). RESULTS: PP and L&Z classification systems revealed a moderate correlation with BV/TV, BS/BV, Tb.Th and Tb.Sp. L&Z's system identified differences among bone types when BV/TV, BS/BV, Tb.Th and Tb.Sp were compared. A weak correlation between PP/L&Z classifications and the expression of bone metabolism regulators (RANK, RANKL, OPG e OC) was found. The analysis of mRNA expression showed no difference between the bone types evaluated. CONCLUSIONS: Our results suggest that PP and L&Z subjective bone-type classification systems are related to histomorphometric aspects. These data may contribute to the validation of these classifications. Bone remodelling regulatory molecules do not seem to influence morphological aspects of the jawbone .

Evaluation of peripheral nerve fibers and mast cells in burning mouth syndrome.

Emerging evidence has revealed a cross-talk in the etiopathogenesis of burning mouth syndrome (BMS) related to peripheral nerve fibers (NF) and neuropeptides secreted by mast cells. Here, we investigated the S-100+ density and PGP 9.5+ integrity of peripheral NF and the tryptase+ mast cell density in the oral mucosa of BMS patients and healthy individuals. A total of 23 oral mucosa specimens (12 BMS and 11 controls) were evaluated. The clinical diagnosis of BMS was based on a careful examination, excluding other local and systemic causes. Samples were taken from an incisional biopsy of the tongue mucosa of individuals with symptomatic BMS, while the margins of the non-neoplastic tongue biopsy served as controls of healthy individuals. Immunohistochemistry was performed to determine the density/mm2 of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells. Similar densities of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells were found in cases of BMS, with a median value of 3.70, 0.70, and 29.24/mm2, respectively, and in the control group, with a median value of 2.60, 0.80, and 26.01/mm2, respectively (p > 0.05). Moreover, the relationship between S100+ and PGP 9.5+ peripheral NF was the same in both groups (p = 0.70). This study demonstrated that there were no alterations in the density and integrity of peripheral NF in the tongue of symptomatic BMS patients. However, the sensitization of peripheral NF in this disease may not depend on mast cell density.

Bone tissue microarchitectural characteristics at dental implant sites. Part 1: identification of clinical-related parameters.

OBJECTIVE: To identify the characteristics of bone tissue microarchitecture by microCT at dental implant bone sites, describing them in terms of clinical parameters. MATERIAL AND METHODS: Forty-six bone implant sites of the maxilla and mandible from 32 volunteers were evaluated by conventional radiographs and CT scans. During the installation of each implant, bone biopsies were removed using a trephine bur at the first drilling to prepare the socket implant. Each sample was evaluated by microCT and dimensional parameters measured. RESULTS: Factor analysis summarized the microparameters into four components, which accounted for 92.8% of the total variance. The identified factors were (1) architecture - variables affecting 3D trabecular bone configuration and organization, (2) density - variables relating to surface/volume ratios and volume/volume ratios, (3) bulk - variables relating to the amount of bone and (4) spacing - variable related to the distance between trabeculae and the quantity and organization of marrow spaces. CONCLUSION: These four summarized factors correspond to clinical and radiographically recognizable parameters used for routine bone quality evaluation for implant treatment planning, which can potentially influence the primary stability of dental implants. The understanding of factors related to bone microarchitecture might reveal important aspects of its mechanical properties, essential for implant success.

The cost of oral cancer: A systematic review.

Although clinical and epidemiological aspects of oral cancers (OC) are well-documented in the literature, there is a lack of evidence on the economic burden of OC. This study aims to provide a comprehensive systematic assessment on the economic burden of OC based on available evidence worldwide. A systematic review was conducted. The population was any individual, who were exposed to OC, considered here as lip (LC), oral cavity (OCC), or oropharynx (OPC) cancer. The outcome was information on direct (medical and non-medical) and indirect (productivity loss and early death) costs. The data sources included Scopus, Web of Science, Cochrane, BVS, and NHS EED. A search of grey literature (ISPOR and INAHTA proceedings) and a manual search in the reference lists of the included publications were performed (PROSPERO no. CRD42020172471). We identified 24 studies from 2001 to 2021, distributed by 15 countries, in 4 continents. In some developed western countries, the costs of LC, OCC, and OPC reached an average of Gross Domestic Product per capita of 18%, 75%, and 127%, respectively. Inpatient costs for OC and LC were 968% and 384% higher than those for outpatients, respectively. Advanced cancer staging was more costly (from ~22% to 373%) than the early cancer staging. The economic burden of oral cancer is substantial, though underestimated.

Ambiguity in bone tissue characteristics as presented in studies on dental implant planning and placement: a systematic review.

OBJECTIVES: To survey definitions of bone tissue characteristics and methods of assessing them in studies of dental implant planning and placement. MATERIAL AND METHODOLOGY: Three databases were searched using specified indexing terms. Three reviewers selected from the titles and retrieved abstracts in accordance with inclusion and exclusion criteria. Descriptions of bone tissue characteristics (bone quality, density and quantity) used before or during dental implant placement were searched for and categorized. RESULTS: The search yielded 488 titles. One hundred and fort-nine publications were selected and read in full text. One hundred and eight were considered relevant. There were many different definitions and classification systems for bone tissue characteristics and examination protocols. Approximately two-third of the included publications reported the Lekholm & Zarb classification system for bone quality and quantity. However, only four studies implemented the Lekholm & Zarb system as originally proposed. A few publications described bone quality in accordance with the Misch or Trisi and Rao classifications systems. Assessment methods were often described only briefly (or not at all in one-fifth of the publications). Only one study presented the diagnostic accuracy of the assessment method, while only two presented observer performance. CONCLUSION: The differing definitions and classification systems applied to dental implant planning and placement make it impossible to compare the results of various studies, particularly with respect to whether bone quality or quantity affect treatment outcomes. A consistent classification system for bone tissue characteristics is needed, as well as an appropriate description of bone tissue assessment methods, their diagnostic accuracy and observer performance.

Direct healthcare costs of lip, oral cavity and oropharyngeal cancer in Brazil.

The efficiency of public policies includes the measurement of the health resources used and their associated costs. There is a lack of studies evaluating the economic impact of oral cancer (OC). This study aims to estimate the healthcare costs of OC in Brazil from 2008 to 2016. This is a partial economic evaluation using the gross costing top-down method, considering the direct healthcare costs related to outpatients, inpatients, intensive care units, and the number of procedures, from the perspective of the public health sector. The data were extracted from the Outpatient and Inpatient Information System of the National Health System, by diagnosis according to the 10th Revision of the International Classification of Diseases, according to sites of interest: C00 to C06, C09 and C10. The values were adjusted for annual accumulated inflation and expressed in 2018 I$ (1 I$ = R$2,044). Expenditure on OC healthcare in Brazil was I$495.6 million, which was composed of 50.8% (I$251.6 million) outpatient and 49.2% (I$244.0 million) inpatient healthcare. About 177,317 admissions and 6,224,236 outpatient procedures were registered. Chemotherapy and radiotherapy comprised the largest number of procedures (88.8%) and costs (94.9%). Most of the costs were spent on people over 50 years old (72.9%) and on males (75.6%). Direct healthcare costs in Brazil for OC are substantial. Outpatient procedures were responsible for the highest total cost; however, inpatient procedures had a higher cost per procedure. Men over 50 years old consumed most of the cost and procedures for OC. The oropharynx and tongue were the sites with the highest expenditure. Further studies are needed to investigate the cost per individual, as well as direct non-medical and indirect costs of OC.

Chondrosarcoma of the temporomandibular joint: a case report in a child.

This article reports a rare case of a temporomandibular joint (TMJ) chondrosarcoma in a child. Chondrosarcoma is a malignant cartilaginous neoplasm that resembles synovial chondromatosis. In the head and neck region, chondrosarcoma is uncommon, corresponding to 6.4% to 12% of all reported cases. The majority of patients with chondrosarcoma are in the third to fourth decades of life. A Pubmed search showed that 20 TMJ chondrosarcoma cases had been reported up to 2008. The present case was of an 11-year-old girl referred to an Oral Disease Center and presenting with a preauricular swelling on the right side and normal ENT evaluation. The patient was healthy. Discrete pain and mild limitation of mouth opening were observed. A panoramic radiograph as well as computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI) revealed an osteolytic lesion in the right TMJ. The skull base and adjacent spaces were preserved but adjacent anatomic structures were displaced. After an incisional biopsy, the patient underwent high condylectomy. Microscopic findings showed a tumor exhibiting cartilaginous tissue proliferation with cellular pleomorphism, nuclear hyperchromasia, and mixoid changes in the matrix. The immunohistochemical analysis of the expression of Ki-67 and Cyclin B1 proteins (cellular proliferation markers) revealed a very low proliferative cell index. The 3.5 years of clinical and imaging follow-up have shown no evidence of recurrence or metastasis, but signs of myofascial disorders could be observed. It is concluded that cartilaginous lesions in the jaws must be regarded with suspicion, since benign and malignant lesions may show similar clinical features. This case emphasized the importance of interdisciplinary approaches to minimize the possibility of misdiagnosis.

Oral e-Health: Definition of Essential Attributes of Oral Health for the Information Record in Primary Care.

Standardization is essential for information sharing among different health care institutions. Our objective was to identify the essential oral health attributes to include in an electronic health record for primary care. This action research study utilized a Definer Group, which selected attributes as a mind map, into four main pillars: Data Collection, Diagnosis, Care Plan and Evaluation. This research applied the practice of knowledge leveling, favoring the interaction of dental specialties and identification of attributes.

Clinicopathologic data of individuals with oral lichen planus: A Brazilian case series.

BACKGROUND: The aim of the present series was to analyze the sociodemographic characteristics, clinicopathologic features, and oral health-related quality of life of 41 individuals with oral lichen planus (OLP). MATERIAL AND METHODS: In a retrospective analysis (1998-2018), individuals with a clinical diagnosis of OLP from a referral service of Oral Medicine of Brazil were invited for follow-up. The individuals were assessed using the Oral Health Impact Profile-14 (OHIP-14) form. Histopathological data were reviewed according to the latest criteria proposed by the American Academy of Oral and Maxillofacial Pathology (AAOMP/2016). RESULTS: This series mainly consisted of females (70.7%) in their forties (31.7%). The buccal mucosa (68.2%) was the most commonly affected site. Reticular (56.1%) and erosive (34.3%) appearances were the most frequent. According to OHIP-14, individuals with OLP at multiple sites in the oral cavity showed worse values in the handicap domain and those who did not respond to corticosteroids showed a higher score on the psychological discomfort domain. CONCLUSIONS: The findings of the present study, using the AAOMP/2016 criteria, agree with case series and retrospective studies reported in the literature. Besides, OLP in its more severe clinical forms had an influence on patient quality of life. Key words:Diagnosis, epidemiology, oral lichen planus, oral mucosa, quality of life.

Evaluation of peripheral nerve fibers and mast cells in burning mouth syndrome

Abstract Emerging evidence has revealed a cross-talk in the etiopathogenesis of burning mouth syndrome (BMS) related to peripheral nerve fibers (NF) and neuropeptides secreted by mast cells. Here, we investigated the S-100+ density and PGP 9.5+ integrity of peripheral NF and the tryptase+ mast cell density in the oral mucosa of BMS patients and healthy individuals. A total of 23 oral mucosa specimens (12 BMS and 11 controls) were evaluated. The clinical diagnosis of BMS was based on a careful examination, excluding other local and systemic causes. Samples were taken from an incisional biopsy of the tongue mucosa of individuals with symptomatic BMS, while the margins of the non-neoplastic tongue biopsy served as controls of healthy individuals. Immunohistochemistry was performed to determine the density/mm2 of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells. Similar densities of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells were found in cases of BMS, with a median value of 3.70, 0.70, and 29.24/mm2, respectively, and in the control group, with a median value of 2.60, 0.80, and 26.01/mm2, respectively (p > 0.05). Moreover, the relationship between S100+ and PGP 9.5+ peripheral NF was the same in both groups (p = 0.70). This study demonstrated that there were no alterations in the density and integrity of peripheral NF in the tongue of symptomatic BMS patients. However, the sensitization of peripheral NF in this disease may not depend on mast cell density.

Efficacy of clinical methods to assess jawbone tissue prior to and during endosseous dental implant placement: a systematic literature review.

PURPOSE: To evaluate the evidence for the diagnostic accuracy of clinical methods to assess bone density, quantity, or quality prior to and during dental implant placement. MATERIALS AND METHODS: A PubMed literature search with specific indexing terms and a hand search were made. From the retrieved titles and abstracts, 3 reviewers selected publications on the basis of predetermined inclusion and exclusion criteria. Data were extracted from the selected publications using a protocol. Original studies were interpreted with the aid of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS: The literature search yielded 145 titles and abstracts, of which 71 were selected and read in full text. Seven studies were judged relevant. In 1 study, no method was presented as the test method. In 6 studies, the results of the test method were compared to those of a reference method. However, only 1 study presented the results in terms of percentage of correct diagnoses. In that study, the use of periapical radiography together with reference images yielded correct assessment of the trabecular pattern of the mandible in 3 categories in 58% of the sites. The kappa index of interobserver agreement was 0.35 and intraobserver agreement was 0.67. Corresponding kappa values for 4 classes of bone quality presented by Lekholm and Zarb were 0.33 and 0.43, respectively. No study examined the accuracy of the method originally described by Lekholm and Zarb. CONCLUSION: The evidence for the efficacy of clinical methods to assess jawbone tissue prior to and during endosseous dental implant placement is sparse. This emphasizes the need for studies that incorporate accepted methodologic criteria for diagnostic efficacy.

Combined Acupuncture and Auriculotherapy in Burning Mouth Syndrome Treatment: A Preliminary Single-Arm Clinical Trial.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic pain disorder that is difficult to diagnose and refractory to treatment; it is more prevalent in pre- and postmenopausal women. Acupuncture and auriculotherapy have been suggested as options for the treatment of pain because they promote analgesia and allow for the reduction of symptoms with lower doses of drugs; this leads to greater patient compliance with treatment and has a positive effect on quality of life. Clinical trials investigating the effectiveness of acupuncture in the treatment of BMS are scarce in the literature. OBJECTIVE: To investigate the effect of combined acupuncture and auriculotherapy on pain management and quality of life in patients with BMS. METHODS: Sixty patients with BMS were subjected to a thorough differential diagnosis. Of these, 12 met the inclusion criteria and agreed to participate. Eight patients completed treatment with acupuncture and auriculotherapy using a previously established protocol. The outcome variables were analyzed before and after treatment: pain/burning (visual analog scale; VAS), salivary flow (unstimulated sialometry), and quality of life (Short-Form Oral Health Impact Profile [OHIP-14]). Two-year follow-up was carried out by assessing VAS and OHIP-14. RESULTS: The intensity of pain/burning decreased significantly after the first treatment sessions, as shown by low values on the VAS (0-2) and a subjective indicator of quality of life (mean = 5.37 ± 3.50). There was no relationship between salivary flow and the intensity of pain/burning. At 2-year follow-up, no statistically significant difference was observed for VAS, but improvement on OHIP-14 was seen. CONCLUSIONS: Combined acupuncture/auriculotherapy was effective in reducing the intensity of burning and improving quality of life. There was no relationship between salivary flow and the intensity of burning mouth. Patients' status improved after acupuncture and auriculotherapy at 2-year follow-up.

Overexpression of immunomodulatory mediators in oral precancerous lesions.

Human leukocyte antigen (HLA) G and E, programmed cell death 1 ligand 1 (PD-L1), IL-10 and TGF-ß are proteins involved in failure of the antitumor immune response. We investigated the expression of these immunomodulatory mediators in oral precancerous lesions (oral leukoplakia-OL; n=80) and whether these molecules were related to the risk of malignant transformation. Samples of normal mucosa (n=20) and oral squamous cells carcinoma (OSCC, n=20) were included as controls. Tissue and saliva samples were analyzed by immunohistochemistry and ELISA respectively. Fifteen OL samples showed severe dysplasia (18.7%) and 40 samples (50%) presented combined high Ki-67/p53. Irrespective of the degree of epithelial dysplasia and the proliferation/apoptosis index of OL, the expression of HLA-G, -E, PD-L1, IL-10, TGF-ß2 and -ß3 was higher to control (P<0.05) and similar to OSCC (P>0.05). The number of granzyme B+ cells in OL was similar to control (P=0.28) and lower compared to OSCC (P<0.01). Salivary concentrations of sHLA-G, IL-10 and TGF-ß did not allow for a distinction between OL and healthy individuals. Overexpression of immunosuppressive mediators in the OL reflects the immune evasion potential of this lesion, which is apparently independent of at cytological and proliferation/apoptosis status.

The Influence of Tactile Perception on Classification of Bone Tissue at Dental Implant Insertion.

BACKGROUND: Various ways of using the Lekholm and Zarb (L&Z) classification have added to the lack of scientific evidence of the effectiveness of this clinical method in the evaluation of implant treatment. PURPOSE: The study aims to assess subjective jawbone classifications in patients referred for implant treatment, using L&Z classification with and without surgeon's hand perception at implant insertion. The association between bone type classifications and quantitative parameters of primary implant stability was also assessed. MATERIALS AND METHODS: One hundred thirty-five implants were inserted using conventional loading protocol. Three surgeons classified bone quality at implant sites using two methods: one based on periapical and panoramic images (modified L&Z) and one based on the same images associated with the surgeon's tactile perception during drilling (original L&Z). Peak insertion torque and implant stability quotient (ISQ) were recorded. RESULTS: The modified and original L&Z were strongly correlated (rho = 0.79; p < .001); Wilcoxon signed-rank test showed no significant difference in the distribution of bone type classification between pairs using the two methods (p = .538). Spearman correlation tested the association between primary stability parameters and bone type classifications (-0.34 to -0.57 [p < .001]). CONCLUSIONS: Tactile surgical perception has a minor influence on rating of subjective bone type for dental implant treatment using the L&Z classification.

Agreement between Histomorphometry and Microcomputed Tomography to Assess Bone Microarchitecture of Dental Implant Sites.

BACKGROUND: Histomorphometry and microcomputed tomography (microCT) have been used in implant studies but need better understanding before being used as equivalent methods. PURPOSE: The purpose of this study was to investigate the agreement between 2D (histomorphometry) and 3D (microCT) reference methods for assessing jawbone microarchitecture in vivo. MATERIAL AND METHODS: Forty-four bone specimens from 32 patients were obtained during implant placement and examined by microCT, followed by hematoxylin-eosin staining and histomorphometric analysis. The morphometric parameters included bone volume density (BV/TV), bone surface fraction (BS/TV), bone surface density, trabecular thickness, trabecular number, and trabecular separation (Tb.Sp). Bland-Altman plots were used for pairwise agreement analysis between the equivalent 3D and 2D parameters, and complemented with Mountain plots. The association between the two methods was tested using Pearson's correlation followed by Passing-Bablok regression. RESULTS: Systematic bias was observed in all Bland-Altman and Mountain plots, including constant bias for BV/TV and Tb.Sp, and proportional bias for all other parameters. Significant correlation was found for BV/TV (r = 0.80; p < .001) and BS/TV (r = 0.44; p = .003), and the Passing-Bablok regression showed constant bias for BV/TV and proportional bias for BS/TV. CONCLUSION: Because of the poor agreement between measures obtained by histomorphometry and microCT, these methods should not be used interchangeably for jawbones.