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 (Au)

Fusion or gemination? An unusual mandibular second molar.

Fusion and gemination is not an uncommon finding and affected most primary dentition and the permanent maxillary incisors. These changes can develop a series of complication. A 11-year-old male presented radiography finding: an unusual mandibular second molar. A well-documented case brings a challenge for radiologists classify between fusion and gemination. In conclusion, this alteration although common in other regions, there are no case in the literature involving "second and third" molar.

Comparación de dos métodos radiológicos para evaluación de densidad ósea en mujeres posmenopáusica / Comparison of two radiological methods for evaluation of bone density in postmenopausal women

Debido a la importancia del diagnóstico precoz de osteoporosis, fue objeto de este estudio realizar la comparación de dos métodos radiológicos convencionales para la evaluación de la densidad ósea en mujeres posmenopáusicas. Fueron seleccionadas imágenes de radiografía panorámica y de radiografía carpal, correspondiente a 68 pacientes de sexo femenino, con edades comprendidas entre los 49 y 80 años de edad, realizadas en la Clínica de Radiología Odontológica, para evaluación previa a la colocación de implantes. Para la interpretación de la densidad ósea en la mandíbula a través de las radiografías panorámicas fue utilizado el método del espesor cortical mandibular (PMI). Para la evaluación de las imágenes radiológicas obtenidas por la radiografía carpal, fue aplicado el método de la radiogrametría. Se concluye que existe correlación entre la presencia de una baja densidad ósea a nivel mandibular observada en la radiografía panorámica en las pacientes de la muestra, con la baja densidad ósea presentada en la radiografía carpal.

Due the importance of diagnosis precocious of osteoporosis, this study carried out the comparison of two conventional radiological methods for the evaluation of bone density in postmenopausal women. X-ray images of panoramic and carpal were selected, corresponding to 68 women between 49 and 80 years old, obtained at the Clinic of Dental Radiology, for holding dental implant. The interpretation of bone density in jaw on panoramic radiography was the method to determine mandibular cortical thickness. The carpal radiography was evaluated for the radiogrammetry method. It was concluded that there was a correlation between low bone density observed in the mandibular panoramic radiography with low bone density on carpal radiography.

Undifferentiated osteosarcoma of the mandible oblique line: a case report / Osteossarcoma indiferenciado da mandíbula: relato de caso clínico na região do trígono retromolar

O osteossarcoma (OS) é o tumor maligno primário mais comum. Entretanto, o osteossarcoma localizado na mandíbula (JOS) é raro, agressivo e maligno, constituindo de 5-13% dos casos de OS do corpo todo. O JOS tem predileção pelo sexo masculino com idade de 34-36 anos. O prognóstico da doença está associado com diversas variáveis tais como a localização do tumor, fase de desenvolvimento, existência ou não de metástases, sexo, idade, e resposta do organismo ao tratamento. Este artigo relata um caso incomum de osteossarcoma localizado na região do trígono retromolar mandibular, composto por osso mesenquimal primitivo, que comumente ocorre nas regiões de extremidades e ossos longos...

This article reports a case of 82 years old woman, who consulted in a private radiology dental clinic for implants planning. In a panoramic radiography, a radiopaque area with sun-ray appearance located above the external oblique line on the right side was observed. The incisional biopsy showed presence of sarcomatous stroma presenting osteoid tissue with irregularly shaped and large amount of osteoblasts, varied sizes and shapes, with prominent nuclei, intensely colored, arranged in a disorderly way around trabecular bone. Histopathological diagnosis was obtained for undifferentiated osteosarcoma. Osteosarcoma located in the jaw (JOS) is rare and aggressive, constituting 5% to 13% of all cases of skeletal osteosarcoma. JOS has a male predilection in third decade of life...

Langerhans cell histiocytosis (Histiocytosis X) – in the mandible / Histiocitose das células de Langerhans (Histiocitose X): na mandíbula

This article reports a case of 65 year-old man consulted in a private radiology dental clinic for a panoramic radiography, where was indicated a radiolucent area, extending into the periapical region of the teeth 35 to 43 to the base of the mandible. Radiography diagnosis was difficult. The immunohistochemical examination showed immunoreactivity for the proteins CD 68, S-100 and CD 1a. Histopathological diagnosis was obtained for Langerhans cell granuloma (histiocytosis X). Langerhans cell histiocytosis is caused by the abnormal proliferation of histiocytes, previously called Histiocytosis X. It is a rare disease that preferentially affects children and young adults with a predilection for males and can affect different parts of the body.

Este artigo relata o caso de um homem de 65 anos que procurou uma clínica de radiologia dental particular para a realização de uma radiografia panorâmica. Foi detectada uma área radiolúcida na região apical dos dentes 35 a 43 que se estendia até a base da mandíbula. O exame imunoistoquimico da lesão mostrou proteínas reativas como a CD 68, S-100 e CD 1a. O diagnóstico do histopatológico foi de Granuloma de Células de Langerhans (Histiocitose X). A Histiocitose das células de Langerhans é causada pela proliferação anormal de histiócitos. É uma doença rara que preferencialmente acomete crianças e adultos jovens e tem predileção pelo sexo masculino, podendo afetar diferentes partes do corpo.

Caracterização das paredes corticais do canal da mandíbula para avaliação de alterações causadas pela osteopenia/osteoporose / Characterization the mandibular canal walls to evaluate changes caused by osteopenia / osteoporosis

A osteoporose é uma epidemia mundial, exprime altas taxas de morbidade e mortalidade, resultando também em altos custos sociais. O exame de densitometria óssea por emissão dupla de raios-X (DXA) é o exame padrão ouro para o diagnóstico da doença. Porém, o alto custo e a disponibilidade de equipamentos, dificultam o acesso ao exame, principalmente nos países pobres e nos emergentes. Triar melhor, e mais precocemente os pacientes para realizar o DXA, é uma estratégia fundamental no combate a essa enfermidade. A radiografia panorâmica vem sendo utilizada na rotina do atendimento odontológico no mundo todo, e tem sido empregada como um método de triagem eficiente de pacientes com baixa densidade mineral óssea. O objetivo deste estudo foi analisar as paredes corticais do canal da mandíbula para a avaliação de possíveis alterações causadas pela osteopenia /osteoporose, na expectativa de indicar ou não a correlação entre a qualidade óssea mandibular e a qualidade óssea sistêmica. A amostra constituiu-se por 52 mulheres, com idade superior a 45 anos (56.4 ± 8.4 anos) divididas em três grupos de acordo com o exame de DXA: Grupo N (n= 26) normal nos três sítios (antebraço, quadril e coluna); Grupo E (n= 18) com osteopenia nos três sítios e Grupo O (n= 8) com osteoporose nos três sítios.

Os resultados demonstraram que houve diferenças significativas na quantidade relativa de pixels pretos na região de ramo (R) do canal da mandíbula (p < 0.05) entre as médias verdadeiras quando comparada entre os grupos da amostra. Nas regiões do canal da mandíbula próximo ao forame mentual (FM) e no ângulo (A) e na análise da quantidade de fragmentos os testes estatísticos não evidenciaram a existência de diferenças significativas, apesar dos valores relativos apontarem uma tendência à maior reabsorção das paredes no grupo O e E em relação ao Grupo N. Concluiu-se que a análise das corticais do canal da mandíbula por meio da quantidade de pixels pretos pode ser um instrumento útil ao cirurgião-dentista na avaliação de baixa densidade mineral óssea.

Osteoporosis is a worldwide epidemic, expresses high morbidity and mortality, resulting also in high social costs. The bone densitometry by dual-energy X-ray absorptiometry (DXA) is the gold standard test for diagnosing the disease. However, its high cost and viability are restricted, especially in poor countries and emerging. Screening better and earlier patients to perform DXA, is a key strategy in combating this disease. Panoramic radiography has been used in routine dental care around the world, and has been employed as an efficient method of screening patients with low bone mineral density. The aim of this study was to analyze the cortical walls of the mandibular canal to evaluate possible changes caused by osteopenia / osteoporosis, hoping to indicate or not the correlation between mandibular bone quality and systemic. 52 women were included aged over 45 years (56.4 ± 8.4 years) were divided into three groups according to the DXA exam: Group N (n = 26) normal in three sites (forearm, hip and spine), Group E (n = 18) with osteopenia at the three sites and Group O (n = 8) with osteoporosis in the three sites. Significant differences were found between relative amount of black pixels in the region of the branch (R) of the mandibular canal (p <0.05) and the mean true when compared among groups of samples. In regions of the mandibular canal near the mental foramen (MF), angle (A) and analysis of the amount of fragments statistical tests did not show the significant differences, despite the figures suggest a trend to higher absorption in the walls the E group and to the detriment of group N. It was concluded that the analysis of the cortical the mandibular canal by the number of black pixels may be a useful to the dentist in the evaluation of low bone mineral density.