Mandibular cortical index in the screening of postmenopausal at low mineral density risk: a systematic review

Objectives: This systematic literature review addressed the use of mandibular cortical index (MCI), assessed by panoramic radiography, for the identification of postmenopausal women at risk of osteoporosis. Methods: Databases were searched for original research studies published from September 2010 to September 2020 using the following keywords: “postmenopausal osteoporosis” and synonyms combined with “panoramic radiography” and synonyms. Only English language manuscripts and studies pertaining to the MCI were selected. Results: A total of 24 studies were included. The publications were highly heterogeneous in terms of the subject of interest, i.e. the MCI, with some studies comparing the usefulness of the MCI using panoramic radiography and using cone beam computed tomography, and others comparing different radiomorphometric indexes developed for panoramic radiography. Conclusions: Based on the literature included in this systematic review, we conclude that the MCI is useful as an auxiliary tool for identifying postmenopausal females at risk of low bone mineral density (BMD), as it correlates with skeletal BMD measured by dual X-ray absorptiometry. Nevertheless, other radiomorphometric indexes obtained from panoramic radiographs, such as panoramic mandibular index, mental index, and mandibular cortical width, are also valuable as auxiliary tools in the identification of postmenopausal females at risk, as they also correlate with BMD. Thus, it is not possible to affirm which index is the most reliable for the identification of postmenopausal females considering the literature screened. PROSPERO registration systematic review CRD42020208152.

Do HIV patients have mandibular osteoporotic alterations? A mandibular cortical index case-control study

Objective: The objective of this study was to evaluate mandibular osteoporotic alterations in patients with HIV infection in comparison to non-HIV-infected patients using panoramic radiographs. Material and Methods: 26 HIV-infected patients and 142 non-HIV-infected patients (control group) were included in this study. Panoramic radiographs of the participants were assessed considering mandibular cortical index (MCI). Non-parametric comparisons between groups were performed, using Mann-Whitney test, at a level significance level of p= 0.05. Results: HIV-infected patients presented lower bone mineral density (BMD) at mandible, assessed by MCI in panoramic radiographs when compared to non-HIV-infected patients. The medication intake of HIV-infected patients was highly heterogeneous and could not be associated to the low BMD presented in the mandibular cortex. Conclusions: HIV-infected patients may present lower mandibular BMD than non-HIV-infected patients. Keywords Panoramic radiograph; osteoporosis; bone mineral density; HIV.

Penilaian kualitas kortikal mandibula pasien diabetes mellitus tipe 2 dengan analisis radiomorfometrik pada radiograf panoramik

Objectives: This research aims to evaluate radiological finding on bone of patients with T2DM (type 2 Diabetes Mellitus) by evaluating mandibular cortical quality using radiomorphometric assessment specifically MCI (Mandibular Cortical Index) and AI (Antegonial Index). Material and Methods: This research is a descriptive analytic cross-sectional study, populations and samples using secondary data radiographs of T2DM patients that have been proven by medical statement from a doctor and normal sample were selected according to specified criterias. Results: It showed between group consisting of patients with T2DM and another one with normal patients, both have dominant result of MCI assessment type C2. While the result of Antegonial Index assessment there were a difference of cortical thickness between two groups. The average AI value from normal patients were 4,179 with standard deviation of 0.420, while another group with T2DM were 3,641 with standard deviation of 0.477. Conclusion: Based on the results of the study, it was found that there has been a significance difference of cortical bone qualities between two groups of samples which can be seen from the result of Antegonial Index, a T2DM patients has average values lower than normal patients, while for the results of MCI assessment between two groups have similar types.

MANDIBULAR BONE QUALITY OF PANORAMIC RADIOGRAPHS IN HIV-INFECTED CHILDREN

Background: People living with HIV may have several pathologic conditions in its body and bone is one of the organs affected by HIV infection. HIV-infected patients have been associated frequently with osteoporosis and lower bone mineral density (BMD) which may lead to the increasing risk of bone fracture. This situation may become more complicated in children and young age as it will affect the long-term bone quality and development later in life until the peak BMD is reached. Objectives: The aim of this study was to measure the mandibular bone quality using the mandibular cortical index (MCI) and panoramic mandibular index (PMI) in panoramic radiographs of HIV-infected children. Method: This study used descriptive cross sectional research design which analyzed panoramic radiographs of HIV-infected children and measured its mandibular bone quality. Total 43 panoramic radiographs of HIV-infected children were observed and analyzed qualitatively using mandibular cortical index (MCI) and panoramic mandibular index (PMI) were used for the quantitave measurement, as it have been widely used for assesing mandibular bone quality in previous studies. Mandibular cortical index (MCI) has 3 categories of cortical bone quality: C1 (normal cortex), C2 (mildly to moderately eroded cortex), and C3 (severely eroded cortex), while the normal ratio of mental foramen-inferior border of mandible to mandibular cortical length in panoramic mandibuIar index is about 0.3. Result: Mandibular cortical index (MCI) of 43 HIV-infected children consist of 4 samples in C1, 38 in C2, 1 in C3, while the panoramic mandibular index (PMI) of 43 HIV-infected children consist of 23 less than normal, 5 normal, 15 more than normal. Conclusions: The most number of mandibular cortical index (MCI) was C2 (mildly to moderately eroded cortex) and the most number of panoramic mandibular index (PMI) was less than normal of HIV-infected children.

RADIOMORPHOMETRIC EVALUATION OF MANDIBULAR CORTICAL INDEX AMONG YOUNG AND MIDDLE-AGED LITHUANIAN INDIVIDUALS

Background and objective. The aim of this study was morphological analysis of the cortical layer in the mandibular base distally from the mental foramen for determination of the mandibular cortical index in the Lithuanian young and middle-aged individuals according to gender, age, general health status, used medicine. Materials and methods. The study included 216 randomly selected subjects aged 19 to 50 years. A questionnaire was used to collect data on subjects’ age, gender, sociodemographic status, diseases, and used medicines, harmful habits. Skeletal bone status was examined according One – Minute test, panoramic radiography was performed, and panoramic radiographic images were analyzed to determine the mandibular cortical index. According to the classification by Klemetti, subjects were divided into 3 index morphological groups: C1, C2, and C3. Analysis was carried out by mentioned factors. Results. There was a significant relationship between mandibular cortical index and subject’s age (F=4.54; df=2; p=0.01), gender (χ2=16.22; df=2; p<0.01), thyroid diseases (p=0.05), hormonal preparation use (p<0.01), cigarette smoking (p<0.01). Conclusions: The study data confirmed the hypothesis that morphological changes in the cortical layer at the mandibular base were found among young and middle aged individuals with normal skeletal bone status and were significantly associated with subject’s age, gender, and other factors such as cigarette smoking, diseases having an influence on bone metabolism, used medicines.

Periodontal disease defects and mandibular cortical index in lupus patients

Objective:Systemic lupus erythematosus is an autoimmune disease that affects multiple organs. It is well known that lupus patients have higher risk of osteoporosis, but if the disease affects mandibular cortical bone and alveolar bone is not fully established. The objective of this study was to evaluate periodontal disease defects and mandibular osteoporotic alterations in patients with lupus as compared to healthy patients using panoramic radiographs.Material and Methods:The panoramic radiographs of 72 patients with lupus and 360 healthy patients were evaluated for the presence of bone loss secondary to periodontal disease, classified as horizontal and vertical bone loss. We also assessed mandibular osteoporotic alterations by using the mandibular cortical index. Logistic regression analysis was applied to estimate the risk of mandibular osteoporotic alterations as well as horizontal and vertical bone loss in patients with lupus as compared to healthy patients.Results:There were no statistically significant differences between groups in the presence of horizontal bone defects and mandibular cortical indexes. However, patients with lupus demonstrated that patients with lupus were 2.17 more likely to present vertical bone loss than healthy patients.Conclusions:Patients with lupus might have higher risk of vertical bone loss than healthy patients due to pathophysiology of their disease. Further larger prospective studies should be performed to confirm our findings.

Performance evaluation of different observers in the interpretation of panoramic radiographs by the mandibular cortical index

OBJECTIVE: Mandibular Cortical Index (MCI) is useful in osteoporosis screening. This study aim was to verify the impact of different expertise levels in the observers’ performances of MCI evaluation in panoramic radiographs (PR).METHODS: Six participants were recruited: one Oral Radiology professor with previous experience (#1), one master’s degree student and radiologist with previous experience (#2), one PhD student and non-radiologist with previous experience (#3), one PhD student and radiologist with no prior experience (#4) and two master’s degree students with no prior experience (#5 and #6). Observers were trained to use the MCI before analyzing 150 PRs of patients with dual energy X-ray absorptiometry (DXA) examination.RESULTS: The Spearman’s Correlation test showed inverse and weak to moderate correlation between MCI and T-scores, and it varied was according to the observe that performed the evaluation. Observers #2 and #3 (with previous MCI experience) showed the highest agreement with the professor, followed by students #4, #5 and #6.CONCLUSION: Students’ expertise using the MCI increased the agreement with the professor regardless of whether the student was an oral radiology specialist; the MCI was correlated with the DXA in all the observer’s evaluations, which indicates that previous training for the MCI can enable any dentist to apply it in osteoporosis screening.