The value of Mental Index (MI) and Gonial Index (GI) in hypertension patients on its correlation with serum calcium and cortisol level

Objective: This research was aimed to analyze the mandibular cortical width based on a mental index (MI) and gonial Index (GI) in hypertension patients correlated with serum calcium and cortisol levels. Materials and Methods: This study was an analytic-observational study with 31 hypertension patients aged 41-79. All of the patients have checked their serum calcium and cortisol level. The panoramic radiograph was taken and analyzed using Image-J Fiji software. The mandibular cortical width was then measured with Mental Index (MI) and Gonial Index (GI) and correlated with the serum calcium and cortisol level. Results: The data obtained from examining serum calcium and cortisol levels and the measurement of Mental Index (MI) and Gonial Index (GI) showed varying results but tended towards normal values. The results of the correlation test between mental index and gonial index with cortisol and serum calcium showed no correlation with p>0.05. Conclusion: There was no correlation between serum calcium and cortisol level in the value of MI and GI in hypertension patients.

Dentists’ knowledge about osteoporosis and their ability to identify the disease

Background Osteoporosis is an underdiagnosed condition, and its seriousness is not considered until severe complications arise. This study aimed to evaluate general dentists’ knowledge about osteoporosis and their ability to identify patients with this disease by assessing mandibular cortical width (MCW) and mandibular cortical index (MCI) on panoramic dental radiographs using a visual method. Methods In this cross-sectional study, an email questionnaire regarding the diagnosis and prevention of osteoporosis was sent to 20,773 dentists in 2016. Those who completed the questionnaire were invited to participate in radiomorphometric training and then to analyze the MCI and MCW of 114 panoramic radiographs of postmenopausal women who underwent both panoramic radiography and bone densitometry. Based on the radiomorphometric indices and while blinded to the densitometry results, the dentists determined whether they would indicate densitometry for these patients. Results The response rate was 2.3%: 485 dentists completed the questionnaire, and 50 evaluated panoramic radiographs using the MCW and MCI. All of them reported some knowledge about osteoporosis, but 41.6% demonstrated a misleading conceptualization of the disease. Approximately 90% reported minimal access to this information during graduation, and only 27.0% were exposed to the topic during their postgraduate studies. Interest in osteoporosis prevention was expressed by 70.7% of the respondents, and interest in learning the radiomorphometric indices was expressed by 99.0%. The sensitivity in the detection of low bone mineral density through the MCW and MCI was 52.9%, and the specificity was 64%. Conclusions Brazilian dentists demonstrated insufficient knowledge about osteoporosis and a low ability to detect osteopenia or osteoporosis by applying radiomorphometric indices.

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.

The radiomorphometric indices of the mandible as a screening method for early detection of osteoporosis in postmenopausal women

The aim of the study was to compare radiomorphometric indices measured on panoramic radiographs: mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI) with the densitometric values of skeletons in postmenopausal women, as well as and to determine the possibilities of their use in screening for early detection of osteoporosis in risky populations. Radiomorphometric indices were measured on panoramic radiographs of 146 postmenopausal patients, mean age 66.3 (±9.7) years, mean menopausal age 16.3 (±10.6) years. By dual energy X-ray absorptiometry (DXA) method were measured bone mineral density of the femur and the lumbar vertebrae (L1–L4). The Receiver Operating Characteristic (ROC) curve analysis was used to determine the changed densitometric finding, and to distinguish osteopenia and osteoporosis. The examinees with lower densitometric values had significantly lower MCW (3.60 mm) and PMI (0.36 mm) than those with regular densitometric values (p<0.001). The most frequent finding in patients with osteopenia was C2 stage of erosion (69.50%; p<0.001), while the C3 stage of erosion (57.40%; p<0.001) was in osteoporosis patients. When differing the normal from the changed finding of densitometry the results were: MCW – area under the curve (AUC) 0.862, sensitivity 92.04%, specificity 75.76%, resolution point ≤4.39 (p<0.001); for PMI-AUC 0.874, sensitivity 76.11%, specificity 84.85%, resolution point ≤ 0.41 (p<0.001) and for MCI-AUC 0.826, sensitivity 87.6%, specificity 69.7%, resolution point> 1 (p<0.001). For early detection of osteopenia and osteoporosis in postmenopausal women in everyday clinical practice, panoramic radiograph as a screening method can be of help.

Analisis ketebalan kortikal, ukuran sudut dan kepadatan trabekula tulang mandibula prajurit dan non prajurit ditinjau dari radiograf panoramik

Objectives: To analyze the cortical thickness, angular size and density of the mandibular bone trabeculae of soldiers and non-soldiers in terms of panoramic radiographs Material and Methods: This study is a comparative analytical descriptive study. The sample used was 65 panoramic radiographic data from soldiers and non-soldiers carried out at LADOKGI TNI AL R E Martadinata Jakarta. Results: Significant differences (p-value <0.05) in the calculation of the MCW value (Mandibular Cortical Width) of male soldiers compared to non-male soldiers (p-value 0.047) and FD FM (Fractal Dimension region superior foramen mentale) values 40-58 years compared to non-soldiers aged 40-58 years (p-value 0.027). Conclusion: There are differences in the size of the cortical thickness of the foramen mentale region (MCW) of the male group and in the value of the superior region of the mandibular foramen mentale (FD) region of the 40-58 years age group between soldiers and non-soldiers in terms of panoramic radiographs.

Mandibular radiomorphometric parameters of women with cemento-osseous dysplasia

Objective: To compare the radiomorphometric parameters of mandibular trabecular and cortical bone of females with and without cemento-osseous dysplasia (COD). Methods A retrospective cross-sectional paired study was conducted. Digital panoramic radiographs were obtained from females diagnosed in a public service of Oral Medicine. The participants were divided into two groups of 50 subjects each: females with a diagnosis of COD (COD group) and females without a diagnosis of COD (non-COD group), randomly chosen from the image database and paired for age. The radiomorphometric parameters analyzed were: mandibular cortical width (MCW), fractal dimension (FD) and mandibular cortical index (MCI). The paired t-test and Wilcoxon test were used to compare MCW and FD values and the McNemar-Bowker test compared the MCI. Results The mean age of both groups was 46.84 ± 11.38 years. The median MCW index was 3.12 mm (2.15–4.55) for the COD group and 3.52 mm (1.90–4.70) for the non-COD group (p = 0.034). The mean FD value of the COD group (1.2039 ± 0.0926) was lower than that of the non-COD group (1.2472 ± 0.0894) in the anatomical region of the interest of mandibular cortical bone (p = 0.031), while no difference was detected in alveolar trabecular bone. The C3 degree of MCI was more frequent in the COD group (p = 0.009). Conclusion: Females with COD had lower values of radiomorphometric parameters in mandibular cortical bone than females of the same age without COD. These results suggest that, in addition to the dental care recommended in the literature, COD females also require more attention and screening for low bone mineral density.

The Innovative and Sustainable Use of Dental Panoramic Radiographs for the Detection of Osteoporosis

This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and CitNetExplorer for analyzing semantic contents, cited references, and temporal citation network. The 280 relevant papers identified were cited 4874 times, having an h-index of 38 and 17.4 citations per paper. The top five major contributing countries were Japan (n = 54, 19.3%), USA (n = 43, 15.4%), Brazil (n = 38, 13.6%), Turkey (n = 38, 13.6%), and the UK (n = 32, 11.4%). Citation per paper correlated with publication count among the authors and institutions. Mandibular cortical width was the most frequently used and most cited measurement index. References published during the 1970s and 1980s have built the foundation for the development of research that investigates the potential associations between osteoporosis and radiographic measurements on panoramic radiographs. Osteoporosis detection by dental panoramic radiographs is a perennially investigated research topic with global contributions. Panoramic radiographs are considered early detection and screening tools for osteoporosis by worldwide research.

The accuracy of panoramic radiography as a screening of bone mineral density in women: a systematic review

Objectives: A systematic review and meta-analysis of diagnostic test accuracy studies was conducted to assess if the radiomorphometric indexes observed in panoramic radiographies could estimate reduced bone mineral density (BMD) similarly to standard technique the bone densitometry (dual energy X-ray absorptiometry) in females older than 30 years. Methods: A systematic search in four databases was conducted until January 2019. Two evaluators performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Data were synthesized on a subgroup meta-analysis with a random effect model and the hierarchical summary receiver-operating characteristic curve was used to calculate pooled estimates of studies. Results: Thirty three studies were included and 12 different radiomorphometric indexes identified, including Mandibular Cortical Index (MCI). The final number of cases pooled for the analysis was 5266 females.The MCI for BMD loss (osteopenia) presented values of sensitivity 0.81 [95% confidence interval (CI), 0.78–0.84] and specificity 0.48 (95% CI, 0.45–0.50), while for osteoporosis sensitivity 0.35 (95% CI, 0.30–0.40) and specificity 0.88 (95% CI, 0.86–0.90). The mandibular cortical width presented values of sensitivity 0.58 (95% CI, 0.40–0.73), specificity 0.73 (95% CI, 0.60–0.83) for osteopenia, while for osteoporosis sensitivity 0.57 (95% CI, 0.36–0.76) and specificity 0.83 (95% CI, 0.68–0.92). Due to the high sensitivity, MCI presented a potential value as a screening tool for initial BMD loss (osteopenia), once tests presenting high sensitivity are described as rarely missing subjects with the disease. To the other hand, MCI to osteoporosis and Mandibular Cortical Width for both conditions are not recommended because presented specificity higher than sensitivity. Conclusion: The MCI can be recommended as a feasible tool to screen initial BMD loss (osteopenia) in females above 30 years old using panoramic radiography exams.