Mandibular radiomorphometric parameters of women with cemento-osseous dysplasia

Abstract

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.

Keywords: bone mineral density; cortical bone; florid cemento-osseous dysplasia; panoramic radiography; trabecular bone.

Figures

Figure 1.

Cropped panoramic radiograph showing the MCW index. The mental foramen is delimited on the digital panoramic radiograph, and two parallel lines are drawn to demarcate the upper and lower edges of the mandibular cortex. A third line is drawn in the center of the mental foramen and perpendicular to the two cortical lines. The cortical width is determined by the measure parallel to the line that surrounds the two structures. MCW, mandibular corticalwidth.

Figure 2.

ROIs used in fractal analysis of a female with florid cemento-ossseus dysplasia. ROIs of 50 × 50 pixels were selected in trabecular bone of the condyle, angle, premolars, molars and anterior regions, and an anatomical ROI was drawn in the mandibular cortical bone (full line square). ROIs of 100 × 100 pixels also measured the fractal dimension of the mandible in the anterior region, right and left ramus (dashed line square).

Figure 3.

Stages of fractal analysis. Cropped from the region of interest (a), Gaussian filter application (σ-35, kernel size = 33 × 33) (b), subtraction of the original image (c); addition of the gray value of 128 (d), binarization (e), erodization (f), dilation (g), inversion (h), skeletonization (i, j) skeletonization overlapping the initial ROI. The results in the boxes are values of 2–64 pixel dimension (k) and graphic representation of the D value corresponding to the fractal dimension (l). ROI, region of interest.

Figure 4.

Images of digital panoramic radiographs of females with cemento-osseous dysplasia showing the MCI. The classification includes three degrees: C1: intact and homogeneous cortical bone without erosion (a, b); C2: few erosions (white arrows) on the upper surface of the mandibular cortex (c, d); C3: several erosions (white arrows) are observed along the entire length of the cortical bone (e, f). C2 and C3 were the most common in the COD group. MCI, mandibular corticalindex.

Figure 5.

Images of digital panoramic radiographs of females of the non-COD group also showing the MCI. C1: intact and homogeneous cortical bone (a, b); C2 with few erosions (white arrows) in the mandibular cortex (c, d), C2 was the most frequent in the non-COD group; and C3: several erosions (white arrows) are observed along the entire length of the cortical bone (e, f). COD, cemento-osseousdysplasia; MCI, mandibular cortical index.