Mandibular Trabecular Bone Analysis Using Local Binary Pattern for Osteoporosis Diagnosis

The assessment of the initial state of bone tissue is important not only for the placement of implants in accordance with the chosen treatment plan, but also for predicting the results of their osseointegration. Until recently, systemic connective tissue diseases were a contraindication to implantation, although it is believed that osseointegrated contact between the surface of an unloaded implant and the surrounding bone tissue is also possible in the case of osteoporosis. However, the effectiveness of implantation in such cases is highly questionable, because with a decrease in the mineral density of bone tissue and changes in its metabolism, there is often an increase in destruction processes, which leads to pathological bone remodeling.
 The aim of the study – to conduct a comparative analysis of the condition, structure and mineral density of jaw bone tissue in patients with systemic osteoporosis, depending on the sex, before the surgical stage of dental implantation.
 Materials and Methods. The condition, structure and density of bone tissue before the surgical stage of dental implantation were determined in 87 patients who needed dental implantation. Orthopantomograms were used to analyze the state of bone tissue in the areas where the operation was planned, for which the type of bone quality was determined according to the C.E. Misch classification. To evaluate the structure and density of bone tissue, patients were examined using spiral computed tomography (SCR) on a Picker PQ 2.00 computed tomograph (Picker International Ink., USA). When processing the information from the CT studies, the image data were studied in different planes (to determine the width and height of the alveolar ridge), and the bone density was determined by the Hansfield scale. To assess the state of bone tissue, ultrasonic densitometry was performed using an Omnisense 7000S apparatus (Sunlight Medical, Israel).
 Results and Discussion. In women with osteoporosis of group I, the radiological characteristics of the bone in the areas of future dental implantation in 36,84% and 34,20% corresponded to bone type D3 and D4, respectively. In men with osteoporosis of group II, bone type D1 prevailed (28,57% of patients) and D2 – 33,33% of patients, as well as in subjects of group III without osteoporosis, in whom the frequency of bone type D1 was visualized in 53,57% of patients and D2 in 28,57% of patients, in the absence of bone type D4. Densitometric studies revealed a decrease in the width and height of the alveolar spines in patients with systemic osteoporosis, with a prevalence of this trend in women of group I. At the same time, the passage of an ultrasound wave along the mandible was significantly lower in patients with osteoporosis compared to those without BMD disorders: 1,9 times in women and 1,3 times in men, p,p1<0.01.
 Conclusions. Thus, metabolic disorders in systemic osteoporosis adversely affect the structures of the oral cavity, especially in women, which may be the reason for the low effectiveness of dental implants and indicate the need to improve orthopedic and surgical treatment by developing adequate osteotropic treatment.

Visual assessment of the mandibular cortex on panoramic radiographs to identify postmenopausal women with low bone mineral densities

Measurements of ideally positioned and systematically mis-positioned skulls were used to evaluate errors in linear measurements and symmetry ratios made with panoramic X-ray images. Digital panoramic images of 30 skulls placed in ideal, shifted and rotated positions, were assessed by measuring distances between anatomic points and fiducial references. Differences between photographic measurements (control) and radiographic measurements were compared. Horizontal measurements included a 20 mm wire and the distance from gonion to mental foramen (G-MF). Vertical distances measured included a 40 mm wire, condyle to sigmoid notch length, and condyle to gonion (posterior mandibular height or PMH). A relative symmetry ratio comparing the difference between right and left PMH was also calculated. Distances measured in panoramic images were corrected using the left vertical wire distance or the panoramic unit's stated magnification factor (1.25x). Greatest differences were noted for horizontal measurements and shifted skull positions. Use of an arbitrary magnification correction was consistently less accurate than use of an internal calibration and resulted in general underestimation of actual dimensions. Measures of PMH varied significantly from expected values for each of the three skull positions (P<0.005). Panoramic accuracy for detecting asymmetry was 67% for ideal, 70% for rotated, and 47% for shifted skull positions when an internal reference was used. Panoramic radiographs should be used with caution in making absolute measurements or relative comparisons. Even when internal fiducial calibration for image distortion of anatomy is used, measurements such as those assessing posterior mandibular facial symmetry may be unreliable.

Dental implantation is a surgical procedure in oral and maxillofacial surgery. Detecting missing tooth regions is essential for planning dental implant placement. This study proposes an automated method that detects regions of missing teeth in panoramic radiographic images. Tooth instance segmentation is required to accurately detect a missing tooth region in panoramic radiographic images containing obstacles, such as dental appliances or restoration. Therefore, we constructed a dataset that contains 455 panoramic radiographic images and annotations for tooth instance segmentation and missing tooth region detection. First, the segmentation model segments teeth into the panoramic radiographic image and generates teeth masks. Second, a detection model uses the teeth masks as input to predict regions of missing teeth. Finally, the detection model identifies the position and number of missing teeth in the panoramic radiographic image. We achieved 92.14% mean Average Precision (mAP) for tooth instance segmentation and 59.09% mAP for missing tooth regions detection. As a result, this method assists diagnosis by clinicians to detect missing teeth regions for implant placement.

The topicality of the problem of periodontal diseases is due to their significant prevalence. The purpose of this work is to study the dynamics of markers of bone metabolism in the process of treatment of generalized periodontitis of the II–III levels of severity in patients with age-related osteoporosis and without osteoporotic changes in the skeleton. The examination and treatment of 104 patients, aged 63–78, equal ratio of men and women, was conducted. Among the selected patients, 49 persons had normal bone mineral density, while the remaining 55 had osteoporotic changes in the bone tissue of involutory genesis. All subjects were assessed for the following indicators ; mineral density of jaw bone tissue (BMD) according to the results of the computer tomography, the concentration of C-Propeptide of Type I Procollagen (CICP) in blood plasma, the activity of tartrate-resistant acid phosphatase (TRAP), bone alkaline phosphatase (BAP), osteocalcin, parathyroid hormone in blood serum, concentration of β-CrossLaps in urine, total calcium and inorganic phosphorus content in blood with calculation of the Ca/P index. It was established that in patients with periodontitis of the II–III degree there was a decrease in the BMD of the alveolar bone in comparison with the control values (P ˂ 0.05), whereas the presence of systemic osteopenia worsened the indices (P ˂ 0.001). The least osteoregenerative activity, which was characterized by the decrease in BAP, TRAP and CICP levels, was registered in patients with generalized periodontitis of the III degree on the background of age-related osteoporosis (P ˂ 0.05). In the patients with generalized periodontitis of the III degree of severity, at the beginning of treatment, a weak negative correlation was found between BMD and TRAP activity (r = –0.292, P &lt; 0.05) and mean strength correlation – with β-CrossLaps in urine (r = –0.348, P &lt; 0.01). The concentration of CICP positively correlated with the mineral density of bone tissue from the third month after the start of treatment (r = 0.312, P &lt; 0.05). As a conclusion, the mineral density of alveolar bone in the process of treatment varies unevenly depending on the severity of generalized periodontitis and the character of osteoporotic changes in the skeleton. The biochemical markers of bone metabolism allow the balance of processes of bone resorption and formation to be determined in order to correct treatment of generalized periodontitis.

Panoramic radiography imaging plays a crucial role in the diagnostic process of dental diseases. However, current artificial intelligence research datasets for panoramic radiography dental image processing are often limited to single-center and single-task scenarios, making it difficult to generalize their results. To address this, we present a multi-center, multi-task labeled dataset. In this study, our dataset comprises three datasets obtained from different hospitals. The first set has 4940 panoramic radiography images and corresponding labels from the Stemmatological Hospital of the General Hospital of Ningxia Medical University. The second set includes 716 panoramic radiography images and labels from the People's Hospital of Yinchuan City, Ningxia. The third dataset contains 880 panoramic radiography images and labels from a hospital in Shenzhen, Guangdong Province. This comprehensive dataset encompasses three types of dental diseases: impacted teeth, periodontitis, and dental caries. Specifically, it comprises 2555 images related to impacted teeth, 2735 images related to periodontitis, and 1246 images related to dental caries. In order to evaluate the performance of the dataset, we conducted benchmark tests for segmentation and classification tasks on our dataset. The results show that the presented dataset could be effectively used for benchmarking segmentation and classification tasks critical to the diagnosis of dental diseases. To request our multi-center dataset, please visit the address: https://github.com/qinxin99/qinxini .

The follow-up of the peri-implant marginal bone loss is the most important criterion for the determination of implant success. The purpose of this study is to measure marginal bone loss using panoramic radiographic images (PRI) of patients treated using a mandibular, two implant-supported, locator-retained denture and to evaluate the compatibility of these findings with those of the finite element analysis (FEA). The PRI of patients who had a mandibular, two implant-supported, locator-retained denture were assessed, and the mesial and distal marginal bone loss of both right- and left-sided implants was measured. Mandibular and maxillary models, which have the features of bilateral balanced occlusion, were created. The surfaces of the generated models were converted in a computer-aided design model that could be transferred to the FEA software, and the forces were defined on contacts formed in maximum intercuspation, lateral, and protrusive movement position for bilateral balanced occlusion. The bone loss in the mesial and distal regions at the right- and left-sided implants was not statistically significant. Higher stresses were formed on the vestibular side under protrusive movement, on the lingual side under maximum intercuspation, on the distolingual side under left unilateral biting, and on the mesiolingual side under right unilateral biting in the FEA. According to FEA, peri-implant bone resorption may be higher in the buccal and palatal regions, implying that panoramic radiographs can be misleading in understanding the amount of peri-implant bone resorption.

Aim:The aim of this study is to determine the bone health in HIV-infected children on antiretroviral therapy (ART).Materials and Methods:This cross-sectional study was carried out in 31 HIV-infected children aged 5–18 years. Each patient underwent testing for serum calcium, phosphorous, alkaline phosphatase, and 25(OH) Vitamin D. Bone mineral density (BMD) was done using a DXA scanner. Patients' z scores for BMD of the lumbar spine and left femoral neck were noted. The factors associated with low BMD were analyzed.Results:Seven (22.6%) children had a low spinal BMD and 6 (19.4%) had low femoral neck BMD. Low serum calcium was seen in 6 (19.4%) patients and high alkaline phosphatase was seen in 15 (48.4%) patients. Low serum 25 (OH) Vitamin D levels were present in 30 (96.8%) patients, whereas all the patients had normal serum phosphorous. Duration of ART in those with low spinal BMD was 4.6 ± 3.4 years as compared to 6.4 ± 3.2 years in those with normal spinal BMD (P = 0.235) and for low left femoral neck BMD was 3.9 ± 2 years as compared to 6.5 ± 3.4 years for those with normal femoral neck BMD (P = 0.031). Mean 25(OH) Vitamin D levels were 8.4 ± 2.8 ng/ml in those with low femoral neck BMD as compared to 13.6 ± 8.3 ng/ml in those with normal femoral neck BMD (P = 0.015). Type of ART did not have any association with low BMD.Conclusion:Over 95% of HIV-infected children have low 25(OH) Vitamin D levels which affect the appendicular BMD. BMD is affected more in children who have been on ART for a shorter time. No particular ART regimen is associated with low BMD.

Panoramic images provide the dental clinician with a survey of anatomy of the jaws. Recent studies suggest that mandibular cortical thickness on panoramic images may be useful in identifying women with low bone mineral density. Panoramic radiographic measurements are considered as indicator of bone turnover. Changes in the thickness of mandibular inferior cortex can be attributed to many factors.The most important aim was to correlate differences in the thickness of mandibular inferior cortex in women regarding , menopausal status and menopausal age, pregnancies, and history of backache using digital panoramic image.A total sample of 199 apparently healthy Iraqi women attending the Dental Teaching Hospital in Al- Mosul city were considered. Each woman was subjected to dental panoramic image. Their ages ranged between (20 – 72) years. The total sample were collected during the period from November 2006 to April 2007 .The information from each woman was recorded in special case sheet. Calibration of the image was done by using known length stainless steel wire fixed in bite piece to be within the center of focal trough anteriorly. The digital dental panoramic image was taken and the thickness of mandibular inferior cortex in the right and left sides were measured and recorded using digital panoramic image measurement tools. All results were obtained under the run of the statistical software MINITAB release 11.12 32 Bit with R-square and t- test.It has been found that age explains 38.4% of the total variability of the changes in mean thickness of mandibular inferior cortex. The results of the one-way analysis of variance test indicated that elder age groups have highly significantly lower mean thickness of mandibular inferior cortex than younger age groups, which emphasize the fact that this is an age related phenomenon (highly significant inverse relation), while pregnancies explains 10.2% of the total variability of the changes in mean thickness of mandibular inferior cortex (highly significant inverse relation). The results of the two-sample t-test indicated that women with history of backache are experience more changes in the mean thickness of mandibular inferior cortex than other women (highly significant relation). For the menopausal age our study show that 21.4% of the total variability of the changes in mean thickness of mandibular inferior cortex related to menopausal age (highly significant inverse relation). Postmenopausal women areto have highly significantly lower mean thickness of mandibular inferior cortex thanpremenopausal women.Because oral health is an integral part of general health, oral problems indigenousto the female population have to be addressed. Hormonal fluctuations affect more thana woman’s reproductive system. Puberty, menses, pregnancy, and menopause allinfluence a woman’s oral health and the way in which dental professionals shouldapproach her dental treatment. Therefore, factors like menopausal status and age,number of pregnancies, history of backache together with age, were considered in thisstudy which has direct effect on mean thickness of mandibular inferior cortex inwomen.

Risk and determinants of low and very low bone mineral density and fractures in a national cohort of Dutch adult childhood cancer survivors (DCCSS-LATER): a cross-sectional study

Low bone mineral density (BMD) is a strong risk factor for fracture in community-dwelling white women, but the relationship in white female nursing home residents, for whom fracture rates are highest, is less clear. To assess the relative contribution of low BMD to fracture risk in nursing home residents. Prospective cohort study with baseline data collected April 1995 to June 1997, with 18 months of follow-up. Forty-seven randomly selected nursing homes in Maryland. A total of 1427 white female nursing home residents aged 65 years or older. Documented osteoporotic fracture occurring during follow-up as a function of baseline BMD measurements higher vs lower than the median, and after controlling for demographic, functional, cognitive, psychosocial, and medical factors. A total of 223 osteoporotic fractures occurred among 180 women. Low BMD and transfer independence were significant independent risk factors for fracture in this nursing home sample (P<.001) and the 2 factors acted synergistically (P =.06) to further increase fracture risk. Compared with women whose BMD was higher than the median (0. 296 g/cm(2)), those whose BMD was lower than the median had an unadjusted hazard ratio for risk of fracture of 2.1 (95% confidence interval [CI], 1.5-2.8); women who were independent in transfer had a hazard ratio of 1.6 (95% CI, 1.2-2.2) compared with women dependent in transfer. Among residents independent in transfer, those with BMD below the median had a more than 3-fold increase in fracture risk compared with those with higher BMD (unadjusted hazard ratio, 3.1; 95% CI, 2.2-4.4). Among residents dependent in transfer, those with BMD below the median had a 60% increase in fracture risk (unadjusted hazard ratio, 1.6; 95% CI, 1.1-2.3). Adjustment for covariates did not alter the BMD-fracture relationship. Our data indicate that low BMD and independence in transfer are significant predictors of osteoporotic fracture in white female nursing home residents. JAMA. 2000;284:972-977

SummaryLow bone mineral density (BMD) increases fracture risk, poor life-quality, and death. Low BMD is prevalent in tobacco-exposed individuals with lung disease; however, they are not included in current screening guidelines. In our study, a majority of individuals with former tobacco exposure not meeting current screening criteria had low BMD.PurposeLow bone mineral density (BMD) is prevalent in tobacco-exposed individuals with lung disease. Guidelines recommend dual x-ray absorptiometry (DXA) screening for osteoporosis in individuals with current tobacco use, but former tobacco use, chronic obstructive pulmonary disease (COPD), and emphysema are not recommended indications for screening. We hypothesized that tobacco-exposed individuals not meeting current osteoporosis screening guidelines have a high prevalence of low BMD, and that low BMD associates with lung-specific risk factors in this population.MethodsWe measured total hip, femoral neck, and lumbar spine BMD with DXA in a tobacco-exposed cohort of men and women 40 years of age and older with ≥ 10 pack years cigarette use. Osteoporosis screening eligibility was determined by modified Fracture Risk Assessment Tool (FRAX) criteria. We investigated lung-related factors associated with low BMD adjusting for age, sex, and diabetes.ResultsOf 472 individuals with former tobacco exposure, 28% did not meet study-defined osteoporosis screening criteria. Of participants not meeting screening criteria, 55% had low BMD on DXA assessment. The presence of CT-determined emphysema was associated with low BMD (adjusted OR 2.1, 95% CI [1.02, 4.42]) in participants not eligible for osteoporosis screening. Lung function, respiratory symptoms, pack years cigarette use, and inhaled corticosteroid use were not associated with low BMD.ConclusionEmphysema on chest CT scan independently associates with low BMD in tobacco-exposed individuals not meeting traditional osteoporosis screening criteria. These findings suggest that osteoporosis screening recommendations should include emphysema as a risk factor for early BMD assessment.

BackgroundDental implant failure is a critical condition that can seriously compromise therapeutic efficacy. Insufficient bone volume, unfavorable bone quality, periodontal bone loss, and systemic conditions, including osteopenia/osteoporosis and diabetes mellitus, have been associated with implant failure. Early indicators of potential implant failure could help mitigate the risk of severe complications. This study aimed to develop an effective implant outcome prediction model using dental periapical and panoramic films.MethodsA total of 248 patients (89 with failed implants and 159 with successful implants) were examined. A total of 529 periapical images and 551 panoramic images were collected from the patients for a deep learning-based model. Based on radiographic peri-implant alveolar bone pattern, implant outcome was divided into three categories: implant failure with marginal bone loss, implant failure without marginal bone loss, and implant success. We extracted features using a deep convolutional neural network (CNN) and built a hybrid model to combine periapical and panoramic images. A comparison among three categories of receiver operating characteristic (ROC) curves was performed. The diagnostic accuracy, precision, recall and F1-score of the dataset were assessed.ResultsOur model achieved an AUC (area under the ROC curve) of 0.972 for failure with marginal bone loss, 0.947 for failure without marginal bone loss and 0.975 for success. In all conditions, for periapical images alone, the diagnostic accuracy was 78.6%; the precision was 0.84, recall was 0.73, and F1-score was 0.75. For panoramic images alone, the diagnostic accuracy was 78.7%; the precision was 0.87, recall was 0.63, and F1-score was 0.66. Both periapical and panoramic images were used in our novel method, and the prediction accuracy was 87%. The precision was 0.85, recall was 0.88, and F1-score was 0.85.ConclusionsThe deep learning model used features from periapical and panoramic images to effectively predict the occurrence of implant failure and might facilitate early clinical intervention for potential dental implant failures.

Persistent low bone mineral density in adolescent idiopathic scoliosis: A longitudinal study

This paper proposes a convolutional neural network (CNN)-based deep learning model for predicting the difficulty of extracting a mandibular third molar using a panoramic radiographic image. The applied dataset includes a total of 1053 mandibular third molars from 600 preoperative panoramic radiographic images. The extraction difficulty was evaluated based on the consensus of three human observers using the Pederson difficulty score (PDS). The classification model used a ResNet-34 pretrained on the ImageNet dataset. The correlation between the PDS values determined by the proposed model and those measured by the experts was calculated. The prediction accuracies for C1 (depth), C2 (ramal relationship), and C3 (angulation) were 78.91%, 82.03%, and 90.23%, respectively. The results confirm that the proposed CNN-based deep learning model could be used to predict the difficulty of extracting a mandibular third molar using a panoramic radiographic image.