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Development of a clinically applicable tool for bone density assessment

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Objectives

To assess the accuracy and reliability of new software for radiodensitometric evaluations.

Methods

A densitometric tool developed by MevisLab® was used in conjunction with intraoral radiographs of the premolar region in both in vivo and laboratory settings. An aluminum step wedge was utilized for comparison of grey values. After computer-aided segmentation, the interproximal bone between the premolars was assessed in order to determine the mean grey value intensity of this region and convert it to a thickness in aluminum. Evaluation of the tool was determined using bone mineral density (BMD) values derived from decalcified human bone specimens as a reference standard. In vivo BMD data was collected from 35 patients as determined with dual X-ray absorptiometry (DXA). The intra and interobserver reliability of this method was assessed by Bland and Altman Plots to determine the precision of this tool.

Results

In the laboratory study, the threshold value for detection of bone loss was 6.5%. The densitometric data (mm Al eq.) was highly correlated with the jaw bone BMD, as determined using dual X-ray absorptiometry (r = 0.96). For the in vivo study, the correlations between the mm Al equivalent of the average upper and lower jaw with the lumbar spine BMD, total hip BMD and femoral neck BMD were 0.489, 0.537 and 0.467, respectively (P < 0.05). For the intraobserver reliability, a Bland and Altman plot showed that the mean difference ± 1.96 SD were within ±0.15 mm Al eq. with the mean difference value small than 0.003 mm Al eq. For the interobserver reliability, the mean difference ±1.96 SD were within ±0.11 mm Al eq. with the mean difference of 0.008 mm Al eq.

Conclusions

A densitometric software tool has been developed, that is reliable for bone density assessment. It now requires further investigation to evaluate its accuracy and clinical applicability in large scale studies.

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References

  1. Homolka P, Beer A, Birkfellner W, Nowotny R, Gahleitner A, Tschabitscher M et al (2002) Bone mineral density measurement with dental quantitative CT prior to dental implant placement in cadaver mandibles: pilot study. Radiology 224(1): 247–252. doi:10.1148/radiol.2241010948

    Article  PubMed  Google Scholar 

  2. Norton MR, Gamble C (2001) Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 12: 79–84. doi:10.1034/j.1600-0501.2001.012001079.x

    Article  PubMed  CAS  Google Scholar 

  3. Molly L (2006) Bone density and primary stability in implant therapy. Clin Oral Implants Res 17(Suppl2): 124–135. doi:10.1111/j.1600-0501.2006.01356.x

    Article  PubMed  Google Scholar 

  4. Esposito M, Hirsch JM, Lekholm U, Thomsen P (1998) Biological factors contributing to failures of osseointegrated oral implants (II). Etiopathogenesis. Eur J Oral Sci 106: 721–764. doi:10.1046/j.0909-8836..t01-6-.x

    Article  CAS  Google Scholar 

  5. Hui SL, Gao SJ, Zhou XH, ConradJohnston C JR, Lu Y, Gluer CC et al (1997) Universal Standardization of Bone Density Measurements: A Method with Optimal Properties for Calibration Among Several Instruments. J Bone Miner Res 12: 1463–1470. doi:10.1359/jbmr.1997.12.9.1463

    Article  PubMed  CAS  Google Scholar 

  6. Johnson JB, Dawson-Hughes B (1991) Precision and stability of dual energy X-ray measurements. Calcif Tissue Int 49: 174–178. doi:10.1007/BF02556113

    Article  PubMed  CAS  Google Scholar 

  7. Osteoporosis in Europe: Indicators and Progress. EU policy of report 2005, International Osteoporosis foundation

  8. Bonnick SL (2004) Densitometry techniques. In: Bonnic SL (ed) Bone densitometry in clinical practice. Humana Press, Totowa, pp 1–24

  9. Jacobs R, Ghyselen J, Koninckx P, van Steenberghe D (1996) Long-term bone mass evaluation of mandible and lumbar spine in a group of women receiving hormone replacement therapy. Eur J Oral Sci 104: 10–16. doi:10.1111/j.1600-0722.1996.tb00039.x

    Article  PubMed  CAS  Google Scholar 

  10. White SC, Atchison KA, Gornbein JA, Nattiv A, Paganini-Hill A (2005) Change in mandibular trabecular pattern and hip fracture rate in elderly women. Dentomaxillofac Radiol 34: 168–174. doi:10.1259/dmfr/32120028

    Article  PubMed  CAS  Google Scholar 

  11. Nackaerts O, Jacobs R, Pillen M, Engelen L, Gijbels F, Devlin H et al (2006) Accuracy and precision of a densitometric tool for jaw bone. Dentomaxillofac Radiol 35: 244–248. doi:10.1259/dmfr/71134064

    Article  PubMed  CAS  Google Scholar 

  12. Horner K, Devlin H, Alsop CW, Hodgkinson IM, Adams JE (1996) Mandibular bone mineral density as a predictor of skeletal osteoporosis. Br J Radiol 69: 1019–1025

    Article  PubMed  CAS  Google Scholar 

  13. Bozic M, Ihan Hren N (2006) Osteoporosis and mandibles. Dentalmaxillofac Radiol 35: 178–184. doi:10.1259/dmfr/79749065

    Article  CAS  Google Scholar 

  14. Southard KA, Southard TE (1994) Detection of simulated osteoporosis in human anterior maxillary alveolar bone with digital subtraction. Oral Surg Oral Med Oral Pathol 78: 655–661. doi:10.1016/0030-4220(94)90181-3

    Article  PubMed  CAS  Google Scholar 

  15. Trouerbach WT, Steen WT, Zwamborn AW, Schouten HJ (1984) A study of the radiographic aluminum equivalent values of the mandible. Oral Surg Oral Med Oral Pathol 58: 610–616. doi:10.1016/0030-4220(84)90088-4

    Article  PubMed  CAS  Google Scholar 

  16. Dornier C, Dorsaz-Brossa L, Thevenaz P, Casagni F, Brochut P, Mombelli A et al (2004) Geometric alignment and chromatic calibration of serial radiographic images. Dentomaxillofac Radiol 33: 220–225. doi:10.1259/dmfr/71716997

    Article  PubMed  CAS  Google Scholar 

  17. Horner K, Karayianni K, Mitsea A, Berkas L, Mastoris M, Jacobs R et al (2007) The Mandibular Cortex on Radiographs as a Tool for Osteoporosis Risk Assessment: The OSTEODENT Project. J Clin Densitom 10(2): 138–146. doi:10.1016/j.jocd.2007.02.004

    Article  PubMed  Google Scholar 

  18. Devlin H, Karayianni K, Mitsea A, Jacobs R, Lindh C, Stelt P, Marjanovic E, Adams J, Pavitt S, Horner K (2007) Diagnosing osteoporosis by using dental panoramic radiographs: The OSTEODENT project. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 104(6): 821–828

    Article  Google Scholar 

  19. Barthe N, Braillon P, Ducassou D, Basse-Cathalinat B (1997) Comparison of two hologic DXA systems (QDR 1000 and QDR 4500/A). Br J Radiol 70: 728–739

    PubMed  CAS  Google Scholar 

  20. Graf JM, Mounir A, Payot P, Cimasoni G (1988) A simple paralleling instrument for superimposing radiographs of the molar regions. Oral Surg Oral Med Oral Pathol 66: 502–506. doi:10.1016/0030-4220(88)90278-2

    Article  PubMed  CAS  Google Scholar 

  21. Dornier C, Dorsaz-Brossa L, Thevenaz P, Casagni F, Brochut P, Mombelli A et al (2004) Geometric alignment and chromatic calibration of serial radiographic images. Dentalmaxillofac Radiol 33: 220–225. doi:10.1259/dmfr/71716997

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Oral Imaging Center, Faculty of Medicine, Katholieke Universiteit Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium

    Y. Sun, O. Nackaerts, M. Loubele, B. Yan & R. Jacobs

  2. Medical Image Computing (PSI), Faculty of Engineering, Katholieke Universiteit Leuven, 3000, Leuven, Belgium

    B. De Dobbelaer, M. Loubele & P. Suetens

  3. Department of Oral and Maxillofacial Surgery, St John’s Hospital, Schiepse bos 6, 3600, Genk, Belgium

    Y. Sun, C. Politis, L. Vrielinck & S. Schepers

  4. Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Gent, Gent, Belgium

    S. Schepers

  5. Department of Morphology, University of Hasselt, Diepenbeek, Belgium

    I. Lambrichts

  6. School of Dentistry, University of Manchester, Manchester, UK

    K. Horner & H. Devlin

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  1. Y. Sun
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  2. B. De Dobbelaer
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  3. O. Nackaerts
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  4. M. Loubele
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  5. B. Yan
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  11. K. Horner
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  12. H. Devlin
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  13. R. Jacobs
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Corresponding author

Correspondence to Y. Sun.

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Sun, Y., De Dobbelaer, B., Nackaerts, O. et al. Development of a clinically applicable tool for bone density assessment. Int J CARS 4, 163–168 (2009). https://doi.org/10.1007/s11548-008-0280-z

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  • DOI: https://doi.org/10.1007/s11548-008-0280-z

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