Fraktal analiz ve radyomorfometrik indeksler: sigara içenlerin dijital panoramik radyografilerinde mandibular kemik yapısındaki değişikliklerin karşılaştırılması

Öz

Amaç: Çalışmanın amacı, çeşitli radyomorfometrik indeksler ve fraktal boyut (FB) analizi kullanarak sigaranın mandibular kemik yapısını nasıl etkilediğini değerlendirmektir. Gereç ve yöntem: Bu retrospektif çalışmaya 56 hasta (28 sigara içen ve 28 sigara içmeyen) dahil edildi. Mandibulada, trabeküler kemikte 45x45 piksellik sekiz ilgi alanı seçildi ve fraktal boyut analizi yapıldı. Mandibular indeks ve mandibular kortikal genişliği ölçmek için dijital panoramik radyografiler kullanıldı. Tüm değerler gruplar arasında karşılaştırıldı. Shapiro-Wilk, bağımsız örneklem t-testi ve Mann-Whitney U testleri kullanılarak toplanan veriler değerlendirildi. Bulgular: Çalışma grubunda 28 (12 kadın, 16 erkek), kontrol grubunda 28 (12 kadın, 16 erkek) olmak üzere yaşları 18 ile 52 arasında değişen toplam 56 hasta değerlendirildi. Gruplar arasında mandibular trabeküler kemikte ROI4 ve ROI8’de istatistiksel olarak anlamlı bir fark vardı, ancak ROI1, ROI2, ROI3, ROI5, ROI6 ve ROI7’nin ortalama FB değerlerinde fark yoktu. PMI ve MCW ölçümleri için gruplar arasında istatistiksel olarak anlamlı bir fark görülmedi (p>0.05). Cinsiyetler arasında yalnızca ROI5’in FB değerleri ve PMI ölçümlerinde istatiksel olarak anlamlı farklılık vardı (p<0.05). FB, PMI ve MCW ölçümleri için sınıf içi korelasyon katsayısı (ICC) değerleri mükemmel güvenilirliğe sahipti. Sonuç: Mental foramenin anterioru ve kondil bölgesindeki trabeküler kemik yapıları sigara içenlerde farklıydı. Kortikal kemik yapılarında fark yoktu.

Anahtar Kelimeler

• Fraktal boyut
• radyomorfometrik indeksler
• sigara
• panoramik radyografi
• osteoporoz

Fractal analysis and radiomorphometric indices: comparison of mandibular bone structure changes on digital panoramic radiographs of smokers

Abstract

Purpose: The purpose of the study was to assess how smoking affected the mandibular bone structure using a variety of radiomorphometric indices and fractal dimension (FD) analysis. Material and methods: 56 patients—28 smokers and 28 non-smokers—were included in this retrospective study. In the trabecular bone of the mandible, eight areas of interest of 45x45 pixels were chosen, and fractal dimension analysis was carried out. All digital panoramic radiographs were used to measure the mandibular index and mandibular cortical width. All values were compared between groups. Utilizing the Shapiro-Wilk test, independent samples t-test and Mann-Whitney U test, collected data were evaluated. Results: A total of 56 patients between the ages of 18 and 52 were evaluated, 28 in the study group (12 female and 16 male) and 28 in the control group (12 female and 16 male). There was a statistically significant difference between the groups in ROI4 and ROI8, but not in the mean FD values of ROI1, ROI2, ROI3, ROI5, ROI6 and ROI7 in the mandibular trabecular bone. No statistically significant differences between groups were seen for PMI and MCW measures (p>0.05). There was a statistically significant difference between genders only in FD values of ROI5 and PMI measurements (p<0.05). The intraclass correlation coefficient (ICC) values for the FD, PMI and MCW measurements had excellent reliability. Conclusions: The trabecular bone structures of the anterior of the mental foramen and the condyle were different in smokers. There was no difference in cortical bone structures.

Keywords

• Fractal dimension
• radiomorphometric indices
• smoker
• panoramic radiography
• osteoporosis

References

1. 1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993;94:646-650. https://doi.org/10.1016/0002-9343(93)90218-e
2. 2. Mishra A, Chaturvedi P, Datta S, Sinukumar S, Joshi P, Garg A. Harmful effects of nicotine. Indian J Med Paediatr Oncol 2015;36:24-31. https://doi.org/10.4103/0971-5851.151771
3. 3. Basavarajappa S, Konddajji Ramachandra V, Kumar S. Fractal dimension and lacunarity analysis of mandibular bone on digital panoramic radiographs of tobacco users. J Dent Res Dent Clin Dent Prospects 2021;15:140-146. https://doi.org/10.34172/joddd.2021.024
4. 4. Abbas S, Baig S, Jamal Q, Danish H, Amber S. Osteoporosis in males and its association with tobacco; smokers and chewers. European J Biotechnol Biosci 2015;3:15-18.
5. 5. Wong PK, Christie JJ, Wark JD. The effects of smoking on bone health. Clin Sci 2007;113:233-241. https://doi.org/10.1042/CS20060173
6. 6. Franciotti R, Moharrami M, Quaranta A, et al. Use of fractal analysis in dental images for osteoporosis detection: a systematic review and meta-analysis. Osteoporos Int 2021;32:1041-1052. https://doi.org/10.1007/s00198-021-05852-3
7. 7. Coşgunarslan A, Canger EM, Soydan Çabuk D. Proton pump inhibitors and mandibular bone quality: a preliminary study. Dentomaxillofac Radiol 2021;50:20200505. https://doi.org/10.1259/dmfr.20200505
8. 8. Zihni Korkmaz M, Yemenoğlu H, Günaçar DN, Ustaoğlu G, Ateş Yildirim E. The effects of vitamin D deficiency on mandibular bone structure: a retrospective radiological study. Oral Radiol 2023;39:69-74. https://doi.org/10.1007/s11282-022-00602-5

9. 9. Ersu N, Akyol R, Etöz M. Fractal properties and radiomorphometric indices of the trabecular structure of the mandible in patients using systemic glucocorticoids. Oral Radiol 2022;38:252-260. https://doi.org/10.1007/s11282-021-00552-4
10. 10. Aktuna Belgin C, Serindere G. Fractal and radiomorphometric analysis of mandibular bone changes in patients undergoing intravenous corticosteroid therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2022;130:110-115. https://doi.org/10.1016/j.oooo.2019.12.009
11. 11. Gulec M, Tassoker M, Ozcan S, Orhan K. Evaluation of the mandibular trabecular bone in patients with bruxism using fractal analysis. Oral Radiol 2021;37:36-45. https://doi.org/10.1007/s11282-020-00422-5
12. 12. Coşgunarslan A, Aşantoğrol F, Soydan Çabuk D, Canger EM. The effect of selective serotonin reuptake inhibitors on the human mandible. Oral Radiol 2021;37:20-28. https://doi.org/10.1007/s11282-019-00419-9
13. 13. Gupta B, Acharya A, Singh S, et al. Evaluation of jawbone morphology and bone density indices in panoramic radiographs of selective serotonin reuptake inhibitor users: a preliminary study. Dentomaxillofac Radiol 2019;48:20170360. https://doi.org/10.1259/dmfr.20170360
14. 14. Kurşun Çakmak E, Bayrak S. Comparison of fractal dimension analysis and panoramic-based radiomorphometric indices in the assessment of mandibular bone changes in patients with type 1 and type 2 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;126:184-191. https://doi.org/10.1016/j.oooo.2018.04.010
15. 15. Aytekin Z, Yilmaz SG. Evaluation of osseous changes in dental panoramic radiography using radiomorphometric indices in patients with hyperthyroidism. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022;133:492-499. https://doi.org/10.1016/j.oooo.2021.10.011
16. 16. Neves FS, Barros AS, Cerqueira GA, et al. Assessment of fractal dimension and panoramic radiomorphometric indices in women with celiac disease. Oral Radiol 2020;36:141-7. https://doi.org/10.1007/s11282-019-00388-z 17. Arsan B, Köse TE, Çene E, Özcan İ. Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:382-391. https://doi.org/10.1016/j.oooo.2016.11.005
17. 18. Eninanç İ, Yalçın Yeler D, Çınar Z. Investigation of mandibular fractal dimension on digital panoramic radiographs in bruxist individuals. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131:600-609. https://doi.org/10.1016/j.oooo.2021.01.017
18. 19. Suer BT, Yaman Z, Buyuksarac B. Correlation of fractal dimension values with implant insertion torque and resonance frequency values at implant recipient sites. Int J Oral Maxillofac Implants 2016;31:55-62. https://doi.org/10.11607/jomi.3965
19. 20. Kış HC, Güleryüz Gürbulak A. Evaluation of the peri-implant bone trabecular microstructure changes in short implants with fractal analysis. Int J Implant Dent 2020;6:13(e1-8). https://doi.org/10.1186/s40729-020-00209-7
20. 21. Ledgerton D, Horner K, Devlin H, Worthington H. Radiomorphometric indices of the mandible in a British female population. Dentomaxillofac Radiol 1999;28:173-181. https://doi.org/10.1038/sj/dmfr/4600435
21. 22. Benson BW, Prihoda TJ, Glass BJ. Variations in adult cortical bone mass as measured by a panoramic mandibular index. Oral Surg Oral Med Oral Pathol 1991;71:349-356. https://doi.org/10.1016/0030-4220(91)90314-3
22. 23. White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:628-635. https://doi.org/10.1016/s1079-2104(99)70097-1
23. 24. Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofac Radiol 1997;26:95-100. https://doi.org/10.1038/sj.dmfr.4600215
24. 25. Yu B, Wang CY. Osteoporosis and periodontal diseases - An update on their association and mechanistic links. Periodontol 2000 2022;89:99-113. https://doi.org/10.1111/prd.12422
25. 26. Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018;14:2029-2049. https://doi.org/10.2147/TCRM.S138000
26. 27. Høiberg MP, Rubin KH, Hermann AP, Brixen K, Abrahamsen B. Diagnostic devices for osteoporosis in the general population: a systematic review. Bone 2016;92:58-69. https://doi.org/10.1016/j.bone.2016.08.011
27. 28. Ratajczak AE, Szymczak Tomczak A, Rychter AM, Zawada A, Dobrowolska A, Krela Kaźmierczak I. Impact of cigarette smoking on the risk of osteoporosis in inflammatory bowel diseases. J Clin Med 2021;10:1515. https://doi.org/10.3390/jcm10071515
28. 29. Al Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The effect of tobacco smoking on bone mass: an overview of pathophysiologic mechanisms. J Osteoporos 2018:1206235. https://doi.org/10.1155/2018/1206235
29. 30. Kavitha MS, An SY, An CH, et al. Texture analysis of mandibular cortical bone on digital dental panoramic radiographs for the diagnosis of osteoporosis in Korean women. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:346-356. https://doi.org/10.1016/j.oooo.2014.11.009
30. 31. Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. 2000;27:585- 590. https://doi.org/10.1016/s8756-3282(00)00381-1
31. 32. Oliveira ML, Pedrosa EF, Cruz AD, Haiter Neto F, Paula FJ, Watanabe PC. Relationship between bone mineral density and trabecular bone pattern in postmenopausal osteoporotic Brazilian women. Clin Oral Investig 2013;17:1847-1853. https://doi.org/10.1007/s00784-012-0882-2
32. 33. Tosoni GM, Lurie AG, Cowan AE, Burleson JA. Pixel intensity and fractal analyses: detecting osteoporosis in perimenopausal and postmenopausal women by using digital panoramic images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:235-241. https://doi.org/10.1016/j.tripleo.2005.08.020
33. 34. Kato CN, Barra SG, Tavares NP, et al. Use of fractal analysis in dental images: a systematic review. Dentomaxillofac Radiol 2020;49:20180457. https://doi.org/10.1259/dmfr.20180457
34. 35. Leite A, Figueiredo P, Caracas H, et al. Systematic review with hierarchical clustering analysis for the fractal dimension in assessment of skeletal bone mineral density using dental radiographs. Oral Radiol 2015;31:1-13. https://doi.org/10.1007/s11282-014-0188-y
35. 36. Law AN, Bollen AM, Chen SK. Detecting osteoporosis using dental radiographs: a comparison of four methods. J Am Dent Assoc 1996;127:1734-1742. https://doi.org/10.14219/jada.archive.1996.0134
36. 37. Magat G, Ozcan Sener S. Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography. Oral Radiol 2019;35:35-42. https://doi.org/10.1007/s11282-018-0316-1
37. 38. Iki M. Osteoporosis and smoking. Clin Calcium 2005;15:156-158.
38. 39. Kopiczko A, Gryko K, Łopuszańska Dawid M. Bone mineral density, hand grip strength, smoking status and physical activity in Polish young men. Homo 2018;69:209-216. https://doi.org/10.1016/j.jchb.2018.08.003
39. 40. Hijazi N, Alourfi Z. Prevalence and factors associated with low bone mass and osteoporosis in syrian postmenopausal women. Mathews J Case Rep 2019;4:58(e1-7). https://doi.org/10.30654/MJCR.10058
40. 41. Cusano NE. Skeletal effects of smoking. Curr Osteoporos Rep 2015;13:302-309. https://doi.org/10.1007/s11914-015-0278-8
41. 42. Updike SX, Nowzari H. Fractal analysis of dental radiographs to detect periodontitis-induced trabecular changes. J Periodontal Res 2008;43:658–664. https://doi.org/10.1111/j.1600-0765.2007.01056.x
42. 43. Yaşar F, Akgünlü F. The differences in panoramic mandibular indices and fractal dimension between patients with and without spinal osteoporosis. Dentomaxillofac Radiol 2006;35:1-9. https://doi.org/10.1259/dmfr/97652136
43. 44. Mostafa RA, Arnout EA, Abo el-Fotouh MM. Feasibility of cone beam computed tomography radiomorphometric analysis and fractal dimension in assessment of postmenopausal osteoporosis in correlation with dual X-ray absorptiometry. Dentomaxillofac Radiol 2016;45:20160212. https://doi.org/10.1259/dmfr.20160212
44. 45. Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE. Diagnostic capabilities of fractal dimension and mandibular cortical width to identify men and women with decreased bone mineral density. Osteoporos Int 2012;23:1631-1636. https://doi.org/10.1007/s00198-011-1678-y
45. 46. Santolia DD, Dahiya DS, Sharma DS, et al. Fractal Dimension and Radiomorphometric analysis of Orthopantomographs in patients with tobacco and areca nut associated oral mucosal lesions: a pilot in- vivo study in a North Indian cohort. Oral Surg Oral Med Oral Pathol Oral Radiol 2022;134:627-638. https://doi.org/10.1016/j.oooo.2022.06.003
46. 47. Chappard C, Brunet Imbault B, Lemineur G, et al. Anisotropy changes in post-menopausal osteoporosis: characterization by a new index applied to trabecular bone radiographic images. Osteoporos Int 2005;16:1193-1202. https://doi.org/10.1007/s00198-004-1829-5
47. 48. Savic Pavicin I, Dumancic J, Jukic T, Badel T, Badanjak A. Digital orthopantomograms in osteoporosis detection: mandibular density and mandibular radiographic indices as skeletal BMD predictors. Dentomaxillofac Radiol 2014;43:20130366. https://doi.org/10.1259/dmfr.20130366
48. 49. Limeira FIR, Rebouças PRM, Diniz DN, Melo DP, Bento PM. Decrease in mandibular cortical in patients with type 1 diabetes mellitus combined with poor glycemic control. Braz Dent J 2017;28:552-558. https://doi.org/10.1590/0103-6440201701523
49. 50. Demiralp KÖ, Kurşun Çakmak EŞ, Bayrak S, Akbulut N, Atakan C, Orhan K. Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study. Oral Radiol 2019;35:23-28. https://doi.org/10.1007/s11282-018-0321-4