Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e624
Jou nal sec ion: Ge odon ology
Publica ion Types: Re iew
Compu e -aided sys em o mo phome ic mandibula index compu a ion
(Using den al pano amic adiog aphs)
Jose López-López 1, Jose-Manuel Ál a ez-López 2, En ique Jané-Salas 1, Albe Es ugo-De esa 3, Raul Ayu-
so-Mon e o 4, Eugenio Velasco-O ega 5, Juan-Jose Segu a-Egea 6
1 PhD. MD, DDS. Specialis in S oma ology. School o Den is y. Depa men o Odon o-s oma ology, Uni e si y o Ba celona
2 PhD, DDS. Compu e Science esea ch scien is , CBLL, New Yo k Uni e si y, and Compu e Vision Cen e , Ba celona
1 PhD. MD, DDS. Specialis in S oma ology. School o Den is y. Depa men o Odon o-s oma ology, Uni e si y o Ba celona
3 MD, DDS. Specialis in S oma ology. School o Den is y. Depa men o Odon o-s oma ology, Uni e si y o Ba celona
4 PhD, DDS. School o Den is y. Depa men o Odon o-s oma ology, Uni e si y o Ba celona
5 PhD, MD, DDS. Specialis in S oma ology. School o Den is y. Depa men o S oma ology, Uni e si y o Se illa
6 PhD, MD, DDS. Specialis in S oma ology. School o Den is y. Depa men o Endodon ics, Uni e si y o Se illa
Co espondence:
Depa amen o Odon o-S oma ology
Facul y o Odon ology-Uni e si y o Ba celona
Uni e si a y Campus o Bell i ge
C/ Feixa LLa ga S/N
08907 L’Hospi ale de Llob ega (Ba celona, Spain)
[email protected]
Recei ed: 03/04/2011
Accep ed: 16/09/2011
Abs ac
Objec i e: We p opose and alida e a compu e —aided sys em o measu e h ee di e en mandibula indexes:
co ical wid h, pano amic mandibula index and, mandibula al eola bone eso p ion index.
S udy Design: Repea abili y and ep oducibili y o he measu emen s a e analyzed and compa ed o he manual
es ima ion o he same indexes.
Resul s: The p oposed compu e ized sys em exhibi s supe io epea abili y and ep oducibili y a es compa ed o
s anda d manual me hods. Mo eo e , he ime equi ed o pe o m he measu emen s using he p oposed me hod
is negligible compa ed o pe o m he measu emen s manually.
Conclusions: We ha e p oposed a e y use iendly compu e ized me hod o measu e h ee di e en mo phome -
ic mandibula indexes. F om he esul s we can conclude ha he sys em p o ides a p ac ical manne o pe o m
hese measu emen s. I does no equi e an expe examine and does no ake mo e han 16 seconds pe analysis.
Thus, i may be sui able o diagnose os eopo osis using den al pano amic adiog aphs.
Key wo ds: Os eopo osis, pano amic mandibula index, co ical wid h, mandibula al eola bone eso p ion
index.
López-López J, Ál a ez-López JM, Jané-Salas E, Es ugo-De esa A,
Ayuso-Mon e o R, Velasco-O ega E, Segu a-Egea JJ. Compu e -aided
sys em o mo phome ic mandibula index compu a ion (Using den al
pano amic adiog aphs). Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17
(4):e624-32.
h p://www.medicinao al.com/medo al ee01/ 17i4/medo al 17i4p624.pd
A icle Numbe : 17637 h p://www.medicinao al.com/
© Medicina O al S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946
eMail: [email p o ec ed]
Indexed in:
Science Ci a ion Index Expanded
Jou nal Ci a ion Repo s
Index Medicus, MEDLINE, PubMed
Scopus, Embase and Emca e
Indice Médico Español
doi:10.4317/medo al.17637
h p://dx.doi.o g/doi:10.4317/medo al.17637
Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e625
In oduc ion
Os eopo osis is a sys emic bone disease cha ac e ized
by educ ion in bone mass and mic o-a chi ec u al de-
e io a ion o bone issue. Os eopo osis is he main dis-
ease o middle age women, especially menopausal ones.
I a ec s o mo e han 75 million people in Eu ope, Ja-
pan and he Uni ed S a es. Spain has one o he highes
incidences in Eu ope since he e a e mo e han 2.5 mil-
lions o a ec ed woman. Fu he , 40% o hese women
a e no diagnosed ye (1). Al hough mass bone and cal-
cium me abolism al e a ions a e e iden in he p emen-
opausal pe iod, he menopause s esses he beginning
o bone loss. I is p olonged un il li e’s end and i is he
main cause o bone ac u es in olde age women (2,3).
The Spanish Associa ion Agains Os eopo osis (AE-
COS) es ima es an annual hip ac u e a e o 60.000 in
Spain. Fu he , he annual a e in he Eu opean Union is
expec ed o inc ease om 414.000 o 972.000 a ec ed
people wi hin he nex 50 yea s. P e en i e measu es
and an ea ly diagnose may help dec easing hese a es
signi ican ly (4). The ea ly onse o os eopo osis can
be de ec ed by dec eased densi y o no mal bone. The
mos widely used echnique o bone densi y es ing is
dual ene gy X- ay abso p iome y (DXA) (5) consis ing
o wo x- ay beams wi h di e ing ene gy le els aimed
a he pa ien ’s bones. Bone densi y da a is in e p e -
ed in compa ison wi h wha is conside ed no mal o
a heal hy young pe son. In his way, he bone densi y
es s calcula e he pe son’s T-sco e. Then, i is compa ed
agains op imal bone densi y and exp essed as numbe
o s anda d de ia ions below he a e age. Finally, ac-
co ding o Wo ld Heal h O ganiza ion c i e ia (6), a T-
sco e g ea e han 1 is conside ed no mal. A T-sco e o
less han -2.5 is indica i e o os eopo osis and a T-sco e
anging om -1 o -2.5 is conside ed as a condi ion o
os eopenia ( he p ecu so o os eopo osis).
Recen s udies indica e he possibili y o assessing he
bone mine al densi y (DMO) analyzing he mandibula
bone mine al densi y (7). In addi ion, some au ho s e-
la e os eopo osis o he mandibula esidual idge eso p-
ion, pe iodon al bone loss and oo h loss (8,9). These
s udies assess and co ela e he os eopo osis diagnose
wi h he adiog aphic esul s in pano amic adiog aphs
(o opan omog aphs, OPG) and pe iapical adiog aphs.
Fu he , hey highligh he ele ance o he den is in he
ea ly onse o his disease. The main den al pano amic
adiog aphy measu es o he os eopo osis diagnose a e:
co ical wid h (CW), also known as mandibula co i-
cal hickness (MTC) (10), pano amic mandibula index
(PMI) (11) and, mandibula al eola bone eso p ion in-
dex (MM a io) (12); see (Fig. 1). Howe e , he alidi y
o hese indexes and ela ed ones such as mandibula
angle (13) and he isual mo phology o he co ical (14)
is unde e iew. Mo eo e , he p ecise measu emen o
hese indexes, in e ms o epea abili y and ep oduc-
ibili y, on den al pano amic adiog aphs is no p ac ical
Fig. 1. Main measu es a e de ined as: a = Co ical wid h (CW); a/b= pano amic mandibula
index (PMI); d/c= mandibula al eola bone eso p ion index (MM a io).
Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e626
and is complica ed in clinical den al p ac ice (14-16).
These indexes ha e been widely used in he li e a u e
o e alua e he DMO and, hus, o diagnose os eopo o-
sis. Fu he , conside ing he o hopan omog aphy is a
common p ac ice in den al clinics mos au ho s p o-
pose using den al adiog aphy measu emen s o he
ea ly diagnose o os eopo osis. Tha is, hey use hese
measu emen s o ad ise pa ien s o de ailed s udies o
hei bone pa hology. Fo ins ance, Ho ne K & De lin
H (7) in 1998 conclude ha he DMO assessed by DXA
is signi ican ly co ela ed wi h DMO measu emen s us-
ing MTC and PMI in pano amic adiog aphs. Fu he ,
in 2002, he same au ho s use measu emen s o co ical
hickness a he den al mandibula o amen (mandibula
index, MI), an egonion (an egonial index, AI) and go-
nion (gonial index, GI) egions o conclude ha only MI
con ibu ed signi ican ly o a diagnosis o low skele al
DMO (17). Whi e SC e al. (18) in 2005, use MTC and
isual co ex analysis desc ibed in Kleme i e al. (14)
o conclude ha bo h indexes a e use ul o inden i y-
ing subjec s ha ing low bone mass. A i in AZ e al. (19)
in 2006, p esen a compu e -aided me hod o es ima e
MTC in digi al adiog aphs and o assess he DMO o
he pa ien s. Taguchi e al. (20) in 2006, use MTC and
he isual co ex analysis combined wi h a isk ac o s
su ey ( he os eopo osis sel -assessmen ool) gi en o
150 pa ien s o conclude ha den is s ha e su icien
clinical and adiog aphic in o ma ion o ad ise women
(younge han 65 yea s old) o unde go a bone densi-
ome y analysis. In ano he s udy, in 2007, Taguchi
e al. (21) use MTC and he isual co ex analysis o
conclude ha pos menopausal women wi h mandibula
dis o ions usually ha e low DMO o e en os eopo osis.
Mo e ecen ly, Vlasiadis e al. (22) in 2008, use men al
pano amic adiog aphy indexes as a simple me hod in
he diagnose o os eopo osis. They conclude ha he e
is a ela ionship be ween spinal BMD, mandibula co -
ical wid h and Kleme i isual co ex analysis.
The e o e, gi en he di icul y associa ed o he meas-
u emen o men al pano amic adiog aphy indexes we
p opose a compu e -aided sys em o compu e hese
measu es exhibi ing, a leas , he same e iciency han
manual (cu en ) es ima ion. Hence, he pu pose o his
s udy is alida ing he bene i s o es ima ing he meas-
u es using he p oposed sys em in on o he manual
me hod. Tha is, we aim o p o e he use ulness o us-
ing a compu e -aided sys em o es ima e mo phome ic
measu es in o hopan omog aphy.
Subjec and Me hods
Ten pano amic adiog aphs om 10 di e en subjec s
a e andomly selec ed om a se o 200 adiog aphs
aken a he Uni e si y Den al Clinic, Uni e si y o
Ba celona. The subse o adiog aphs is analyzed by 10
di e en examine s. They a e den is s wi h mo e han 3
yea s o clinical expe ience. All o hem ook a 1 hou
heo y-and-p ac ice cou se o lea n he manual and
compu e -aided measu emen p ocedu es.
Measu es o e alua e:
Th ee di e en measu es a e e alua ed: co ical wid h
(CW), pano amic mandibula index (PMI) and, man-
dibula al eola bone eso p ion index (MM a io) (Fig.
1). Manual measu emen o hese indexes is ca ied ou
d awing lines pa allel o he long axis o he mandible
and angen ial o he in e io bo de o he mandible.
Fu he , a line pe pendicula o his angen in e sec -
ing he in e io ma gin o he men al o amen is d awn.
Measu emen s a e aken along his pe pendicula line
as shown in (Fig. 1). I he men al o amen is isible on
bo h sides o he mandible he measu emen s a e a e -
aged. Tha is, he mean alue o he indexes is consid-
e ed. Al hough his is a simple p ocess o es ima e he
measu emen s i is no p ac ical p o iding high in e -
obse e a ia ions. Tha is, measu emen s p o ided by
di e en den is s a e di e en .
Compu e -aided measu emen sys em:
In his sec ion, he p oposed algo i hm o es ima ing
mo phome ic mandibula indexes is in oduced. The
algo i hm is based on he knowledge o se e al poin s
manually anno a ed in he image (Fig. 2A). These poin s
de ine he uppe and lowe bo de o he mandible, he
in e io ma gin and he cen e o he men al o amen,
and he co ical wid h. Thus, he edious p oblem o lo-
ca ing he mandibula axis and measu ing dis ances in
a p in ed o hopan omog aphy is educed o selec nine
poin s in a digi al image.
Based on hese poin s he algo i hm d aws suppo lines
o es ima e he mo phome ic mandibula indexes. In
his way, he uppe and lowe bo de s a e modeled using
second o de cu es (pa abolas). Using hese pa abolic
models has wo main ad an ages: i s simplici y since
only h ee adjus able coe icien s a e equi ed, and i s
physical plausibili y since he bo de o he mandible
can be easonably app oxima ely by a pa abolic unc-
ion in he image plane (Fig. 2B). The coe icien s o
hese models a e ixed based on inpu poin s (Pmu and
Pml espec i ely) in a leas squa e sense. Tha is, he
coe icien s o each cu e minimize he sum o squa ed
esiduals. Residuals a e de ined as he sho es Euclid-
ian dis ance be ween each inpu poin and he esul ing
cu e.
Gi en he lowe bo de o he mandible and he poin
de ining he in e io ma gin o he men al o amen P l,
he suppo line ℓÞ passing pe pendicula o he bo de
and h ough P l is d awn. This line de ines he sho -
es dis ance be ween he in e io ma gin o he o amen
and he lowe bo de o he mandible. Then, he slope
o he mandibula axis is uniquely de ined by he line
ℓß angen o he lowe mandibula bo de a xo, he in-
e sec ion poin be ween ℓÞ and he lowe mandibula
Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e627
bo de (Fig. 2C). De i a i es o he cu e a e aken and
e alua ed a xo o de i e he slope o ℓß. Then, he slope
o ℓÞ is ob ained since hese wo lines a e pe pendicu-
la . Robus ness agains in e io o amen ma gin de ini-
ion is achie ed by selec ing mul iple poin s de ining he
in e io ma gin o he men al o amen. In his case, he
algo i hm selec s he poin co esponding o he mini-
mum dis ance.
A his poin , co ical wid h (C) is es ima ed along ℓÞ
using Pcw, he co ical wid h poin . This poin loca es
he in e sec ion be ween he in e io mandibula co ex
and ℓÞ. Fu he mo e, he pano amic mandibula index
(PMI) is compu ed as he a io o he hickness o he
in e io mandibula co ex in he men al egion o e he
dis ance be ween he lowe bo de o he mandible and
he in e io ma gin o he men al o amen. This index is
also compu ed along ℓÞ using Pcw.
The emaining is es ima ing he M/M a io. This is done
ex ending ℓÞ o in e sec he uppe bo de o he mandi-
ble as shown in (Fig. 2D). Measu es a e aken along his
line be ween mandible bo de s and he lowe bo de and
P c, he cen e o he men al o amen. I mo e han one
poin is selec ed o de ine he cen e o he o amen hei
cen oid is used o compu e he measu e.
All he measu es used o compu e he indexes a e gi en
in pixels. Ne e heless, he ou pu o he algo i hm is
gi en in millime e s using wo con e sion a ios: dis o -
ion a io and pixel o millime e a io. The o me e e s
o he dis o ion in oduced in he imaging p ocess. The
la e e e s o he dis ance o he mandible co e ed by
each pixel in he image. These a ios a e de ice depend-
en . The dis o ion a io mus be in oduced manually
whe eas he pixel o millime e a io can be es ima ed
by compa ing manually measu ed dis ances in a p in ed
o hopan omog aphy agains he numbe o pixels in he
co esponding image.
Finally, he algo i hm o compu ing he mo phome ic
mandibula indexes is summa ized as ollows: 1) Pe -
o m algo i hm calib a ion i equi ed. 2) Load and dis-
play he egion o in e es o an o hopan omog aphy. 3)
Selec a leas h ee poin s de ining he uppe bo de o
he mandible (Pmu). 4) Selec a leas h ee poin s de in-
ing he lowe bo de o he mandible (Pml). 5) Selec a
leas one poin de ining he in e io ma gin o he men-
al o amen (P l). 6) Selec a leas one poin de ining he
cen e o he men al o amen (P c). 7) Selec he poin
(Pcw) along he line ℓÞ o de ine he mandibula in e io
co ical wid h. This line is angen o he lowe mandi-
Fig. 2A. The algo i hm is based on nine poin s manually labelled in each image. Pmu: poin s
de ining he uppe mandibula bo de . Pml: poin s de ining he lowe mandibula bo de . P c:
he cen e o he o amen. P l: in e io ma gin o he o amen. Pcw: poin s de ining he co ical
wid h. 2B. Second o de cu es (pa abolas) a e used o model he uppe and lowe bo de s o he
mandible. These cu es can easonably app oxima e he eal shape o he mandible based on a
leas h ee poin s. 2C. Suppo lines a e d awn o de ine he slope and posi ion o he mandibula
axis. 2D. Di e en suppo lines a e d awn au oma ically based on use inpu . ℓÞ is ex ended
o in e sec he uppe bo de o he mandible. All he indices a e measu ed along his ex ension
line. Co ical wid h is de ined by a, Pano amic mandibula index is a/b and he M/M a io is
d/c.
Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e628
ble bo de and passes h ough he in e io o amen ma -
gin. 8) Sa e he esul s i equi ed.
Me hodology:
Th ee di e en measu emen s se s a e ca ied ou by
each examine in each o hopan omog aphy wi h en
minu es b eak be ween measu emen s. OPG a e an-
domly selec ed a each measu emen ound. This p oc-
ess is epea ed using he manual and compu e -aided
measu emen me hods. Fu he , hal examine s pe o m
he manual me hod i s and hen, he compu e ized
one. Hal examine s pe o m he compu e ized me hod
i s and hen he manual one. Hence, he measu emen
p ocess o each OPG is summa ized as ollows:
1) Manual me hod: 30 measu emen s pe o hopan o-
mog aphy. Each examine measu es 3 imes each OPG
ollowing he manual me hod as desc ibed in Benson
BW e al. (11) and Kleme i E & Kolmakow S (14), (Fig.
1).
2) Compu e -aided me hod: 30 measu emen s pe o ho-
pan omog aphy. Each examine measu es 3 imes each
OPG using he p oposed compu e -aided sys em.
Measu emen s ob ained using he manual p ocedu e a e
w i en by he examine a he end o he h ee ounds
and subsequen ly an ex e nal use in oduces hese al-
ues in o a da abase. Measu emen s ob ained using he
compu e ized me hod a e s o ed di ec ly in o he da a-
base. The ou pu o he sys em is an excel ile o each
OPG exhibi ing he di e en measu emen s aken by
each examine .
S a is ical Analysis:
Repea abili y and ep oducibili y a e used o analyze
he esul s in e ms o in e - and in a-examine ag ee-
men espec i ely. Repea abili y e e s o he a i-
abili y o he measu emen s ob ained by one examine
(obse e ) while measu ing he same da a epea edly.
Rep oducibili y is he a iabili y o he measu emen
sys em caused by di e ences in he obse e beha io .
These measu es a e es ima ed h ough he p ecision o
he measu emen s exp essed as he a iance o mul i-
ple measu emen s by a single pe son. Fu he mo e, he
ange o eliabili y o he measu emen s is analyzed us-
ing he 95% con idence in e al. In addi ion, a e age
ime equi ed o es ima e he indexes using bo h me h-
ods (manual and compu e -aided) is conside ed. Finally,
pai -wise compa isons be ween manual and compu e
aided measu emen s a e compu ed by Wilcoxon signi i-
cance es (23).
Resul s
Repea abili y o he measu es is analyzed measu ing
he ag eemen achie ed when one use measu es he
same in di e en o hopan omog aphs. (Table 1) lis s
he di e ences pe use o each index. Fu he mo e,
he dis ibu ions o e o s (di e ences) o all he use s
a e shown in (Fig. 3A, 3B and 3C), o he h ee indexes
espec i ely. As shown, he a iabili y using he p o-
posed sys em is lowe han manually compu ing each
index. Tha is, di e ences be ween he same use meas-
u emen s a e lowe when he examine akes he bene i
o he compu e aided sys em.
Rep oducibili y o he measu emen s is analyzed using
he a e age measu emen s pe use . Gi en an o ho-
pan omog aphy, he a e age alue pe use is es ima ed
using he di e ences be ween each use measu emen
Compu e aided Manual
CW PMI M/M CW PMI M/M
Use 1 ±0.2922 ±0.0187 ±0.2552 ±0.5724 ±0.0546 ±0.1864
Use 2 ±0.5678 ±00449 ±0.4819 ±0.6806 ±0.0769 ±0.3505
Use 3 ±0.5471 ±0.0431 ±0.3497 ±0.7131 ±0.1136 ±0.5537
Use 4 ±0.4907 ±0.0414 ±0.4777 ±0.8830 ±0.2561 ±0.4900
Use 5 ±0.2530 ±0.235 ±0.3541 ±0.7955 ±0.0911 ±0.4323
Use 6 ±0.2479 ±0.0173 ±0.2240 ±0.7051 ±0.1126 ±0.5016
Use 7 ±0.5304 ±0.0425 ±0.3993 ±0.8165 ±0.0910 ±0.5617
Use 8 ±0.5158 ±0.0408 ±0.4799 ±0.8095 ±0.1179 ±0.5182
Use 9 ±0.3218 ±0.0229 ±0.3180 ±0.8095 ±0.1024 ±0.5531
Use 10 ±0.5499 ±0.0470 ±0.3945 ±0.7665 ±0.1057 ±0.4774
Table 1. Use a iabili y.

Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e629
o e he a e age measu emen om all he use s. Each
use measu emen is compu ed as he a e age alue o
all ials. As a esul , he summa y o alues lis ed in
(Table 1, 2A and 2B).
Fu he mo e, h ee e o dis ibu ions a e ob ained,
one o each index (Fig. 3D, 3E and 3F). The summa y
o s a is ics o e hese dis ibu ions and he Wilcoxon
signi icance es a e lis ed in (Table 3A). F om hese
esul s, we can conclude ha ou compu e -aided sys-
em ou pe o ms he manual p ocedu e in e ms o
ep oducibili y (23). Time equi ed o compu ing he
indexes is analyzed. A e age ime pe analysis is lis ed
in (Table 3B).
As shown, he a e age ime pe o hopan omog aphy
Fig. 3A. Pe use co ical wid h a iabili y. 3B. Pe use pano amic index a iabili y. 3C. Pe use M/M a io a i-
abili y. 3D. Dis ibu ion o e o s when di e en examine s measu e he same o hopan omog aphy (OPG). 3E.
Dis ibu ion o e o s when di e en examine s measu e he same OPG. 3F. Dis ibu ion o e o s when di e en
examine s measu e he same OPG.
Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e630
Le
Compu e aided Manual
CW PMI M/M CW PMI M/M
1 6.663±0.24 0.426±0.01 2.482±0.26 6.067±0.61 0.438±0.24 2.037±0.37
2 4.677±0.19 0.423±0.01 2.714±0.13 5.400±1.31 0.444±0.13 2.287±0.69
3 4.778±0.22 0.387±0.02 1.809±0.04 5.533±0.79 0.379±0.10 2.021±0.36
4 4.653±0.22 0.478±0.02 3.648±0.32 5.300±0.85 0.382±0.09 2.288±0.48
5 4.657±0.18 0.454±0.03 3.267±0.42 4.867±0.53 0.292±0.05 2.049±0.44
6 5.662±0.15 0.400±0.01 1.782±0.10 6.233±0.74 0.319±0.11 1.868±0.35
7 4.972±0.29 0.256±0.01 1.461±0.08 5.200±0.93 0.422±0.08 2.136±0.36
8 6.747±0.19 0.470±0.02 2.487±0.19 7.133±0.71 0.348±0.12 1.774±0.26
9 5.635±0.19 0.365±0.01 2.564±0.11 6.667±0.35 0.307±0.05 1.995±0.38
10 5.415±0.34 0.388±0.01 2.268±0.21 5.100±0.80 0.367±0.62 2.156±0.43
Table 2A. Use measu emen a iabili y o he le side o each o hopan omog aphy.
Righ
Compu e aided Manual
CW PMI M/M CW PMI M/M
1 5.621±0.47 0.393±0.02 1.835±0.21 6.133±0.71 0.367±0.06 2.148±0.40
2 4.716±0.12 0.456±0.01 2.029±0.29 5.867±0.57 0.399±0.15 2.132±0.33
3 2.465±1.38 0.212±0.12 1.343±0.75 5.400±0.64 0.221±0.20 1.119±0.98
4 4.828±0.19 0.529±0.01 2.029±0.29 5.400±0.83 0.393±0.09 2.098±0.43
5 4.735±0.15 0.496±0.04 2.087±0.26 4.333±0.35 0.437±0.09 2.215±0.46
6 5.501±0.24 0.415±0.01 1.263±0.13 5.967±1.24 0.450±0.17 1.754±0.55
7 5.127±0.24 0.284±0.01 1.909±0.19 5.067±0.94 0.382±0.14 1.806±0.30
8 6.557±0.36 0.446±0.02 1.648±0.19 5.800±0.69 0.366±0.07 1.665±0.26
9 5.826±0.28 0.334±0.05 1.766±0.66 6.167±0.91 0.357±0.10 1.781±0.61
10 5.332±0.31 0.333±0.02 1.553±0.26 4.967±0.33 0.330±0.04 1.708±0.55
Table 2B. Use measu emen a iabili y o he igh side o each o hopan omog aphy.
index Compu e
Aided Manual Wilcoxon
es
CW ±0.2194 ±0.7605 1
PMI ±0.0174 ±0.1093 1
M/M a io ±0.2076 ±0.4070 1
Table 3A. S anda d de ia ion o e o s when di e en examine s
measu e he same o hopan omog aphy. The hi d column lis s
he Wilcoxon signi icance es o he ep oducibili y expe imen .
A posi i e alue (1) indica es ha he compu e aided sys em ou -
pe o ms he manual p ocess.
A e age
ime
S anda d
de ia ion
Compu e -aided 16,08s. ±7.45s.
Manual 156,66s. ±45,95s.
Table 3B. A e age ime equi ed o measu e all h ee indexes
in a single o hopan omog aphy using he manual and he p o-
posed compu e -aided me hods.
Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e631
using he compu e aided sys em is 16 seconds. How-
e e , he a e age ime equi ed o pe o m he same
analysis manually is highe han 2 minu es. Hence, we
can conclude han using he compu e aided me hod
educes signi ican ly he equi ed ime pe analysis.
The e o e, he compu e -aided me hod also educes he
use a igue and, consequen ly, imp o es he long e m
accu acy o he analysis.
Discussion
The e a e a numbe o wo ks using pho odensi ome -
ic analysis o diagnose os eopo osis. Fo ins ance, Na-
kamo o T e al. (24) in 2008, pe o m g ay le el analysis
in OPG o iden i y pa ien s wi h os eopo osis. Jonasson
G e al. (25) in 2001, p edic he skele al DMO using a
pho odensi ome ic measu emen o he bone mass o
he mandible, he abecula pa e n o he al eola bone
and i s in e den al hickness. O he au ho s de ine a c i-
e ion o classi y abecula pa e ns as dense, he e oge-
neous o spa se (26,27). They conclude ha he isual
assessmen o he abecula pa e n in OPG can be used
o iden i y pa ien s ha ing os eopenia o os eopo osis.
highly in luenced by he expe ise o examine s. These
au ho s compa e manual and compu e ized me hods o
es ima e he co ical wid h. As a esul , hey conclude
ha bo h sys ems a e highly co ela ed al hough hey do
no speci y he sys em used. Howe e , esul s ega ding
ime o deg ee o di icul y a e no p o ided (19).
The p oposed compu e -aided sys em is use iendly and
does no equi e wo much ime o es ima e he meas-
u es. Fu he , gi en an o opan omog aph, i is highly
epe i i e o a gi en examine . In addi ion, gi en he
low examine a igue p oduced, in aexamine calib a-
ion using he epea abili y index p oposed by Landis
JR & Koch GG (28) is easible. Fu he mo e, he e a e
no e o s associa ed wi h he anno a ion p ocess since
i is done au oma ically. Tha is, he sys em p o ides
an excel ile as ou pu wi h all he measu emen s pe
o opan omog aph. Finally, he p ecision o he compu-
e -aided me hod in he measu emen s in on o he
manual one mus be highligh ed. Example measu es o
a single o hopan omog aphy a e lis ed in (Table 4). As
shown, measu ing he co ical wid h manually leads o
ough measu es. Howe e , using he compu e –aided
Compu e aided Manual
Righ Le Righ Le
CW PMI M/M CW PMI M/M CW PMI M/M CW PMI M/M
Use 1 4,97 0.37 2,07 6,14 0,40 2,27 5 0.33 1.94 5 0.42 2.05
Use 2 4,23 0.32 2,56 6,69 0,41 2,34 4 0.27 1.45 6 0.32 1.40
Use 3 5,76 0.40 2,02 6,41 0,42 2,39 5 0.34 2.34 6 0.43 2.59
Use 4 5,36 0.37 1,78 6,42 0,42 2,25 5 0.36 2.80 7 0.23 2.24
Use 5 6,11 0.41 1,31 6,80 0,43 2,25 5 0.43 0.90 5 0.27 0.98
Use 6 5,71 0.39 2,32 6,60 0,42 2,36 5 0.42 1.80 5 0.30 1.89
Use 7 5,84 0.40 1,61 6,68 0,41 2,63 6 0.43 0.40 4 0.17 2.34
Use 8 5,61 0.38 1,34 6,41 0,38 2,25 5 0.33 1.70 4 0.26 2.65
Use 9 6,32 0.42 1,28 7,62 0,47 2,29 5 0.28 1.10 4 0.33 1.29
Use 10 6,18 0.42 2,63 6,40 0,41 2,46 5 0.51 0.80 4 0.21 2.30
Table 4. Example measu es o a gi en o hopan omog aphy using bo h me hods: compu e -aided and manual.
Rega ding manual measu emen s in den al pano amic
adiog aphs, he e a e only a ew wo ks add essing
hem using a compu e ized sys em. A i in AZ e al. (19)
in 2006, use a compu e -aided me hod in digi al adio-
g aphs o es ima e MTC. The sys em elies on image
enhancemen echniques o measu e MTC. Howe e ,
since he ma gins o he co ex a e no always clea ly de-
ined he sys em equi es manual assis ance o pe o m
i s ask. Fu he , he a iabili y o he measu emen s is
sys em p o ides highe accu acy educing he p opaga-
ion o e o s. On he con a y, he e a e di e en di -
icul ies associa ed o he manual measu emen me hod
such as speci ic illumina ion, magni ica ion, examine
calib a ion as p oposed in Ledge od e al. (29) o sys-
ema ic measu emen s as p oposed by Ka ayianni e al.
(30). Fu he , he manual p ocedu e is ulne able o e -
o s when anno a ing egis e ed measu es.
Med O al Pa ol O al Ci Bucal. 2012 Jul 1;17 (4):e624-32. Compu e -aided measu emen s in den al pano amic adiog aphs
e632
Conclusions
We ha e p oposed a e y use iendly compu e ized
me hod o measu e h ee di e en mo phome ic man-
dibula indexes: co ical wid h, pano amic mandibula
index and mandibula al eola bone eso p ion index.
The p oposed me hod exhibi s supe io epea abili y
and ep oducibili y a es compa ed o s anda d manual
me hods. Mo eo e , he ime equi ed o pe o m he
measu emen s using he p oposed me hod is negligible
compa ed o pe o m he measu emen s manually. F om
he esul s we can conclude ha he sys em p o ides a
p ac ical manne o pe o m hese measu emen s. I
does no equi e an expe examine and does no ake
mo e han 16 seconds pe analysis. Thus, i may be sui -
able o diagnose os eopo osis using den al pano amic
adiog aphs.
Re e ences
1. Na as Cáma a FJ, Fe nández de San iago FJ, Bayona Ma zo I,
Mingo Gómez T, de la Fuen e Sanz MM, Cacho del Amo A. P e a-
lence o os eopo osis assessed byquan i a i e ul asound calcaneus
measu emen s in ins i u ionalized elde ly popula ion. An Med In e -
na. 2006;23:374-8.
2. Fi e J, Nolla JM, Gómez-Vaque o C, Ma ínez-Aguilá D, Val e -
de J, Roig-Esco e D. A compa a i e s udy o compu ed digi al ab-
so p iome y and con en ional dual-ene gy X- ay abso p iome y in
pos menopausal women. Os eopo os In . 2001;12:565-9.
3. Na es Díaz M. Os eopo o ic ac u es in Spanish women. Med
Clin (Ba c). 2006;127:413-4.
4. Comps on JE, Papapoulos SE, Blancha d F. Repo on os eopo-
osis in he Eu opean Communi y: cu en s a us and ecommenda-
ions o he u u e. Wo king Pa y om Eu opean Union Membe
S a es. Os eopo os In . 1998;8:531-4.
5. Roig Vilaseca D, Gómez Vaque o C. Wha clinical guideline
should we use o he managemen o os eopo osis?. Med Clin (Ba c).
2011;136:293-4.
6. Wo ld Heal h O ganiza ion. Assessmen o ac u e isk and i s
applica ion o sc eening o pos menopausal os eopo osis. Repo o
a WHO S udy G oup. Wo ld Heal h O gan Tech Rep Se . 1994;843:1-
129.
7. Ho ne K, De lin H. The ela ionship be ween mandibula bone
mine al densi y and pano amic adiog aphic measu emen s. J Den .
1998;26:337-43.
8. Whi e SC. O al adiog aphic p edic o s o Os eopo osis. De ma o-
maxillo ac Radiol. 2002;31:84-92.
9. Kaye EK. Bone heal h and o al heal h. J Am Den Assoc.
2007;138:616-9.
10. Taguchi A, Tanimo o K, Suei Y, O ani K, Wada T. O al signs as
indica o s o possible os eopo osis in elde ly women. O al Su g O al
Med O al Pa hol O al Radiol Endod. 1995;80:612-6.
11. Benson BW, P ihoda TJ, Glass BJ. Va ia ions in adul co ical
bone mass as measu ed by a pano amic mandibula index. O al Su g
O al Med O al Pa hol. 1991;71:349-56.
12. Yasa L, Sönmez AS, U ku N, Ozcan J, Cebi Z, Sa an K, e
al. E ec o misop os ol on bone mine al densi y in women wi h
pos menopausal os eopo osis. P os aglandins O he Lipid Media .
2006;79:199-205.
13. B as J, an Ooij CP, Ab aham-Inpijn L, Kusen GJ, Wilmink
JM. Radiog aphic in e p e a ion o he mandibula angula co ex:
A diagnos ic ool in me abolic bone loss. Pa I. No mal s a e. O al
Su g O al Med O al Pa hol. 1982;53:541-5.
14. Kleme i E, Kolmakow S. Mo phology o he mandibula co ex
on pano amic adiog aphs as an indica o o bone quali y. Den o-
maxillo ac Radiol. 1997;26:22-5.
15. Taguchi A, Asano A, Oh suka M, Nakamo o T, Suei Y, Tsuda
M, e al. OSPD In e na ional Collabo a i e G oup. Obse e pe o -
mance in diagnosing os eopo osis by den al pano amic adiog aphs:
esul s om he os eopo osis sc eening p ojec in den is y (OSPD).
Bone. 2008;43:209-13.
16. Caku B, Dagis an S, Sahin A, Ha o li A, Yilmaz A. Reliabili y
o mandibula co ical index and mandibula bone mine al densi y
in he de ec ion o os eopo o ic women. Den omaxillo ac Radiol.
2009;38:255-61.
17. De lin H, Ho ne K. Mandibula adiomo phome ic indices in
he diagnosis o educed skele al bone mine al densi y. Os eopo os
In . 2002;13:373-8.
18. Whi e SC, Taguchi A, Kao D, Wu S, Se ice SK, Yoon D, e al.
Clinical and pano amic p edic o s o emu bone mine al densi y.
Os eopo os In . 2005;16:339-46.
19. A i in AZ, Asano A, Taguchi A, Nakamo o T, Oh suka M, Tsuda
M, e al. Compu e -aided sys em o measu ing he mandibula co -
ical wid h on den al pano amic adiog aphs in iden i ying pos me-
nopausal women wi h low bone mine al densi y. Os eopo os In .
2006;17:753-9.
20. Taguchi A, Tsuda M, Oh suka M, Kodama I, Sanada M, Naka-
mo o T, e al. Use o den al pano amic adiog aphs in iden i ying
younge pos menopausal women wi h os eopo osis. Os eopo os In .
2006;17:387-94.
21. Taguchi A, Oh suka M, Tsuda M, Nakamo o T, Kodama I, In-
agaki K, e al. Risk o e eb al os eopo osis in pos -menopausal
women wi h al e a ions o he mandible. Den omaxillo ac Radiol.
2007;36:143-8.
22. Vlasiadis KZ, Damilakis J, Veleg akis GA, Skou e is CA, F a-
gouli I, Goumenou A, e al. Rela ionship be ween BMD, den al pano-
amic adiog aphic indings and biochemical ma ke s o bone u no-
e in diagnosis o os eopo osis. Ma u i as. 2008;20:226-33.
23. Wang L, Li R. Weigh ed Wilcoxon- ype smoo hly clipped abso-
lu e de ia ion me hod. Biome ics. 2009;65:564-71.
24. Nakamo o T, Taguchi A, Oh suka M, Suei Y, Fuji a M, Tsuda
M, e al. A compu e -aided diagnosis sys em o sc een o os eopo-
osis using den al pano amic adiog aphs. Den omaxillo ac Radiol.
2008;37:274–81.
25. Jonasson G, Bank all G, Kilia idis S. Es ima ion o skele al bone
mine al densi y by means o he abecula pa e n o he al eola
bone, i s in e den al hickness, and he bone mass o he mandible.
O al Su g O al Med O al Pa hol O al Radiol Endod. 2001;92:346-
52.
26. Lindh C, Ho ne K, Jonasson G, Olsson P, Rohlin M, Jacobs R, e
al. The use o isual assessmen o den al adiog aphs o iden i ying
women a isk o ha ing os eopo osis: he OSTEODENT p ojec .
O al Su g O al Med O al Pa hol O al Radiol Endod. 2008;106:285-
93.
27. De lin H, Ka ayianni K, Mi sea A, Jacobs R, Lindh C, an de
S el P, e al. Diagnosing os eopo osis by using den al pano amic a-
diog aphs: he OSTEODENT p ojec . O al Su g O al Med O al Pa-
hol O al Radiol Endod. 2007;104:821-8.
28. Landis JR, Koch GG. An applica ion o hie a chical kappa- ype
s a is ics in he assessmen o majo i y ag eemen among mul iple
obse e s. Biome ics. 1977;33:363-74.
29. Ledge on D, Ho ne K, De lin H, Wo hing on H. Radiomo -
phome ic indices o he mandible in a B i ish emale popula ion.
Den omaxillo ac Radiol. 1999;28:173-81.
30. Ka ayianni K, Ho ne K, Mi sea A, Be kas L, Mas o is M, Jaco-
bs R, e al. Accu acy in os eopo osis diagnosis o a combina ion o
mandibula co ical wid h measu emen on den al pano amic adio-
g aphs and a clinical isk index (OSIRIS): he OSTEODENT p ojec .
Bone. 2007; 40:223-9.