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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(12): 663-669
DOI: 10.1055/s-0037-1606622
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Mandibular Inferior Cortex Erosion on Dental Panoramic Radiograph as a Sign of Low Bone Mineral Density in Postmenopausal Women

Erosão do córtex mandibular inferior em radiografias maxilares panorâmicas como sinal de osteoporose em mulheres na pós-menopausa
Juliana Zigart Brum Carmo
1   Department of Obstetrics and Gynecology, Hospital Universitário Júlio Müller, Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
,
Sebastião Freitas de Medeiros
1   Department of Obstetrics and Gynecology, Hospital Universitário Júlio Müller, Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
› Author Affiliations
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Publication History

15 December 2016

11 August 2017

Publication Date:
27 November 2017 (online)

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Abstract

Objective To examine the role of the panoramic mandibular radiograph in the diagnosis of low bone mineral density (BMD) in postmenopausal women.

Methods A cross-sectional study including volunteer women aged over 40 years in amenorrhea due to ovarian failure for at least 12 months, who were cared for at the climacteric outpatient clinic of a university hospital in the city of Cuiabá, in the state of Mato Grosso, Brazil. The panoramic radiographs were evaluated using a specific software. Two aspects were analyzed in the mandibular panoramic radiograph: a qualitative aspect regarding the shape of the mandibular cortical bone, and a quantitative aspect regarding the width of the mandibular cortical bone. The morphology of the mandibular cortical bone in the digital panoramic radiograph was determined bilaterally by the observation of the bone structure between the mental foramen and the base of the jaw. The mandibular cortical bone was categorized into three groups. The mental index (MI) was used to evaluate the thickness of the mandibular cortical bone through a perpendicular line drawn from the base of the mandible at the height of the center of the mental foramen, with another line drawn tangent to the inferior border of the mandible, and a third line parallel to the line at the superior border of the mandible. The MI data are expressed in millimeters, with a normal value of 3.0 mm. The densities of the lumbar spine and femur, expressed in g/cm2, were categorized as normal, osteopenia or osteoporosis.

Results The agreement index between the MI and the BMD of the lumbar spine was good (Kappa = 0.718), but the same index between the MI and the BMD of the femoral neck was poor (Kappa = 0.443). An excellent agreement occurred when the mandibular cortical index (MCI) was compared with the BMD of the lumbar spine (Kappa = 0.912). The agreement between MCI and the BMD in the femur was moderated (Kappa = 0.579).

Conclusion The radiomorphometric indices evaluated in the mandibular panoramic radiograph are capable of identifying postmenopausal women with low mineral density in the mandible, and the results can be used to refer these women to appropriate medical investigation and/or treatment.

Resumo

Objetivo Verificar o papel das radiografias maxilares panorâmicas no diagnóstico de osteoporose em mulheres na pós-menopausa.

Métodos Estudo de corte transversal, incluindo mulheres voluntárias com idade acima de 40 anos e amenorreia por falência ovariana havia pelo menos 12 meses, atendidas no ambulatório de climatério de um hospital universitário de Cuiabá-MT entre 2014 e 2015. As radiografias panorâmicas foram avaliadas por um programa de mensuração específico. Dois aspectos foram analisados na radiografia panorâmica mandibular: um qualitativo, referente à forma da cortical óssea mandibular, e outro quantitativo, referente à largura da cortical óssea mandibular. A morfologia da cortical óssea mandibular na radiografia panorâmica digital foi determinada pela observação das estruturas ósseas da região entre o forame mentoniano e a cortical óssea mandibular, bilateralmente, sendo categorizada em três grupos. O índice mentoniano (IM) foi utilizado para avaliar a espessura do córtex mandibular por meio de uma linha perpendicular à base da mandíbula na altura do centro do forame mentoniano; uma segunda linha é tangente à borda inferior da mandíbula, e uma terceira linha é tangente à superior da mandíbula. Os dados são expressos em milímetros, com um valor normal de 3,0 mm. A densitometria da coluna lombar e do fêmur, expressa em g/cm2, foi categorizada em normal, osteopenia ou osteoporose.

Resultados Observou-se boa concordância entre os resultados dos testes realizados. Quando comparado o índice mentoniano (IM) com a densitometria mineral óssea (DMO) da região lombar da coluna, o Kappa foi de 0,718, e quando o mesmo índice foi comparado com a DMO da região do colo do fêmur, ele foi de 0,443, demostrando boa concordância entre os dois testes. Um melhor grau concordância ocorreu quando comparados o índice da cortical óssea mandibular (ICM) com a DMO da região lombar da coluna (0,912) e quando comparados o ICM e a DMO da região do fêmur 0,579.

Conclusão Os índices radiomorfométricos avaliados nas radiografias panorâmicas mandibulares mostraram ser capazes de identificar precocemente mulheres pós-menopáusicas com baixa DMO, e podem ser usados para que elas sejam encaminhadas para o tratamento/exame médico adequado.

Keywords

osteoporosis - climacteric - mandible - panoramic radiograph - menopause

Palavras-Chave

osteoporose - climatério - mandíbula - radiografia panorâmica - menopausa
 

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