International Journal of Morphology
versão On-line ISSN 0717-9502
Int. J. Morphol. v.25 n.2 Temuco jun. 2007
Int J. MorphoL, 25(2):337-340, 2007.
Comparative Bilateral Bone Density of the Mandible Angle
Densidad Ósea Bilateral Comparativa del Ángulo de la Mandíbula
**Joáo Paulo Mardegan Issa; *Rodrigo Tiossi; **Alma Blásida Concepción Elizaur Benitez Catirse; **Solange Aparecida Caldeira Monteiro & **Plauto Christhopher Aranha Watanabe
*Graduate student, Faculty of Dentistry of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
SUMMARY: The aim of this study was to assess a bilateral comparison of the mandible density in both sex young patients with computer densitometry. Fifty panoramic radiographs were obtained from young patients with ages between 18 and 23 years old (group A = 25 female and group B = 25 male) standardized, using the same X-Ray equipment (Siemens, lOKvp, 7mA), scanned with a 282.110 pixels resolution, and transferred later to a computer and using the SIDEXIS (Sirona, USA) program to analyze the bone densitometry performance. Bilateral sites were standardized with the objective to measure the bone density. Obtained data were registered and submitted to statistical analysis. The following means and standard deviations were obtained, in pixels, for the right and the left side, respectively: group A= 154.36±36.90 e 186.12+31.41, group B= 162.07±34.94 and 180.15+30.96. These values show statistical difference between different sides and groups (p<0.05), with a higher bone density on the left side in both groups, especially in group A.
KEYWORDS: Bone density; Mandible; Panoramic; x-ray; Radiography.
RESUMEN: El objetivo de este estudio fue realizar una comparación bilateral de la densidad de mandíbula en pacientes jóvenes de ambos sexos con computadora densitométrica ósea. Fueron obtenidas 50 radiografías panorámicas de pacientes jóvenes entre 18 y 23 años de edad (Grupo A = 25 femenino y el grupo B = 25 masculino), utilizando el mismo equipo de radiografía (Siemens, 1 OKvp, 7mA). Se escaneó con una resolución de 282,110 pixels, transfiriéndose luego a un computador para el estudio por medio del programa SIDEXIS (Sirona, USA) para analizar el desempeño densitométrico de hueso. Los sitios bilaterales fueron estandarizados con el objetivo de medir la densidad de hueso. Los datos obtenidos fueron registrados y sometidos a análisis estadístico. Las medias y los desvíos padrón fueron obtenidos en pixels, para el lado derecho y el lado izquierdo, respectivamente: Grupo A = 154,36±36,90 y 186,12±31,41, grupo B = 162,07±34,94 y 180,15±30,96. Estos valores muestran la diferencia estadística entre lados y grupos diferentes (p<0,05), con una densidad más alta de hueso en el lado izquierdo en ambos grupos, especialmente en grupo A.
PALABRAS CLAVE: Densidad ósea; Mandíbula; Radiografía panorámica, Radiografía.
Bone density is an essential element for countless works in dentistry and by being a conclusive factor in situations where a correct diagnosis of a certain injury is needed, for implant planning, for comparative density studies between different types of bones, osteoporosis studies, orthodontics and even for studying non-functional oral habits (Garcia & Souza, 1999; Verhoeven et al, 2000; Francischone & Tavano, 2000; Pluskiewics et al, 2000; Manssini et al, 2000; Southard et al,. 2001; Choel et al, 2004; Sato etal, 2005).
An essential aspect on works involving bone density, aiming a wide variety of purposes, is the choice of the bone tissue to be analyzed (Jonasson, 2005). Among various bone elements components of the craniofacial structure, mandible is the choice element for such procedure being its angle a representative site of the mandibular density (Verhoeven etal, 2000; Souza etal, 1999; Barros etal, 2001; Maki et al, 2002). It is known that the bone density of the mandible is correlated to the lumbar spine bones, which is an important fact for the osteoporosis diagnosis (Henrikson et al, 1974; Homer etal, 1996; White et al, 2005; Fogelman & Blake, 2006).
For the bone density of the mandible analysis, among a variety of methods for such procedure, we can mention the double X-Ray emission, the ultrasound measuring, computerized bone densitometry and the optic reading (Garcia & Souza; Puppineia/., 1998; Manssini etal; Dutra et al, 2005).
Thus, the purpose of the present study was to establish a bilateral comparative analysis of the mandibular angle bone density, considering the morphological characteristics, from young patients of both genders, in a highly mixed population such as the Brazilian population, through computerized bone densitometry, being useful as a complementary exam for future treatments that involve bone structures that consists the stomatognathic system.
MATERIAL AND METHOD
This work followed the ethic rules determined by the CONEP (Conselho Nacional de Ética em Pesquisa, Brazil). For the development of the present scientific study, a methodology where 50 panoramic radiographies were previously selected, standardized in the same X-Ray equipment (Siemens, 1 OKvp, 7mA) and developed through the manual method: time-temperature was used. The 50 radiographies were divided in two groups named A and B, composed by 25 radiographs of female group and 25 radiographs of male group, respectively, all of them with ages between 18 and 23 years old. Once the sample was selected, the radiographs were scanned with a 282.110 pixels resolution and stored in a computer to use the
SIDEXIS program (Sirona, USA) for bone densitometry analysis (Fig. 1). For the bone density measurement, bilateral sites were used between the lower edge of the mandibular canal and the bone cortical from the lower base of the mandible in the mandibular angle region. Following the Groups A and B division, the SIDEXIS program was applied bilateral and individually on the images, obtaining numeric data which were sequentially tabled for statistical analysis, using ANOVA and the Tukey-Kramer's test (a=0.05).
After methodological sequence, the following results were obtained and organized in the Table I.
The obtained values after statistical analysis showed statistical difference in the comparison between sides and groups (p<0.05), with higher bone density on the left side in both groups and higher values in the group A.
This work was set to establish a bilateral comparative analysis of the mandible angle bone density in young patients of both genders, in a sample of patients that characterize the mixed races in the Brazilian population, through computerized bone densitometry exam, aiming to provide assistance for future treatments that involve the composing bone structures of the stomatognathic system.
The SIDEXIS program for bone densitometry provides a numeric analysis of each dot contained in a linear trace made in a radiography using the program. These representative numbers of bone density established by the program were analyzed after a statistical study. The mean values obtained showed that there was a bilateral statistical difference in the mandible bone density, when compared the right side with the left side on individuals of the same gender and also when compared individuals of different genders. Similar results were also found in various scientific studies (Puppin et al; Garcia & Souza). The results presented in this work partially agree with the Knezovic-Ziatric & Celebic (2003) work. They also found different radiodensities in the mandibular bone, especially in the gonio region, on patients using total prosthesis and partially removable prosthesis. The authors afore mentioned did not find difference between individuals of different genders, which does not agree with the results found in this work.
The results found in our study showed variability in the mandibular bone density related to the patient's gender, and the same results were found by Dutra et al., which also found relations between the ages and the amount of teeth present in the patient's mouth. These results are different from the studies of Kingsmill & Boyed (1998) and Tomaszewski & Czerwinski (2002), since Dutra etal. found a density balance in the bone mineralization among the several mandibular sites studied and found no differences between individuals of different genders, and the authors later mentioned found higher values of bone density in the male individuals.
The present study was made with a previous selection of the craniofacial bone to be bilaterally analyzed. The mandible was chosen by being a representative bone of different signs and densities, and also for being important for the diagnosis of several diseases and anomalies (Garcia & Souza; Manssini etal.; Southard etal, 2000; Christgau et al, 1998; Ay etal, 2005; Jonasson; Nackaerts etal, 2006).
By working in a radiographic study to evaluate the bilateral bone density and in both genders, panoramic x-rays were used, since the mandible was selected as the bone to be studied and the fact that the mandible provides a wide visualization of the sites to be measured and also provides a better standardization of the groups. Past studies showed that the panoramic x-ray is adequate for bone densitometry, and it also serves well as a comparative document to other bones (Francischone & Tavano; Southard et al, 2001; Dutra etal). Scanning the radiographs and applying computerized bone densitometry are effective to such procedure (Souza et al; Barros et al; Ay et al; Dutra et al). According to Kuhl & Nummikoski (2000), intraoral radiographic absorption is precise and indicated for bone density analysis procedures.
The results presented indicate a higher bone density, based on optical pixels, in the female population, especially on the left side, being this difference between sides explained by individual anatomic variations that occur in the various ethnic groups composing the Brazilian population. Besides, bone densitometry analysis using panoramic x-rays, showed to be an elemental exam to diagnose the diversity of anomalies to afflict the stomatognathic system and is also precise in detecting the different levels of mineralization in the mandibular regions, being an essential exam to establish future treatments to patients.
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Dr. Joáo Paulo Mardegan Issa