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ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 29-33

Alveolar bone density based on image density of intraoral radiography using artificial intelligence software: Cases of osteoporosis patients with antiresorptive medications administration before tooth extraction


1 Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Niigata, The Nippon Dental University, Niigata, Japan
2 Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Niigata, The Nippon Dental University, Niigata, Japan

Date of Submission20-Apr-2022
Date of Decision15-Jun-2022
Date of Acceptance15-Jun-2022
Date of Web Publication22-Jul-2022

Correspondence Address:
Ichiro Ogura
Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Niigata, The Nippon Dental University, 1-8 Hamaura-cho, Chuo-ku, Niigata, Niigata 951-8580
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomr.jomr_9_22

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  Abstract 


Background: In recent years, an artificial intelligence (AI) software “DentalSCOPE” for alveolar bone density based on image density of intraoral radiography was developed. Aims: The purpose of this study was to evaluate the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE. Materials and Methods: Five osteoporosis patients with antiresorptive medications administration before tooth extraction were analyzed using a computer program “DentalSCOPE” for alveolar bone density based on image density of intraoral radiography. The alveolar bone density around extraction tooth was compared to lytic and sclerotic bone reaction with the opposite side as normal region. Statistical analyses of alveolar bone density were performed with Wilcoxon rank-sum test. P < 0.05 was considered statistically significant. Results: The alveolar bone density of the opposite side as normal region (972.9 ± 74.3 mg/cm2) was significantly higher than those of lytic bone reaction (633.9 ± 114.2 mg/cm2, P = 0.043) and lower than those of sclerotic bone reaction (1144.0 ± 99.4 mg/cm2, P = 0.043). Conclusions: This study evaluated the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE and indicated that the computer program could be useful for the evaluation of osteoporosis patients.

Keywords: Alveolar bone density, antiresorptive medications, artificial intelligence, diagnostic sciences, intraoral radiography


How to cite this article:
Kobayashi E, Minami Y, Ogawa R, Tezuka Y, Ogura I. Alveolar bone density based on image density of intraoral radiography using artificial intelligence software: Cases of osteoporosis patients with antiresorptive medications administration before tooth extraction. J Oral Maxillofac Radiol 2022;10:29-33

How to cite this URL:
Kobayashi E, Minami Y, Ogawa R, Tezuka Y, Ogura I. Alveolar bone density based on image density of intraoral radiography using artificial intelligence software: Cases of osteoporosis patients with antiresorptive medications administration before tooth extraction. J Oral Maxillofac Radiol [serial online] 2022 [cited 2022 Aug 17];10:29-33. Available from: https://www.joomr.org/text.asp?2022/10/2/29/351671




  Introduction Top


In recent years, a computer program “DentalSCOPE” for alveolar bone density based on image density of intraoral radiography was developed.[1],[2] The system had a special X-ray beam indicator in which a special calcium carbonate reference object was embedded, measured the image density of the reference object automatically, and calculated the mineral density value of an arbitrary region of interest using artificial intelligence (AI) software. The computer program is a computer-assisted detection (CAD) system for intraoral radiography and useful for preliminary screening of osteoporosis in dental practice.

Medication-related osteonecrosis of the jaw (MRONJ) is a well-known complication of treatment with bisphosphonates, denosumab, and other drugs, such as antiresorptive medications.[3] Those medications are effective in treating osteoporosis and bone metastases of cancer. The diagnosis of MRONJ is currently based on the clinical parameters alone.[4] Multimodal imaging, such as panoramic radiography,[5] cone-beam computed tomography,[6] scintigraphy, multidetector computed tomography, magnetic resonance imaging,[7],[8],[9] and single-photon emission computed tomography-computed tomography,[10],[11],[12],[13],[14],[15] are useful for detecting and evaluating MRONJ. However, to the best of our knowledge, alveolar bone density of osteoporosis patients has been little presented in the literature. The purpose of this study was to evaluate the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE.


  Materials and Methods Top


Patient population

This study was approved by the ethics committee of our university. After providing written informed consent, five osteoporosis patients with antiresorptive medications administration before tooth extraction (5 women; age 72–84 years, mean age 77.4 years) were analyzed using an alveolar bone density based on image density of intraoral radiography using AI software at our university hospital from November 2021 to December 2021. All patients were diagnosed and treated for osteoporosis at other hospitals.

Image acquisition and analysis

Intraoral radiography was performed with intraoral X-ray unit (Heliodent Plus; Sirona Dental Systems, Tokyo, Japan), and computed radiography was performed with imaging plate and scanner (VistaScan; YOSHIDA, Tokyo, Japan) following our protocol.[1],[2]

Alveolar bone density based on image density of intraoral radiography was analyzed using commercially available software (DentalSCOPE; Media Co, Tokyo, Japan) following our protocol.[1],[2] The alveolar bone density around the extraction tooth was compared to lytic and sclerotic bone reaction with the opposite side as normal region.

Statistical analysis

Statistical analyses of alveolar bone density were performed with using rank-sum test. These analyses were performed using statistical package IBM SPSS Statistics, version 26 (IBM Japan, Tokyo, Japan). P < 0.05 was considered statistically significant.


  Results Top


[Figure 1] and [Figure 2] indicate the DentalSCOPE software for mandibular premolar of an 83-year-old woman in osteoporosis with antiresorptive medications administration before tooth extraction (Case 4). She was referred to our hospital with the chief complaint of a pain of the premolar on the left side of the mandible. The alveolar bone density around extraction tooth was measured as lytic bone reaction (1: Yellow), sclerotic bone reaction (2: Pink), and the opposite side as normal region (3: Green). Data on patients with antiresorptive medications administration before tooth extraction are shown in [Table 1]. Regarding the alveolar bone density around the extraction tooth in Case 4, lytic bone reaction, sclerotic bone reaction, and the opposite side as a normal region were 644.9 mg/cm2, 1128.2 mg/cm2, and 1051.5 mg/cm2, respectively.
Figure 1: The DentalSCOPE software of mandibular premolar of an 83-year-old woman in osteoporosis with antiresorptive medications administration before tooth extraction (Case 4)

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Figure 2: The DentalSCOPE software of same patient (Case 4). The alveolar bone density around extraction tooth was measured lytic bone reaction (1: yellow), sclerotic bone reaction (2: pink), and opposite side as normal region (3: green)

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Table 1: Data on patients with antiresorptive medications administration before tooth extraction

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[Table 2] shows the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction. The alveolar bone density of opposite side as normal region (972.9 ± 74.3 mg/cm2) was significantly higher than those of lytic bone reaction (633.9 ± 114.2 mg/cm2, P = 0.043) and lower than those of sclerotic bone reaction (1144.0 ± 99.4 mg/cm2, P = 0.043).
Table 2: Alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction

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  Discussion Top


We evaluated the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE and indicated that DentalSCOPE could be useful for the evaluation of the alveolar bone density of osteoporosis patients.

Bone mineral density (BMD) is one of the major parameters of bone strength, and the evaluation is important for the diagnosis of osteoporosis. Dual-energy X-ray absorptiometry systems provide accurate methods for the assessment of BMD.[16] Nakamoto et al.[17] showed a CAD system based on mathematical morphology for identifying postmenopausal women with low skeletal BMD or osteoporosis. Their results suggested that a CAD system applied to panoramic radiography may be useful for identifying postmenopausal women with low skeletal BMD or osteoporosis. Kavitha et al.[18] indicated a CAD system to continuously measure mandibular inferior cortical width on panoramic radiography and evaluate the system's efficacy in identifying postmenopausal women with low skeletal BMD. They concluded that their CAD system was a useful procedure in triage screening for osteoporosis. However, it is important in the field of dentistry to develop a simple method for the analysis of BMD with intraoral radiography because intraoral radiography has been widely accepted as a valuable diagnostic tool in dental diseases. We consider that the DentalSCOPE would be useful for the follow-up of MRONJ, the dental implant pre- and post-operative examination, and the screening of osteoporosis in dental practice.

Oohashi et al.[1] showed that the alveolar bone density of the mandibular premolar region in young adult men (980 ± 80 mg/cm2) was significantly higher than that in young adults' women (880 ± 140 mg/cm2, P = 0.006). Furthermore, Mizuhashi et al.[2] indicated that the alveolar bone density of the sclerotic bone reaction, resulting from the periapical inflammatory disease (1140 ± 80 mg/cm2), was significantly higher than those of the normal periapical region (940 ± 60 mg/cm2, P = 0.000). In this study, the alveolar bone density of opposite side as normal region (972.9 ± 74.3 mg/cm2) was significantly higher than those of lytic bone reaction (633.9 ± 114.2 mg/cm2, P = 0.043) and lower than those of sclerotic bone reaction (1144.0 ± 99.4 mg/cm2, P = 0.043). We consider that further research is necessary to validate these results.

There were several limitations to this study. The number of osteoporosis patients was too small because osteoporosis patients with antiresorptive medications administration before tooth extraction were rare at our hospital. We consider that it is a clinical pilot study of osteoporosis patients using DentalSCOPE.


  Conclusions Top


This study evaluated the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE and indicated that the computer program could be useful for the evaluation of osteoporosis patients.

Financial support and sponsorship

This work was supported by JDSF-FPC1-2021-05.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Oohashi M, Mizuhashi F, Sugawara Y, Saegusa H, Katsumata A, Ogura I. Computer-assisted measurement of radiographical alveolar bone density using intraoral radiographs: Preliminary study on comparison between men and women in young adults. J Oral Maxillofac Radiol 2020;8:1-4.  Back to cited text no. 1
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2.
Mizuhashi R, Sugawara Y, Oohashi M, Mizuhashi F, Saegusa H, Ogura I. Quantitative periapical radiography using computer-assisted measurement for intraoral projections. J Oral Maxillofac Radiol 2021;9:17-9.  Back to cited text no. 2
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3.
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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