RESUMO
OBJECTIVES: The objective of this study was to develop a technique for detecting cortical bone dimensional changes in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). STUDY DESIGN: Subjects with BRONJ who had cone-beam computed tomography imaging were selected, with age- and gender-matched controls. Mandibular cortical bone measurements to detect bisphosphonate-related cortical bone changes were made inferior to mental foramen, in 3 different ways: within a fixed sized rectangle, in a rectangle varying with the cortical height, and a ratio between area and height. RESULTS: Twelve BRONJ cases and 66 controls were evaluated. The cortical bone measurements were significantly higher in cases than controls for all 3 techniques. The bone measurements were strongly associated with BRONJ case status (odds ratio 3.36-7.84). The inter-rater reliability coefficients were high for all techniques (0.71-0.90). CONCLUSIONS: Mandibular cortical bone measurement is a potentially useful tool in the detection of bone dimensional changes caused by bisphosphonates.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Tomografia Computadorizada de Feixe Cônico/métodos , Doenças Mandibulares/diagnóstico por imagem , Doenças Mandibulares/patologia , Idoso , Análise de Variância , Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não ParamétricasRESUMO
INTRODUCTION: The aim of this study was to evaluate craniofacial asymmetry by using 2-dimensional (2D) posteroanterior cephalometric images, 3-dimensional cone-beam computed tomography (CBCT), and physical measurements (gold standard). METHODS: Ten dry human skulls were assessed, and radiopaque markers were placed on 17 skeletal landmarks. Twenty linear measurements were taken on each side to compare the right and left sides and to compare these measurements with the physical measurements made with a digital caliper. To acquire the 2D posteroanterior radiographs, an Extraoral Phosphor Storage Plate (Air Techniques, Chicago, Ill) was used as the image receptor with a Eureka x-ray-Duocon Machlett unit (Machlett Laboratores, Chicago, Ill). Three-dimensional imaging data were acquired from a CB MercuRay (Hitachi Medical, Tokyo, Japan). RESULTS: On average, the right side was larger than the left for most of the 20 distances evaluated in the digital 2D and the CBCT images, and there was poor agreement between the digital 2D images and the physical measurements (kappa = 0.0609) and almost perfect agreement (kappa = 0.92) between the CBCT and physical measurements when individual measurements were considered. CONCLUSIONS: Human skulls, with no apparent asymmetry, had some differences between the right and left sides, with dominance for the right side but with no clinical significance. CBCT can better evaluate craniofacial morphology when compared with digital 2D images.