Change in the mandibular cortical morphology at pre- and postdental implant operations using artificial intelligence-based computer-aided diagnosis for panoramic radiography

Ruri Ogawa; Ichiro Ogura

doi:10.4103/jomr.jomr_23_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 10 | Issue : 3 | Page : 76-79

Change in the mandibular cortical morphology at pre- and postdental implant operations using artificial intelligence-based computer-aided diagnosis for panoramic radiography

Ruri Ogawa¹, Ichiro Ogura²
¹ Quantitative Diagnostic Imaging, Field of Oral and Maxillofacial Imaging and Histopathological Diagnostics, Course of Applied Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, Japan
² Quantitative Diagnostic Imaging, Field of Oral and Maxillofacial Imaging and Histopathological Diagnostics, Course of Applied Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata; Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan, Japan

Date of Submission	10-Aug-2022
Date of Decision	14-Sep-2022
Date of Acceptance	04-Oct-2022
Date of Web Publication	29-Dec-2022

Correspondence Address:
Ruri Ogawa
The Nippon Dental University Graduate School of Life Dentistry at Niigata, 1-8 Hamaura-Cho, Chuo-Ku, Niigata 951-8580
Japan

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jomr.jomr_23_22

Abstract

Background: Recently, an automated diagnostic software called PanoSCOPE was developed. Aims: The aim of this study was to investigate whether there was any change in the mandibular cortical morphology at pre- and postdental implant operations using a computer aided diagnosis (CAD) system for panoramic radiography. Materials and Methods: Twenty patients were examined by panoramic radiography for pre- and postdental implant operations on the same date. The mandibular cortical index (MCI) and degree of deformation were analyzed using PanoSCOPE. The MCI classifications of all patients were evaluated with kappa coefficients between pre- and postdental implant operations. The degree of deformation of pre- and postdental implant operations was performed by the Pearson's rank correlation test. P value lower than 0.05 was considered statistically significant. Results: MCI of predental implant operation was Class 1: 10 cases, Class 2: nine cases, and Class 3: one case. MCI of postdental implant operation was Class 1: eight cases, Class 2: nine cases, and Class 3: three cases. The kappa coefficients between pre- and postdental implant operations were 0.746 (P < 0.001). We plotted degree of deformation of postdental implant operation (X) against degree of deformation of predental implant operation (Y) and observed a significant correlation (Y = 0.660 + 10.867 (n = 20, R² = 0.650, P < 0.001). Conclusions: This study showed that there was no significant change in the mandibular cortical morphology at pre- and postdental implant operations using the CAD system and indicated that the CAD system can be useful for the quantitative evaluation of MCI of patients with dental implant operation.

Keywords: Computer-assisted, dental implants, diagnosis, panoramic, radiography

How to cite this article:
Ogawa R, Ogura I. Change in the mandibular cortical morphology at pre- and postdental implant operations using artificial intelligence-based computer-aided diagnosis for panoramic radiography. J Oral Maxillofac Radiol 2022;10:76-9

How to cite this URL:
Ogawa R, Ogura I. Change in the mandibular cortical morphology at pre- and postdental implant operations using artificial intelligence-based computer-aided diagnosis for panoramic radiography. J Oral Maxillofac Radiol [serial online] 2022 [cited 2023 Mar 25];10:76-9. Available from: https://www.joomr.org/text.asp?2022/10/3/76/366162

Introduction

Panoramic radiography is widely used as a standard radiographic examination tool for implant dentistry as a preoperative diagnostic and treatment planning aid.^[1],[2] In the recent years, it has been shown that there is a difference in measurements between panoramic radiography and cone-beam computed tomography (CBCT), and CBCT is more accurate than panoramic radiography.^[3],[4],[5] However, panoramic radiography imparts a low radiation dose while giving the best radiographic survey.^[1],[2]

In some studies, panoramic radiographs are used to determine the risk of osteoporosis in the future.^[6],[7] Recently, an artificial intelligence (AI)-based computer-aided diagnosis (CAD) system for panoramic radiography was developed to scan the inferior margin of the mandible and automatically evaluate the mandibular cortical index (MCI).^[8],[9] The “PanoSCOPE” is useful for screening of osteoporosis in the dental practice. Furthermore, it has been reported on the MCI in medication-related osteonecrosis of the jaw with osteoporosis^[10]and in relation to age and gender.^[11] However, a few studies of pre- and postdental implant operations have evaluated the MCI and degree of deformation of the cortical bone of the mandible using the AI-CAD system. We investigated whether there was any change in the mandibular cortical morphology, such as MCI and degree of deformation, at pre- and postdental implant operations using the AI-CAD system.

Materials and Methods

Patient population

Twenty patients were examined by panoramic radiography for pre- and postdental implant operations on the same date at our university hospital from September 2020 to October 2021. The patients comprised 11 men and nine women with a mean age of 65.5 years (range 43–81 years). This prospective study was approved by the Ethics Committee of our institution (ECNG-R-318), and all patients gave written informed consent.

Data analysis

Panoramic radiography was performed using Veraviewepocs (MORITA, Kyoto, Japan), following our hospital maxillofacial protocol (a tube voltage; 70 kV, a tube current; 10 mA).^[10] Imaging analyses of comparison of pre- and postdental implant operations, such as MCI and degree of deformation of the cortical bone of the mandible, were performed automatically using PanoSCOPE (MEDIA, Tokyo, Japan) that scanned the mandibular inferior cortex on panoramic radiography, following our hospital maxillofacial protocol.^[10] The MCI classification was as follows: normal (Class 1), mildly to moderately eroded (Class 2), or severely eroded (Class 3). The degree of deformation was calculated using the thickness and roughness of the mandibular cortex.

Statistical analysis

The MCI classifications of all patients were evaluated with kappa coefficients between pre- and postdental implant operations. Statistical analyses for the degree of deformation of pre- and postdental implant operations were performed by the Pearson's rank correlation test. These analyses were performed with IBM SPSS Statistics 26 (IBM Japan, Tokyo, Japan) using a 5% significance level.

Results

[Table 1] shows the comparison of the MCI of pre- and postdental implant operations using PanoSCOPE. The MCI of predental implant operation was Class 1: 10 cases, Class 2: nine cases, and Class 3: one case. Furthermore, the MCI of postdental implant operation was Class 1: eight cases, Class 2: nine cases, and Class 3: three cases. The kappa coefficients between pre- and postdental implant operations were 0.746 (P < 0.001).

Table 1: Comparison of mandibular cortical index of pre- and postdental implant operations using PanoSCOPE

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Scatter diagram in the degree of deformation shows the relationship between pre- and postdental implant operations using PanoSCOPE [Figure 1]. We plotted degree of deformation of postdental implant operation (X) against degree of deformation of predental implant operation (Y) and observed a significant correlation (Y = 0.660 + 10.867 (n = 20, R² = 0.650, P < 0.001).

Figure 1: Scatter diagram in degree of deformation shows the relationship between pre- and postdental implant operations using PanoSCOPE

Click here to view

Discussion

Panoramic radiography is widely used as a standard radiographic examination tool for implant dentistry as a preoperative diagnostic and treatment planning aid.^[1],[2] Recently, an AI-CAD system for panoramic radiography was developed to scan the inferior margin of the mandible and automatically evaluate the MCI.^[8],[9] However, a few studies of pre- and postdental implant operations have evaluated the MCI and degree of deformation of the cortical bone of the mandible using the AI-CAD system. We investigated whether there was any change in the mandibular cortical morphology, such as MCI and degree of deformation, at pre- and postdental implant operations using the AI-CAD system “PanoSCOPE.”

Osteoporosis shows the symptoms of bone mass loss and a high risk of pathologic fractures and needs early diagnostic methods for the medical community.^[12],[13] Dual X-ray absorptiometry is considered the gold standard for the quantification of bone mineral density of osteoporosis patients.^[14],[15] Furthermore, we consider that the MCI with PanoSCOPE may be useful for preliminary screening of osteoporosis in the dental practice with panoramic radiography, and MCI with PanoSCOPE is deeply related to osteoporosis. Therefore, PanoSCOPE should be an effective tool for the objective and quantitative evaluation of the MCI.

In this study, the MCI of predental implant operation was Class 1: 10 cases, Class 2: nine cases, and Class 3: one case. Furthermore, the MCI of postdental implant operation was Class 1: eight cases, Class 2: nine cases, and Class 3: three cases. The kappa coefficients between pre- and postdental implant operations were 0.746 (P < 0.001). PanoSCOPE is useful for screening of osteoporosis in the dental practice.^[8],[9] We consider that PanoSCOPE may predict the prognosis for patients with dental implant operation.

Furthermore, we plotted degree of deformation of postdental implant operation (X) against degree of deformation of predental implant operation (Y) and observed a significant correlation (Y = 0.660 + 10.867 (n = 20, R² = 0.650, P < 0.001). This study showed that there was no significant change in the mandibular cortical morphology at pre- and postdental implant operations using the CAD system. However, those data were not a perfect match. We consider that the reproducibility of panoramic radiography is important.

There were several limitations of this study. The sample was relatively small. Further research in the prognosis for patients with dental implant operation is necessary to validate these results.

Conclusions

We investigated whether there was any change in the mandibular cortical morphology at pre- and postdental implant operations using a CAD system for panoramic radiography. This study showed that there was no significant change in the mandibular cortical morphology at pre- and postdental implant operations using the CAD system, and indicated that the CAD system can be useful for the quantitative evaluation of MCI of patients with dental implant operation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Kayal RA. Distortion of digital panoramic radiographs used for implant site assessment. J Orthod Sci 2016;5:117-20.
2.	Vazquez L, Nizam Al Din Y, Christoph Belser U, Combescure C, Bernard JP. Reliability of the vertical magnification factor on panoramic radiographs: Clinical implications for posterior mandibular implants. Clin Oral Implants Res 2011;22:1420-5.
3.	Bertram A, Eckert AW, Emshoff R. Implant-to-nasal floor dimensions projected by panoramic radiographs in the maxillary incisor-canine region: Implications for dental implant treatment. Odontology 2022;110:171-82.
4.	Magat G, Oncu E, Ozcan S, Orhan K. Comparison of cone-beam computed tomography and digital panoramic radiography for detecting peri-implant alveolar bone changes using trabecular micro-structure analysis. J Korean Assoc Oral Maxillofac Surg 2022;48:41-9.
5.	AlQahtani NA. Assessment of the position and level of mental nerve for placement of implants using cone-beam computed tomography & panoramic radiograph in the Saudi population. Saudi Dent J 2022;34:315-20.
6.	Taguchi A. Triage screening for osteoporosis in dental clinics using panoramic radiographs. Oral Dis 2010;16:316-27.
7.	Taguchi A, Tanaka R, Kakimoto N, Morimoto Y, Arai Y, Hayashi T, et al. Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis. Oral Radiol 2021;37:189-208.
8.	Muramatsu C, Matsumoto T, Hayashi T, Hara T, Katsumata A, Zhou X, et al. Automated measurement of mandibular cortical width on dental panoramic radiographs. Int J Comput Assist Radiol Surg 2013;8:877-85.
9.	Muramatsu C, Horiba K, Hayashi T, Fukui T, Hara T, Katsumata A, et al. Quantitative assessment of mandibular cortical erosion on dental panoramic radiographs for screening osteoporosis. Int J Comput Assist Radiol Surg 2016;11:2021-32.
10.	Ogura I, Kobayashi E, Nakahara K, Haga-Tsujimura M, Igarashi K, Katsumata A. Computer programme to assess mandibular cortex morphology in cases of medication-related osteonecrosis of the jaw with osteoporosis or bone metastases. Imaging Sci Dent 2019;49:281-6.
11.	Ogawa R, Ogura I. AI-based computer-aided diagnosis for panoramic radiographs: Quantitative analysis of mandibular cortical morphology in relation to age and gender. J Stomatol Oral Maxillofac Surg 2022;123:383-7.
12.	Link TM. Osteoporosis imaging: State of the art and advanced imaging. Radiology 2012;263:3-17.
13.	Kazakia GJ, Majumdar S. New imaging technologies in the diagnosis of osteoporosis. Rev Endocr Metab Disord 2006;7:67-74.
14.	Bauer JS, Link TM. Advances in osteoporosis imaging. Eur J Radiol 2009;71:440-9.
15.	Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254-9.