Table 2.
Population studied, number of participants of each study (n), main results, comparisons performed results (between indexes) and conclusions
| Authors | Population Studied | n | Main results | Comparisons performed | Conclusions |
|---|---|---|---|---|---|
| Alam et al.8 | Postmenopausal females divided in two groups: with osteoporosis and without osteoporosis, according to their DXA results. | 60 | A significant difference in the mandibular cortical shape index between the two groups was observed. | When the postmenopausal females with osteoporosis were compared with postmenopausal females without osteoporosis, the indexes MCW, PMI, M/M ratio and FD did not present any statistically significant results. MCI presented the risk of osteoporosis in the C3 category was 11.36 times higher than that in the C2 category and 10.64 times higher for C2 than for C1; moreover, the risk of osteoporosis in the C3 category was 111.11 times higher than that in the C1 category. | The MCI on panoramic radiographs are effective indicators of osseous changes in postmenopausal females with osteoporosis. |
| Kato et al.9 | Postmenopausal females exclusively, classified according to DXA results. | 54 | The sensitivity and specificity for panoramic radiographs: 52.6 and 56.2%, respectively; for panoramic reconstructions of CBCTs with 5-, 15-, and 25 mm slice thicknesses: 63.1 and 43.7%, 50.0 and 50.0%, and 52.6 and 62.5%, respectively. |
Panoramic reconstructions using CBCT with different slices were compared to panoramic radiographs using MCI. Panoramic reconstructions from CBCTs with 25 mm slice thickness seems to be the most accurate. | The panoramic reconstruction of CBCT with 25 mm slice thicknesses seems to be the most accurate among the examinations evaluated. Panoramic radiographs and CBCT may be useful for the screening of low BMD in post-menopausal females. |
| Golhar et al.10 | Premenopausal (control group) and post-menopausal females (study group). BMD status were classified using phalanx T-score. | 100 | In Pre-menopausal group, 45 (90%) patients belonged to C1 classification, while 5 (10%) patients belonged to C2 classification. In Post-menopausal group, 22 (44%) patients belonged to C1 cortical classification, while 21 (42%) patients belonged to C2 cortical quality and 7 (14%) patients belonged to C3 cortical classification. | Correlations between MCI and the phalanx T-score were observed. Phalanx T-score was not correlated with other indexes relating radiomorphometric measurements PMI, MR and MCW. |
MI and MCI associate well and combining the two may be more helpful rather than using either of them alone. |
| Nasreen et al.11 | Postmenopausal females divided in two sub groups: females from urban and rural area. Vitamin D3 levels were measured. | 60 | Urban group: 0.0% of the subjects in the C1 category, 40.0% of the subjects in C2 category and 60.0% of the subjects in the C3 category. Rural group: 46.7% of the subjects in the C1 category, 43.3% of the subjects in the C2 category, and 10% of the subjects in the C3 category. | MCI, MI, PMI and vitamin D3 levels were compared between groups and their correlation with vitamin D3 levels were tested. MI and PMI did not corelate with vitamin D3 levels. The results considering the correlation between MCI and vitamin D levels were not mentioned in the manuscript. | The findings in panoramic radiographs correlates with serum vitamin D3 level and higher significant values were observed in rural females when compared to females from urban areas. |
| Grocholewicz et al.12 | Postmenopausal females exclusively; BMD status assessed by QUS at the radius and proximal phalanx III finger. | 97 | Higher scores of MCI classification were observed in older females. MCI significantly correlated with the skeletal status, distance between lower mandibular borders behind mental foramen and mandibular ratio. | MCI correlates with phalanx T-score. Phalanx T-score was not correlated with PMI, MR and MCW. | MCI can be effectively assessed on panoramic radiographs and could be used as a screening tool osteoporosis. This index is very simple for application. |
| Navabi et al.13 | Postmenopausal females were divided in osteopenic and osteoporotic, according to their DXA results. | 50 | MCW and MCI was significantly correlated with BMD. | The results showed that MCW is an appropriate index of osteoporosis in post-menopausal females. MCI “almost “correlated with BMD, p = 0.07) |
Postmenopausal females with low femoral BMD have thinner mandibular cortex at the mental foramen region. Dental panoramic radiographs are useful screening tools for postmenopausal osteoporotic patients, give sufficient information to make an early diagnosis and prevent from osteoporotic fractures in elderly females. |
| Choi et al.5 | Females divided in eight groups, according to age ranges. Peripheral DXA was applied to classify females BMD. | 252 | It was found different inverse correlations between MCI and the different forearm sites. | This study did not compare MCI with other indices, only verified MCI correlation with age and peripheral DXA. | Age-related bone loss is more evident in the proximal forearm than in the distal forearm. Furthermore, MCI can express a better inverse correlation with peripheral DXA at the proximal forearm than with the distal forearm. |
| Munhoz et al.2 | Brazilian postmenopausal females with three different ethnicities (afrodescendant, Asian, Caucasian). Peripheral DXA was applied to classify females BMD. | 150 | Age is the only variable associated with osteoporotic alterations in the mandible that reflects on MCI. An inverse correlation was found between the MCI and the T-scores from peripheral DXA. | This study did not compare MCI with other indices, only verified MCI correlation with age, body mass index, ethnic group and peripheral DXA. | Patient’s age is associated with BMD and MCI. The MCI is inversely correlated with peripheral DXA. |
| Munhoz et al.14 | Postmenopausal females divided in diabetics and non-diabetics. Peripheral DXA was applied to classify females BMD. | 228 | Mean Z score values were significantly higher in diabetics than in non-diabetics. T and Z score values were significantly correlated with MCI. | This study did not compare MCI with other indices, only verified MCI correlation with peripheral DXA | Type two diabetes may be associated with increased BMD in postmenopausal females. MCI from panoramic radiographs is moderately correlated with DXA in patients with diabetes with osteoporosis. |
| Pallagatti et al.15 | Postmenopausal females exclusively. DXA was applied to classify females BMD. | 60 | The average accuracy in detecting normal bone, osteopenia and osteoporosis was 58.08%, 63.3 and 64.74% respectively. | This study did not compare MCI with other indices. | Panoramic radiographs MCI can be used as a screening tool for the evaluation as well as early detection of osteoporosis. |
| Carmo et al.16 | Brazilian postmenopausal females. Femoral and lumbar spine DXA was applied to classify females BMD. | 198 | MCI and BMD of lumbar spine were correlated (κ = 0.912). The agreement between MCI and the BMD in the femur was moderated (κ = 0.579). | The correlation of MCI and IM with DXA were compared. The higher correlation was found between MCI and lumbar spine DXA when compared to IM and lumbar spine or femoral DXA, and when compared to MCI and femoral DXA. | The radiomorphometric indices are capable of identifying postmenopausal females with low BMD in the mandible. |
| Kolte et al.17 | pre- and postmenopausal periodontally healthy and with chronic periodontitis. | 120 | MCI evaluation showed a high prevalence of C2 and C3 patterns postmenopausal females. MCI presented correlation with MI and age. MI and PMI values in digital panoramic radiographs were reduced in patients affected with periodontitis. | Although MI, PMI, MCI were assessed, these radiomorphometric indexes were not directly compared. MI and PMI were reduced in females affected with periodontitis. Considering MCI, A reduction between the percentage of C1 pattern in pre- and postmenopausal periodontitis patients was also observed, indicating a more severe erosion of the mandibular cortex in the postmenopausal patients. |
A positive association between MCI and chronic periodontitis in postmenopausal females was noticed. Bone density reduces in postmenopausal females, and the positive association between MCI and chronic periodontitis in postmenopausal females confirms the high risk of osteoporosis in them. |
| Grgic et al.18 | Postmenopausal females divided in groups: osteoporosis, osteoporosis treated with bisphosphonates and control group. | 120 | A higher number of patients with C3 classification was found in the MCI were found in the osteoporosis group but the difference was not significant. No significant differences were found in MI or MCI (p = .06) in all the examined groups. |
MCI and MI specificity and sensitivity were compared. For both indexes, authors tried distinct cut-of points; however no optimal values of sensitivity and specificity were found. | MI and MCI are not precise diagnostic tools for diagnosing low BMD in postmenopausal females. (Observation from this review authors: we consider that MCI had significant difference between groups as p = 0.06) |
| Alonso et al.19 | Females over 45 years old | 30 | No differences were found between the diagnostic results based on panoramic radiography and CBCT panoramic reconstruction. | Panoramic reconstructions using CBCT were compared to panoramic radiographs using MCI. Disagreement between the techniques were verified, particularly in the classification C2 and C1. | The MCI is not an adequate means of assessing bone quality with CBCT. The higher values on MCI classification found for the cross-sectional slices could be associated with better visibility of erosions or defects in mandibular cortical bone on the CBCT image. |
| Jagelavičienė et al.20 | Lithuanian postmenopausal females 50–77 years old, classified using calcaneum BMD. |
129 | The differences in BMD were statistically significant between Groups C1 and C3, Groups C2 and C3, and between the calcaneal BMD groups. There was a statistically significant inverse correlation between the MCI and calcaneal BMD. | This study did not compare MCI with other indices. | The analysis of the MCI validity in BMD status showed low sensitivity (69.4%) and specificity (53.9%). |
| Majumder and Harum.21 | Postmenopausal females divided in osteoporotic, osteopenic and normal. DXA was applied to classify females BMD. | 1315 | The changes in the MCI (C2 and C3) were more frequent in osteoporotic condition rather than osteopenic and normal. | MCI pixel intensity and mandibular alveolar bone mass in panoramic radiographs were assessed but not directly compared. | Changes in postmenopausal alveolar bone were strongly correlated with the BMD of systemic skeletal bone. |
| Kim et al.22 | Korean postmenopausal females with 50 years old or older. DXA was applied to measure BMD. | 194 | BMD at the lumbar spine and total hip were significantly lower in participants with reduction of mandibular width, thinning and resorption of mandibular cortex by the MI and MCI. | Correlations with BMD were assessed using MCI, MC and simple visual estimation. However, comparisons were not performed. | The thickness and morphological changes of mandibular inferior cortical bone are associated with BMD, independent of age, height and weight. |
| Valerio et al.23 | Postmenopausal womens divided in: normal, osteopenic and osteoporosis according to their DXA. | 64 | There were significant differences between the normal and lower bone mineral density groups (osteopenia and osteoporosis) for MCI. | MCI, MI and three indices created by the authors (mental posterior index 1, 2 and 3) were assessed. All the indices were capable of differ females at osteoporosis risk. | The radiomorphometric indices evaluated in panoramic radiographs can be used to identify postmenopausal females with low BMD. |
| Gaur et al.24 | Postmenopausal females exclusively, divided as osteoporotic, osteopaenic and normal according to their DXA results. | 40 | The sensitivity (100%) and specificity (88.88%) of MCI showed good results. | MCI, PMI, MI, antegonial index and gonion index were assessed. Significant reductions of the mean values were observed in the osteoporotic group as compared to normal and osteopaenic groups for all the radiomorphometric indices except for the antegonial index group. | Orthopantomographs may be useful in screening patients with osteoporosis, mainly among postmenopausal females. |
| Martínez – Maestre et al.25 | Spanish postmenopausal females, divided in females that experienced previous fractures (with T-score lower than −2.5) and females without previous fractures (control group). | 120 | C1 group had less cases of females with previous fractures than C2 and C3. C2 has less fractures than C3. | No direct comparisons were performed between indexes. PMI and MI values were significantly lower in cases than in controls. | Panoramic radiomorphometrics mandibular indexes such as MCI, PMI, and MI, may be useful for identifying the population at higher risk for fracture. |
| Khojastehpour et al.26 | Iranian postmenopausal females. DXA was applied to measure BMD and females were grouped in according to DXA results in order to perform comparisons between indexes. | 119 | There were significant associations between BMD and MCI. | Cortical width and shape (MCI) were assessed, and it was observed a significant correlation between age and these indexes. There was also a significant correlation between cortical width and cortical shape of the mandible For both vertebral and femoral BMD, there was a statistically significant difference between the cortical width of normal and osteopenic/osteoporotic groups, however this difference was not significant between the osteopenic and osteoporotic groups. BMD was significantly correlated with cortical shape in both lumbar vertebrae and femoral neck regions. | Postmenopausal females with thin or eroded mandibular inferior cortex may have an increased risk for low BMD or osteoporosis |
| Khatoonabad et al.27 | Postmenopausal females. Hip BMD was measured in order to group females according to T-scores in: osteoporosis, osteopaenic and normal. | 140 | Moderate to severe cortical erosion (C2 and C3) significantly increased the likelihood of osteopenia and osteoporosis. | MCW and M/M ratio showed statistically significant differences between the three groups. No significant difference was found in PMI between the groups. Statistically significant difference in the quality of mandibular cortex (assessed using MCI) between the groups. | Panoramic radiography gives sufficient information to make an early diagnosis regarding osteoporosis in post-menopausal females. Panoramic radiographs may be valuable in the prevention of osteoporotic fractures in elderly females. |
| Mudda et al.3 | Pre and postmenopausal females with generalized periodontitis. | 60 | No association between periodontitis and MCI was found. | MCI, PMI and MI were related to the menopausal status. Patients with C3 category were seen only in post-menopausal group after 54 years of age. | Radiomorphometric indices could be used by general dentists after a little training to detect post-menopausal females at higher risk of osteoporosis. |
| Leite et al.28 | Postmenopausal females exclusively. Hip and lumbar sipne DXA was applied to measure BMD. | 351 | Associations of the MCI and simple visual estimation of the cortical width with BMD, determined at the lumbar spine, femoral neck, and total hip, were significantly lower in patients with thinning and resorption of mandibular cortex identified by the simple visual estimation and MCI, respectively | The qualitative indices (MCI and simple visual estimation) were more convenient than the quantitative indices and demonstrated better association with hip and spinal BMDs. | Antegonial indices and gonial angles cannot be used as osteoporosis predictors. The most accurate indices were the MI, MCI, and visual estimation of cortical width. |
MCI: mandibular cortical index; MCW: mandibular cortical width; BMD: bone mineral density; QUS: quantitative ultrasound; MI: mental index; PMI: Panoramic mandibular index; CBCT: cone beam computed tomography; USG: ultrasound; DXA: dual X-ray absorptiometry; M/M ratio: mandibular alveolar bone resorption degree; FD: fractal dimension; MR: mandibular ratio.