Diagnostic performance of fractal dimension and radiomorphometric indices from digital panoramic radiographs for screening low bone mineral density


  • Angela Jordão Camargo Universidade de São Paulo
  • Arthur Rodriguez Gonzalez Cortes Universidade Ibirapuera
  • Eduardo Massaharu Aoki Universidade de São Paulo
  • Marina Gazzano Baladi Universidade de São Paulo
  • Emiko Saito Arita Universidade de São Paulo
  • Plauto Christopher Aranha Watanabe Universidade de São Paulo http://orcid.org/0000-0001-5524-1395




Radiography. Panoramic. Osteoporosis. Mandible.


A number of panoramic radiographic measurements have been associated with osteoporotic alterations. However, little is known about the differences in sensitivity and specificity among these measurements for screening low bone mineral density (BMD). Aim: To correlate and compare precision, sensitivity and specificity of panoramic radiomorphometric indices and fractal dimension (FD) for screening low BMD (i.e. osteopenia and osteoporosis). Methods: Sixty-eight female patients (42.78±15.59 years) were included in this study. Body mass index (BMI), mandibular cortical index (MCI), mandibular cortical width (MCW), FD and connectivity (C) were assessed. Low BMD was diagnosed by peripheral dual-energy X-ray absorptiometry (p-DXA). Non-parametric correlations were assessed among all variables. In addition, sensitivity and specificity of MCI, MCW and FD were estimated for screening low BMD. Results: Significant correlation was found between FD and BMI (p=0.013; r=0.269). In addition, FD was the most sensitive method for screening low BMD (70.8%, p=0.001). FD and MCI presented a significant and relatively high sensitivity, whereas MCW presented a high specificity for screening low systemic BMD Conclusions: Among the analyzed methods, FD and MCI offer a significant and relatively high sensitivity, whereas MCW offers a high specificity for screening low BMD.


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Author Biographies

Angela Jordão Camargo, Universidade de São Paulo

Possui graduação em Odontologia pela Faculdade de Odontologia de Ribeirão Preto da Universidade de São Paulo. Possui especialização em Radiologia e Imaginologia Odontológica pela Faculdade de Odontologia de Ribeirão Preto da Universidade de São Paulo. Possui mestrado em Radiologia Odontológica pela Faculdade de Odontologia da Universidade de São Paulo.

Arthur Rodriguez Gonzalez Cortes, Universidade Ibirapuera

Possui graduação em Odontologia (Noturno) pela Universidade de São Paulo, mestrado em Odontologia (Patologia Bucal) pela Universidade de São Paulo e doutorado em Odontologia (Diagnóstico Bucal) pela Universidade de São Paulo. 

Eduardo Massaharu Aoki, Universidade de São Paulo

Aluno de Doutorado do Programa de Diagnóstico Bucal da FOUSP. Possui graduação em Odontologia pela Universidade de São Paulo (2002). Especialista em Ortodontia, Mestre em Diagnóstico Bucal pela FOUSP (2016). Tem experiência na área de Odontologia, com ênfase em Radiologia e Ortodontia.

Marina Gazzano Baladi, Universidade de São Paulo

Cirurgiã Dentista. Mestre, Doutora pela Faculdade de Odontologia da Universidade de São Paulo - FOUSP e Pós-Doutoranda em Anatomia pelo ICB - Instituto de Ciências Biomédicas da Universidade de São Paulo. Professora colaboradora da Faculdade de Odontologia São Leopoldo Mandic, Sociedade Paulista de Ortodontia (SPO), Departamento de Anatomia ICB - USP e da Universidade Metropolitana de Santos-UNIMES. Especialista em Ortodontia.

Emiko Saito Arita, Universidade de São Paulo

Possui graduação em Odontologia pela Universidade de São Paulo em 1975. Pós-Graduação em Clínicas Odontológicas Nível de Mestrado pela Universidade de São Paulo em 1985 e Doutorado em Odontologia (Diagnóstico Bucal) pela Universidade de São Paulo em 1990. Especialista em Radiologia pelo Conselho Regional de Odontologia do Estado de São Paulo em 1982.

Plauto Christopher Aranha Watanabe, Universidade de São Paulo

Possui graduação em Faculdade de Odontologia de Rib Preto pela Universidade de São Paulo (1985), mestrado em Radiologia Odontológica pela Universidade Estadual de Campinas (1992) e doutorado em Odontologia (Diagnóstico Bucal) pela Universidade de São Paulo (1999). 


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How to Cite

Camargo AJ, Cortes ARG, Aoki EM, Baladi MG, Arita ES, Watanabe PCA. Diagnostic performance of fractal dimension and radiomorphometric indices from digital panoramic radiographs for screening low bone mineral density. Braz. J. Oral Sci. [Internet]. 2017 Apr. 20 [cited 2022 Aug. 12];15(2):131-6. Available from: https://periodicos.sbu.unicamp.br/ojs/index.php/bjos/article/view/8648764




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