Get Permission Manna, Singh, Khan, and Manna: Using a panoramic radiographic study, the Panoramic Mandibular Index (PMI), Mandibular Cortical Width (MCW) or Mental Index (MI) are used to assess bone mineral density (BMD) in postmenopausal women and identify sexual dimorphism


Introduction

Bone remodelling is a normal process in which it constantly changes as a result of ongoing resorption and formation. In this process, the total bone mineral density (BMD) is maintained as the old bone is removed and new bone is produced. BMD declines in older persons as a result of an increase in bone resorption relative to bone production. The resorption rate is significantly greater and BMD declines in postmenopausal women. Resorption causes osteopenia, which develops into osteoporosis over a longer period of time. BMD is a gauge that is often used to quantify bone mass in mg/cm2 at a particular location.1, 2

"Disease characterised by low bone mass and micro architectural degeneration of bone tissue, resulting to heightened bone fragility and a corresponding increase in fracture risk" is how osteoporosis is defined. Age and gender are the two physiological elements that control osteoporosis the most. Several variables affect the prognosis of osteoporosis.2, 3

Osteoporosis may be shown in many different areas of the human body, but as dental professionals, we are particularly interested in the mandible as a diagnostic region. The quantity and quality of the jawbones are crucial factors in dental treatment and treatment outcomes. By evaluating the BMD, osteoporosis, or osteopenia in various places, such as the inferior cortex of the mandible, cortical width of the mandible, and so forth, in an orthopantomogram, we can determine the quality and amount of jaw bone.1, 4

Human identification is a crucial goal in forensic science. The sick person can be positively identified via dental identification. The panoramic radiograph is an important technique to identify the victims in mass murder and catastrophe victim identification. We can identify the victim by examining different orofacial regions in panoramic radiography. The victim's gender must first be determined in order to identify the victim. The sexual dimorphism in an orthopantomogram may be evaluated in a number of ways, including by measuring the mandible's length and the cortical bone's breadth. 4

To identify osteoporosis, osteopenia, or to compare them to sexual dimorphism, a variety of radiomorphometric indices including the panoramic mandibular index (PMI), mental index (MI), gonion index (GI), antigonial index (AI), and mandibular cortical index (MCI) are utilised. The PMI is the ratio of the mandibular cortex's thickness to the distance between the inferior mandibular cortex and the mental foramen.5, 6

Nevertheless, the gold standard for BMD measurement is the dual energy x ray absorptiometry (DXA) scan. The DXA scanner generates both high- and low-energy x-rays, and it detects how many of these penetrate the bone. It computes the difference between the bone's absorption of high- and low-energy x-rays. The World Health Organization (W.H.O.) has established certain standards for determining bone density.7 To identify the normal, osteoporosis, and osteoporosis in humans, it advises calculating the T-score. The T-score is determined by comparing the patient's measured BMD to the mean BMD in young adults, which is then compared to the standard deviation of the young adult population. T -1.0, -2.5, T -1.0, and T -2.5, respectively, stand for osteopenia, osteoporosis, and normal.7, 8

Materials and Methods

This study was authorised by the institution's research ethics committee. For the study, 100 patients (50 men and 50 women) who visited Teerthankar Mahaveer Dental College's department of oral medicine and radiology were randomly chosen. The age range was taken to be 50–78 years old, with a mean age of 59.45. The patients were first informed of the significance and necessity of the research and given the instruction to remove all artificial items, such as dentures, ear rings, and hair bands, from the head and neck region prior to the scans. The patients' informed permission was gained for the same.

Inclusion criteria were

  1. A Individual above the age of 50

  2. After menopause (after 12 months of amenorrhea with no obvious pathology

  3. Women who have never had a hysterectomy or an oophorectomy

Exclusion criteria were

  1. Those who smoke, drink, or have any systemic illness that can affect the bones

  2. Pathologies, such as cysts and tumours, altered the jawbones

The study's objectives were to identify sexual dimorphism and use the panoramic mandibular index and mandibular cortical width or mental index as screening tools for BMD evaluation. Gender identification and osteoporosis risk assessment were the main goals of the study.

All of the patients had orthopantomograms using radiation protection techniques (Planmeca Proline XC, Finland). According to patient-related criteria, 68-72 kVp and 7 mA were chosen, with a total filtration of 2.5 mm Al. The Planmeca Romexis programme then obtained the OPGs while taking the patient's information into account, and the Sidexis 4 software evaluated them. To ensure a more accurate assessment, the three oral medicine and radiology professionals worked under identical circumstances.

All the measurements were done in the Sidexis 4 software. Following measurements were calculated-

  1. Superior Length (SL) - SL is the distance between the superior margin of the mental foramen and the inferior border of mandible. In figure 1. A-A’ represents the SL.

  2. Inferior Length (IL) – IL is the distance between inferior margin of the mental foramen and the inferior border of the mandibble. In figure 1. B-B’ represents the IL.

  3. Mandibular cortical width (MCW) or mental index (MI) - First described by Ledgerton et al. 3 A perpendicular line was traced which passes through the center of mental foramen to the lower border of mandible tangentially. In figure 2. C-C’ represents the MCW.

After the measurements of these three distances, PMI was calculated. It was first described by Benson et al in 1991.1, 2, 3

  1. Superior PMI (sPMI = MCW/SL or MI/SL

  2. Inferior PMI (iPMI = MCW/IL or MI/IL

The bone density may vary due to the varying occlusal stresses in both sides, thus all measures were computed bilaterally in the OPGs. The mean values of the subjects' right and left sides were then subjected to statistical analysis using the t-test. One of the observers recorded all the information gathered from each patient and entered it into an unique pro forma created just for the research (Table 1 & 2). The Pearson's correlation was used to gauge the observers' level of accuracy. There was a substantial correlation coefficient.

Figure 1

SL is the distance between the inferior border ofthe mandible and the superior margin of the mental foramen. A-A' stands for theSL. The inferior edge of the mental foramen and the inferior border of themandible are separated by the distance IL. B-B stands for the IL.

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/1b1b22a8-7971-4224-8249-a61834063362-uimage.png

Figure 2

MCW orMI are represented by C-C'.

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/3226af14-e4df-458c-aefa-1496f8a73305-uimage.png

Figure 3

All ofthe individuals' SL, IL, and MCW or MI were measured bilaterally in this way,and the mean value was computed.

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/066f11f7-b1d7-460a-8634-58cc377de2cf-uimage.png

Table 1

Sample No.

Sex

Age (Years)

Mean SL Of Left & Right (mm)

Mean IL Of Left & Right (mm)

Mean MCW or MI Of Left & Right (mm)

sPMI = MCW or MI/SL Mean of Left & Right (mm)

iPMI = MCW or MI/IL Mean of Left & Right (mm)

1.

Male

50

20.13

16.90

5.11

0.25

0.30

2.

Male

50

19.25

16.82

4.91

0.25

0.29

3.

Male

50

19

16.71

2.44

0.12

0.14

4.

Male

51

18.47

15

3.95

0.21

0.26

5.

Male

51

17.67

15.11

4.78

0.27

0.31

6.

Male

52

18.56

16

5.09

0.27

0.31

7.

Male

52

19.12

16.21

3.99

0.20

0.24

8.

Male

53

20.49

16.25

3.67

0.17

0.22

9.

Male

53

21.38

16.01

3.56

0.16

0.22

10.

Male

53

16.09

14

4.91

0.30

0.35

11.

Male

53

17.22

14.11

5

0.29

0.35

12.

Male

54

17.34

13

4

0.23

0.30

13.

Male

54

16.05

13.89

3.82

0.23

0.27

14.

Male

54

17.65

13.41

2.99

0.16

0.22

15.

Male

55

15.76

12.55

3.11

0.19

0.24

16.

Male

55

16.77

13.80

2.43

0.14

0.17

17.

Male

55

18.59

13.31

3.92

0.21

0.29

18.

Male

55

19.43

14.01

4.33

0.22

0.30

19.

Male

55

15.66

12.11

3.98

0.25

0.32

20.

Male

55

14.76

12

4.90

0.33

0.40

21.

Male

55

14.90

11

2.13

0.14

0.19

22.

Male

55

16.08

12.97

3.22

0.20

0.24

23.

Male

55

16

12.98

3.45

0.21

0.26

24.

Male

55

17.46

14

4.01

0.22

0.28

25.

Male

56

16.55

13.01

3.44

0.20

0.26

26.

Male

56

16.33

13.97

4.33

0.26

0.30

27.

Male

57

15.91

12

5

0.31

0.41

28.

Male

57

14.61

12

4.99

0.34

0.41

29.

Male

57

17.87

14.95

4.97

0.27

0.33

30.

Male

57

16.04

14

3.98

0.24

0.28

31.

Male

57

16

13.39

4.15

0.25

0.30

32.

Male

58

17.91

14.91

4.54

0.25

0.30

33.

Male

58

18

15.21

5.11

0.28

0.33

34.

Male

58

16

13.05

4.91

0.30

0.37

35.

Male

59

15

12.46

3.42

0.22

0.27

36.

Male

59

15.77

12.22

4.22

0.26

0.34

37.

Male

59

17.34

14.56

3.19

0.18

0.21

38.

Male

59

17.09

14.78

5.21

0.30

0.35

39.

Male

59

16.97

14.99

4.19

0.24

0.27

40.

Male

60

16.74

14

5

0.29

0.35

41.

Male

60

16.91

13.92

4.97

0.29

0.35

42.

Male

60

16.84

14.02

4.32

0.25

0.30

43.

Male

60

17.40

15

3.99

0.22

0.26

44.

Male

61

21.02

17.92

5.11

0.24

0.28

45.

Male

61

19.81

16.22

5.36

0.27

0.33

46.

Male

65

19

15.22

5.98

0.31

0.39

47.

Male

66

18.87

14.67

4.99

0.26

0.34

48.

Male

67

16.44

13.02

4.89

0.29

0.37

49.

Male

67

15.97

13.25

3.99

0.24

0.30

50.

Male

68

16

13

4

0.25

0.30

Mean Age = 56.82

Mean SL =

17.32

Mean IL =

14.15

Mean MCW or MI = 4.23

Mean sPMI =

0.24

Mean iPMI =

0.29

Table 2

sPMI& iPMI in females

S. No.

Sex

Age (Years)

Mean SL Of Left & Right (mm)

Mean IL Of Left & Right (mm)

Mean MCW or MI Of Left & Right (mm)

sPMI = MCW or MI/SL Mean of Left & Right (mm)

iPMI = MCW or MI/IL Mean of Left & Right (mm)

1.

Female

50

16.06

14.22

3.33

0.20

0.23

2.

Female

50

14.04

11.98

4

0.28

0.33

3.

Female

50

16.44

13.23

4.11

0.25

0.31

4.

Female

51

14.22

11.98

2.65

0.18

0.22

5.

Female

51

13.99

11.99

3.54

0.25

0.29

6.

Female

52

14.77

12.11

4.44

0.30

0.36

7.

Female

52

15.23

12.98

4.89

0.32

0.37

8.

Female

53

15

12.56

3.98

0.26

0.31

9.

Female

54

16

13.98

4.56

0.28

0.32

10.

Female

54

14.87

12.11

4.32

0.29

0.35

11.

Female

55

15.33

12.98

4.65

0.30

0.35

12.

Female

56

16.22

14.11

3.98

0.24

0.28

13.

Female

56

17.32

15

4.09

0.23

0.27

14.

Female

56

14.11

12

2.43

0.17

0.20

15.

Female

56

15.09

12.22

3.54

0.23

0.28

16.

Female

56

15.34

12

3.51

0.22

0.29

17.

Female

56

16.99

14

5.44

0.32

0.38

18.

Female

57

17

14.53

5

0.29

0.34

19.

Female

57

16.43

13.98

4.45

0.27

0.31

20.

Female

58

13.39

12.98

3.23

0.24

0.24

21.

Female

58

14.34

12.33

3.29

0.22

0.26

22.

Female

58

15.09

13.21

4.93

0.32

0.37

23.

Female

59

15.99

13

4

0.25

0.30

24.

Female

60

16.43

14.76

3

0.18

0.20

25.

Female

60

16.65

14.34

2.33

0.13

0.16

26.

Female

61

15.77

12.32

1.54

0.09

0.12

27.

Female

62

15.33

12

3.04

0.19

0.25

28.

Female

63

15.97

14.1

4.21

0.26

0.29

29.

Female

64

14.99

12.44

4.44

0.29

0.35

30.

Female

65

15.34

12

3.54

0.23

0.29

31.

Female

66

16.42

14.44

3.56

0.21

0.24

32.

Female

66

18.43

16

3.15

0.17

0.19

33.

Female

67

14.55

12

2.50

0.17

0.20

34.

Female

67

15.97

13

4.20

0.26

0.32

35.

Female

68

15.56

12

4.01

0.25

0.33

36.

Female

68

15.44

12.22

3.98

0.25

0.32

37.

Female

68

15.01

12.97

4.33

0.28

0.33

38.

Female

69

15.34

13.33

2.11

0.13

0.15

39.

Female

70

16.78

15

1.34

0.07

0.08

40.

Female

70

14.44

11.98

1.90

0.13

0.15

41.

Female

71

14.54

12.49

2.21

0.15

0.17

42.

Female

71

13.53

11

2.44

0.18

0.22

43.

Female

71

15.98

13.30

2.58

0.16

0.19

44.

Female

72

14.54

12.65

2.65

0.18

0.20

45.

Female

72

14.37

11

2.98

0.20

0.27

46.

Female

73

16.65

14.08

4.79

0.28

0.34

47.

Female

74

15.29

13.09

3.95

0.25

0.30

48.

Female

75

15.99

12.44

3.70

0.23

0.29

49.

Female

78

14.56

11.98

1.56

0.10

0.13

50.

Female

78

13.98

11.01

1.32

0.09

0.11

Mean Age = 62.08

Mean SL =

15.45

Mean IL =

12.94

Mean MCW or MI = 3.89

Mean sPMI =

0.22

Mean iPMI =

0.26

Table 3

Meanage of the study subjects

Minimum

Maximum

Mean

Std. Deviation

Age_Years

100

50.00

78.00

59.4500

7.02287

Table 4

Sexualdimorphism in SL parametre

Sex

Mean

Std. Deviation

Std. Error Mean

T value

P value

SL

Male

50

17.3244

1.64755

.23300

6.478

0.001 (Sig)

Female

50

15.4222

1.05358

.14900

Table 5

Sexual dimorphism in IL plane

Sex

Mean

Std. Deviation

Std. Error Mean

T value

P value

IL

Male

50

14.1578

1.51185

.21381

4.531

0.001 (Sig)

Female

50

12.9484

1.12989

.15979

Graph 1
https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/ec8bc860-ffed-473f-850d-6790a9144a4d-uimage.png

Graph 2
https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/468d6958-b609-49a5-b98e-6f2596a506bb-uimage.png

Graph 3
https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/b41c4e00-efcb-47ff-a4b3-08a35ab7942e-uimage.png

Table 6

Sexualdimorphism in MCW parameter

Sex

Mean

Std. Deviation

Std. Error Mean

T value

P value

MCW

Male

50

4.2390

.83651

.11830

4.060

0.001 (Sig)

Female

50

3.4744

1.03632

.14656

Table 7

Sexualdimorphism in sPMI parametre

Sex

Mean

Std. Deviation

Std. Error Mean

T value

P value

spmi

Male

50

.2406

.05016

.00709

1.445

0.084 (Sig)

Female

50

.2204

.06468

.00915

Graph 4
https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/07c17c5b-a502-4a8f-aa38-db7665ac73d1-uimage.png

Table 8

Sexualdimorphism in iPMI parametre

Sex

Mean

Std. Deviation

Std. Error Mean

T value

P value

ipmi

Male

50

.2954

.05946

.00841

2.357

0.020 (Sig)

Female

50

.2630

.07691

.01088

Figure 4
https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/690c86bb-368d-4ed1-83c7-b8aad461b082/image/ac744c9a-2d9b-453d-9079-6c1754902a3b-uimage.png

Result

The average age was 56.82 years for men and 62.08 years for women. The average SL, IL, and MCW in men were 17.32mm, 14.15mm, and 4.23mm, respectively. The mean sPMI and iPMI for men were subsequently determined to be 0.24 and 0.29, respectively. Females' respective mean SL, IL, and MCW measurements were 15.45mm, 12.94mm, and 3.98mm. The mean sPMI and iPMI for females were afterwards 0.22 and 0.26, respectively. (Table 1, Table 2)

The 100 research participants had an average age of 59.45 years. The age-related standard deviation (SD) was 7.02287. (Table 3). Males had greater mean SL and IL than females, with mean differences of 1.90 and 1.20, respectively, and these differences were statistically significant (Table 4, Table 5). Males also had greater mean MCW or MI than females, with a statistically significant mean difference of 0.80. (Table 6). Males had slightly higher mean sPMI and iPMI scores than females, respectively, with mean differences of 0.02 and 0.03 that were statistically significant (Table 7, Table 8).

Discussion

Sex hormones like testosterone and oestrogen in males and females, respectively, promote bone formation. 8 Males and females attain their peak bone mass at ages 40 and 30 and 35, respectively. Certain cytokines induce osteoclastic activity of bone, whereas oestrogen inhibits this action, avoiding osteoporosis. 9 Parathyroid hormones will boost osteoclastic activity when oestrogen levels fall. As oestrogen levels fall, calcium absorption also suffers, which in turn has an impact on vitamin D production.8, 9 The PMI was initially suggested as a radiomorphometric technique by Benson et al in 1991. They proposed that the distance between the inferior border of the mandible and the mental foramen remained mostly consistent throughout life. 9, 10 It is partially based on the approach recommended by Wical and Swoope for determining the relationship between mandibular height below the inferior margin of the mental foramen and residual ridge resorption (RRR). The PMI evaluation process is a straightforward process. Finding the boundaries of the mental foramina in certain cases was the only challenge in this investigation. In this study, the mean of the bilateral measures was computed.[11-12,22]11, 12

Male and female sPMI and iPMI in this study were 0.24 and 0.29 and 0.22 and 0.26, respectively, with a mean difference of 0.02 and 0.03 that was comparable to the study carried out in the American population by Benson et al. 1, 6, 8 (Mean PMI- 0.31-0.35 in males and 0.25-0.26 in females). In the Indian population, Bertha et al. found a similar finding (mean PMI 0.28–0.36 for women and 0.30–0.38 for men). In their studies of the Indian population, Rao et al.16 and Khaitan et al. 1 similarly obtained comparable results: the mean PMI in men and females was 0.26-0.28, while the mean sPMI and iPMI in males and females, respectively, were 0.23-0.27 and 0.29-0.35.

Similar in our study, the majority of recent research indicates that men have a wider range of PMI (sPMI and iPMI) than women. The greater risk category for osteoporosis can thus be ruled out using the radiomorphometric index (PMI). Women who have recently had menopause are at a greater risk than males of same age for developing decreased BMD.

A cortical width of 3 mm was deemed to be the ideal criterion for referral for bone densitometry by Devlin and Horner. 13, 14, 15 The results of our present study's MCW in males and females were 4.23 and 3.98, respectively. This was comparable to the outcome of the study by Khaitan et al1 (3.96-4.71 in males and 3.86-4.54 in females). Similar results to those of our current study (3.928 in males and 3.155 in females) were noted by Hardanti et al. White et al, 1, 14 and Klemetti et al. 16, 17, 18, 19 both agreed that MCW is more appropriate in the mid-4mm range.

The sPMI and iPMI were evaluated for both the groups (0.24 and 0.29 for men and 0.22 and 0.26 for females, respectively), in order to evaluate sexual dimorphism. In the present study, we discovered that the mean sPMI and iPMI were statistically significantly greater in men than in women. Kalinowskiet al. 16, 17, 19 discovered a comparable outcome.

In our research, the mean SL and IL were found to be greater in men than in females (17.32 and 14.15 for males and 15.45 and 12.94 for females, respectively), which was in accordance with the results of Khaitan et al.1, 18

All of the study's metrics, including SL, IL, PMI, MCW, and MI, produce statistically significant results when assessing sexual dimorphism.

Limitations

For the purposes of evaluating BMD and sexual dimorphism, this study does not represent any particular age or racial group. Our sample size was modest, thus bigger population groupings may have different results. We only evaluated age groups above 50 to identify sexual dimorphism, although it may differ in younger years.

Conclusion

After evaluating all the data, it can be said that radio morphometric indices PMI and MCW or MI may be trusted to accurately measure bone mineral density. Nevertheless, due to the paucity of studies, PMI and MCW results for assessing sexual dimorphism may differ. Nonetheless, in the current investigation, we were able to evaluate sexual dimorphism using PMI and MCW results that were statistically significant.

Ethical Clearance

Taken from university ethical committee for research.

Source of Funding

None.

Conflict of Interest

No conflict of interest.

References

1 

T Khaitan AK Shukla P Gupta SR Naik Is panoramic mandibular index a reliable marker in the evaluation of bone mineral density and sexual dimorphism?J Forensic Dent Sci20191131339

2 

P Govindraju M Kumar TS Chandra P Balaji P Sowbhagya Patel V. Preedy V. Panoramic Radiomorphometric Indices of Mandible: Biomarker for OsteoporosisBiomarkers in Bone Disease. Biomarkers in Disease: Methods, Discoveries and Applications2017SpringerDordrecht

3 

BW Benson TJ Prihoda BJ Glass Variations in adult cortical bone mass as measured by a panoramic mandibular index.Oral Surg Oral Med Oral Pathol19917134956

4 

AY Kwon KH Huh WJ Yi SS Lee SC Choi MS Heo Is the panoramic mandibular index useful for bone quality evaluation? Imaging Sci Dent2017475489673PMCID

5 

AN Law AM Bollen Ssu-kuang chen , detecting osteoporosis using dental radiographs: a comparison of four methodsJ Am Dent Assoc199612712173442

6 

B Gaur A Chaudhary PV Wanjari M Sunil P Basavaraj Evaluation of panoramic Radiographs as a Screening Tool of Osteoporosis in Post Menopausal Women: A Cross Sectional StudyJ Clin Diagn Res20137920515

7 

G Saran N Misra D Umapathy SG Channaiah P Singh S Srivatava Evaluation of the relationship of mandibular cortical index and panoramic mandibular index with bone mineral density using panoramic radiography in postmenopausal women: A short studyJ Indian Acad Oral Med Radiol20152753982

8 

L Khojastehpour S Mogharrabi MH Dabbaghmanesh I Nasrabadi Comparison of the mandibular bone densitometry measurement between normal, osteopenic and osteoporotic postmenopausal womenJ Dent (Tehran)20131034264091

9 

D Akshita V Asha Reliability of panoramic radiographic indices in identifying osteoporosis among postmenopausal womenJ Oral Maxillofac Radiol201753544

10 

R Guiglia Di Fede O Lo Russo L Sprini D Rini Osteoporosis, jawbones and periodontal diseaseMed Oral Patol Oral Cir Bucal2013181e939PMCID

11 

AA Bajoria A Ml G Kamath M Babshet P Patil P Sukhija Evaluation of Radiomorphometric Indices in Panoramic Radiograph - A Screening ToolOpen Dent J2015930310

12 

A Qaseem V Snow P Shekelle R Hopkins MA Forciea DK Owens Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of PhysiciansAnn Intern Med200814896804

13 

D Ledgerton K Horner H Devlin H Worthington Radiomorphometric indices of the mandible in a British female population.Dentomaxillofac Radiol199928317381

14 

MB Alonso AR Cortes AJ Camargo ES Arita FH Neto PC Watanabe Assessment of panoramic radiomorphometric indices of the mandible in a brazilian populationISRN Rheumatol20113263751

15 

B Drozdzowska W Pluskiewicz B Tarnawska Panoramic-based mandibular indices in relation to mandibular bone mineral density and skeletal status assessed by dual energy X-ray absorptiometry and quantitative ultrasoundDentomaxillofac Radiol20023163618

16 

E Hastar Evaluation of mental index, mandibular cortical index and panoramic mandibular index on dental panoramic radiographs in the elderlyEuropean J Dent20115607

17 

S Uysal BL Cağirankaya MG Hatipoğlu Do gender and torus mandibularis affect mandibular cortical index? A cross-sectional studyHead Face Med2007337

18 

S Hardanti F Oscandar Description of mandibular bone quality based on measurements of cortical thickness using Mental Index of male and female patients between 40-60 years oldImag Sci Dent20114141513

19 

K Horner H Devlin The relationships between two indices of mandibular bone quality and bone mineral density measured by dual energy X-ray absorptiometryDentomaxillofac Radiol19982711721



jats-html.xsl


This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International, which allows others to remix, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

  • Article highlights
  • Article tables
  • Article images

Article History

Received : 08-02-2024

Accepted : 30-05-2024


View Article

PDF File   Full Text Article


Copyright permission

Get article permission for commercial use

Downlaod

PDF File   XML File   ePub File


Digital Object Identifier (DOI)

Article DOI

https://doi.org/ 10.18231/j.adr.2024.006


Article Metrics






Article Access statistics

Viewed: 519

PDF Downloaded: 129