Hastar, Yilmaz, Orhan of osteoporosis, assessment of bone mass, and graphs in the elderly with osteoporosis and with- identification of fracture risk are important goals out osteoporosis. when evaluating patients for osteoporosis.3,4 Sub- jects with a self-reported history of osteoporotic MAtErIALs And MEtHods fractures also tend to have increased resorption Study sample and thinning of the mandibular lower cortex.5 Four hundred eighty-seven elderly dental pa- Several investigators have stated that osteoporo- tients (age-range 60-88 years, mean age 67.9; 239 sis results in reduced jaw bone mass and altered men, 248 women) were evaluated at the Depart- mandibular structure, especially of the inferior ment of Oral Diagnosis and Radiology (Suleyman border (mandibular lower cortex).6,7 Demirel University, Faculty of Dentistry, Isparta), Dental radiographs, especially panoramic im- who were receiving either routine or emergency ages, have been used to predict low bone min- dental care. Menopausal age in women, the type eral density in patients. A number of mandibular of denture worn, and oral parafunctions (tooth cortical indices, including the mandibular corti- clenching, tooth-grinding) were recorded for each cal index (MCI), mandibular cortical width (MCW) patient, in addition to the gender, dentition status, and panoramic mandibular index (PMI), have been age, and osteoporotic status according to the pa- developed to assess and quantify the quality of tients’ medical anamnesis. mandibular bone mass and to observe signs of re- All panoramic images were made using pan- sorption on panoramic radiographs for identifica- oramic machine (Planmeca PM 2002 CC Proline; tion of osteopenia. The best established of these Helsinki, Finland) by a radiology technician. One is the mental index (MI), which is the mean of the researcher evaluated each image according to pa- widths of the lower border cortex below the two tient positioning, head alignment and film density mental foramina. Osteopenia can be identified by and contrast to avoid including radiographs with the thinning of the cortex at the lower border of distortion. the mandible. A thin mandibular cortical width has been shown to be correlated with reduced skeletal Radiographic measurements bone mineral density.4,8-10 The mandibular cortical Images were digitized (300 dpi) with a flatbed index describes the porosity of the mandible and scanner that had a transparency adapter (Epson is related to the mandibular bone mineral den- Perfection V700 Photo/V750 Pro). Linear mea- sity. Many studies have shown that this index is surements were performed using specialized an- a useful method of osteoporosis screening.5,11-14 alytical software (Image J 1.42) at a correction for The panoramic mandibular index is the ratio of the 30% magnification, relatively, to better simulate thickness of the mandibular cortex to the distance the clinical situation. Mandibular cortical width between the mental foremen and the inferior at the mental region (MCW), panoramic mandibu- mandibular cortex.15 lar index (PMI), and morphologic classification of Although many studies3,9,10,13,14,16-18 have evalu- mandibular cortex (Mandibular Inferior Cortex ated mandibular radiomorphometric indices (MI, grade) were assessed on the dental panoramic MCI, PMI) as indicators of possible osteoporosis radiographs by an observer. Cortical width at the in postmenopausal women, few studies4,8,19 have mental foremen region was assessed according evaluated these measurements in older men. to the technique described by Ledgerton et al21 in Because most elderly individuals have more which the mental foremen is identified and a line opportunities to visit a dental clinic than to visit a traced perpendicular to the tangent to the lower medical clinic for diagnosis of osteoporosis, it is border of the mandible and through the center of important to determine the relationship between the mental foremen. The cortical width was mea- panoramic radiomorphometric indices and skel- sured bilaterally, and the mean cortical width was etal bone mineral density.20 calculated.21 The aims of this study were to evaluate the in- The mandibular cortical shape is classified into fluence of gender and dental status on the mental one of three groups according to the method of index, mandibular cortical index, and panoramic Klemetti et al:22 C1—the endosteal cortical mar- mandibular index on dental panoramic radio- gin is even and sharp on both sides, normal cortex January 2011 - Vol.5 61 European Journal of Dentistry