Yasar, Akgunlu ocnLusIons In conclusion, contrary to other radiomorphometric indices, such as PMI, MCW, AGI and GI; in MCI no measurements and calculations are needed but visual assessment plays a significant role and this creates a major limitation in the application of the technique clinically, especially in inter-observer agreement. It is possible to differentiate mandibular cortices having Cl 1 cortices from Cl 2 and Cl 3 cortices by evaluating MCI quantitatively with Fractal Dimension and Lacunarity however Fractal Dimension and Lacunarity could not differentiate Cl 2 cases from Cl 3. The reason of this might be the relatively small number of cases having Cl 3 cortices and it can be advised that Fractal Dimension and Lacunarity can be used as supportive diagnostic techniques to MCI in cases where inter-observer agreement is important and desired because these techniques are independent from observers and they can overcome the limitation of disagreement among observers in MCI classification. The Kappa values of this study were varying between 0.718-0.805 and this may be seen as visual evaluation of MCI is superior to Fractal Dimension and Lacunarity because these techniques could not differentiate Cl 2 cases from Cl 3, but the real limitation of visual evaluation of MCI is reported to be in inter- observer agreement in various studies and these techniques would overcome this limitation of MCI evaluation by eliminating observer dependency. As it was aimed to evaluate whether Fractal Dimension and Lacunarity could differentiate different shapes of mandibular cortical bone in this preliminary study, the bone mineral density status of the patients were not known. Further study is needed with osteoporotic and non- osteoporotic patients and greater sample size especially for Cl 3 cases. In that case it would be possible to evaluate whether Fractal Dimension and Lacunarity can discriminate osteoporotic patients from non-osteoporotic ones. AcKnoWLedGMents This study was supported by Scientific Research Projects (BAP) of Selcuk University. October 2008 - Vol.2 RefRencs 1. NIH Consensus Development Panel. Osteoporosis prevention, diagnosis and therapy. JAMA 2000;285:785- 795. 2. Eddy DM, Jonston JJ, Cummings SR, Dawson-Hughes B, Lindsay R, Melton LJ, et al. Osteoporosis: Review of the evidence for prevention, diagnosis and treatment and cost effectiveness analysis. Status report. Osteoporos Int 1998;4(Suppl):1-80. 3. Espallargues M, Sampietero-Colom L, Estrada MD, Sola M, del Rio L, Setoain J, Granados A. Identifying bone mass related risk factors for fracture to guide bone densitometry measurements. A systematic review of the literature. Osteoporosis Int 2001;12:811-822. 4. WHO scientific group. Prevention and management of osteoporosis. WHO Technical Report Series 2003;921. Geneva. 5. Consensus Development Conference and treatment of osteoporosis? Osteoporosis Int 1997;7:1-6. 6. National Osteoporosis Foundation Osteoporosis: review of the evidence for prevention, diagnosis and treatment. Osteoporosis Int 1998;8(Suppl 4):s7- 80. 7. Hailey D, Marshall D, Sampietro-Colom L, Rico R, Granados A, Asua J, Jonsson E. International collaboration in health technology assessment: a study of technologies used in management of osteoporosis. Health Policy 1998;43:233- 241. 8. Taguchi A, Suei Y, Sanada M, Ohtsuka M, Nakamoto T, Sumida H, et al. Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. Am J Roentgenol 2004;183:1755-1760. 9. Beneyto YM, Banos MA, Lajarin LP, Rushton VE. Clinical justification of dental radiology in adult patients: A review of the literature. Med Oral Patol Oral Cir Bucal 2007;12:E244- 251. 10. Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporosis Int 2002;13:373-378. 11. Bollen AM, Taguchi A, Hujoel PP, Hollender LG. Case control study on self reported osteoporotic fractures and mandibular cortical bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:518-524. 12. Klemetti E, Kolmakov S, Kroger H. Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res 1994;102:68-72. 13. TaguchiA,SueiY,OhtsukaM,OtaniK,OhtakiM.Usefulnessof panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofac Radiol 1996;25:263- 267. 289 European Journal of Dentistry