Evaluation of Osteoporosis /endodontic courses

INDIAN DENTAL
ACADEMY
Leader in continuing
Dental Education
www.indiandentalacademy.com

Osteoporosis And Diabetes: A Match Made
From Hell
Osteoporosis -bones become
less dense- more likely to
fracture.
Studies have shown that diabetes is definitely associated with
having weaker bone structures.. …….
More than 50 years since Drs. Albright and Reifenstein
demonstrated that diabetes could be associated with loss of
bone mass.
Diabetes -disorder of
metabolism
Insulin -anabolic effects on
bone - abnormal insulin levels

Mechanism
Osteocalcin
Markers of bone resorption
Insulin-like growth factors
Reduced numbers of osteoblasts
Increasing serum osteocalcin after glycemic control in diabetic men.
Calcif Tissue Int. 1995;57:422-425.
Bone loss and bone turnover in diabetes. Diabetes. 1995;44:775-782.

Indian Dental academy
Leader continuing dental education
Offer both online and offline dental
courses

Bones- radial, femoral & lumbar spine
Mandibular BMD – using panaromic
images
using IOPA
using digital images
Br J Radiol. 1996 Nov .
Bone. 2007 Jan 24.
Community Dent Oral Epidemiol. 2007 Dec .

Aims and Objectives
•To obtain digital IOPA images of diabetic and
non diabetic individuals
• Counting the number of trabeculae in specified
area on digital IOPA images
•To compare the number of trabeculae /mm2 in
diabetics and non diabetics

Materials and Method
Propective study
males
Age >40 years
Sample size-21 normal,
21 diabetics
Contributing departments
Department of general
medicine
Department of oral
medicine & radiology

INCLUSION CRITERIA
 21 healthy male patients of Indian origin age >=40 years
and equal number of age and sex matched controlled
diabetic patients.
 Patients should have lower premolars and 1st
molars on
any one side of the jaw.
 Patients who are free from or having mild gingivitis /
periodontitis .

EXCLUSION CRITERIA
•Patients suffering from diabetes from less than 1 year.
• Patients on corticosteroid therapy.
• Patients with positive history of smoking.
• Patients suffering from advanced periodontal diseases.
• Any other obvious cause for osteoporosis.

Radiographic Assessment
Digital radiograph Adobe photoshop cs2

Life size image

Rotating canvas Calibrating radiographsReference 2nd
premolar

Filter and smart sharpen

Measurements
Assessment of bone loss
molar
premolar
Number of trabeculae in the specified
area
Number of trabeculae/mm2

Statistical analysis
Students t test was done to compare number of
trabeculae/mm2
between control and diabetic group…
Correlations between age , number of trabeculae/mm2
and bone loss…
statistics

Results
Various parameters involved in study
are
age
Bone loss..
Number of trabeculae/mm2
Duration of diabetes
Number of trabeculae/mm2 varied significantly between diabetic
and healthy group (p value<0.05 , shown by t test)
Number of trabeculae/mm2 (mean)
p value<0.0O40
NORMAL: 0.1987
DIABETIC: 0.1737

Results
t test also reveals that the average crestal bone loss in the
molar region in controls and diabetics are statistically
significant (p <0.05)
Control and diabetic
Correlation between age - number of
trabeculae/mm2
- bone loss
crestal bone loss in molar region shows correlation with
age
No correlation between duration of diabetes and number of
trabeculae/mm2 www.indiandentalacademy.com

DISCUSSION
Present study : Prospective study
Sample size : 21
Region of interest…
Counting trabeculae…
Duration of diabetes…

The diabetic connection…
Regions of interest…
Mandibular bone mineral density as a predictor of
skeletal osteoporosis
Selecting regions of interest on intraoral radiographs for
the prediction of bone mineral density
DISCUSSION
Br J Radiol. 1996 Nov ;69 (827):1019-25
Dentomaxillofacial Radiology (2008) 37, 375–379

Duration of diabetes…
Glycemic control …
Lack of relationship between glycemic control and bone
mineral density in type 2 diabetes mellitus
Glycemic control and alveolar bone loss progression in
type 2 diabetes
DISCUSSION
Ann Periodontol. 1998 Jul ;3 (1)
BGrlayzcielimanic Jocounrntraol l oafn Md ebdoincael maninde
Braiol ldoegnicsaitly Research (2007) 40: 221-227

Number of
trabeculae/mm2…
Clin Oral Investig. 2007 Sep ;11 (3):225-9 17668257 (P,S,G,E,B,D)
Bone. 2007 Jan 24; : 17317351 (P,S,G,E,B,D)
DISCUSSION
Prediction of bone mineral density with dental radiographs
Bone density measurement in intraoral radiographs.

Outcome …
• Number of trabeculae/mm2
• Crestal bone loss
• Age correlation
• Duration of diabetes

Limitations of our study
 Pilot study hence sample size was smaller
 Inter and intra observer reliability was not checked
 Results were not compared with gold standard DXA

Future avenues…
Prospective study should be done using larger sample size
Also considering duration of diabetes , fasting blood sugar
levels and glycosylated haemoglobin levels
Correlating number of trabeculae /mm2 with dual energy x-ray
absorbtiometery and BMD of other bones.

Acknowledgement

• It is the duty to make the posing of
questions our natural and unbreakable
habit.
Istavan Orke’ny
Thank you

Thank you
28
To
stay the
course…
Sometimes
u have
to make
waves.
• It is the duty to make the posing of
questions our natural and unbreakable
habit.
Istavan Orke’ny

Evaluation of Osteoporosis /endodontic courses

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Evaluation of Osteoporosis /endodontic courses

Similar to Evaluation of Osteoporosis /endodontic courses (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Evaluation of Osteoporosis /endodontic courses