Evaluation of osseous changes in dental panoramic radiography using radiomorphometric indices in patients with hyperthyroidism

Published:October 23, 2021DOI:


      The aim of the present study was to compare radiomorphometric measurements on panoramic images of patients with hyperthyroidism (HT) to those of a control population.

      Study Design

      In this retrospective study, the mental index (MI), inferior panoramic mandibular index (PMI), antegonial index (AI), gonial index (GI), and mandibular cortical index (MCI) were evaluated on dental panoramic radiographs (DPRs) of 40 patients with HT and 40 healthy age- and sex-matched individuals and compared between the groups. Quantitative data (MI, PMI, AI, and GI) were analyzed with the Student t and Mann-Whitney U tests. Categorical data (MCI) were analyzed with the chi-square test.


      Statistically significant differences between the patient and control groups were found for inferior PMI (P = .001) and AI (P = .017) values, with smaller mean values among the patients. However, the measurements of MI (P = .59) and GI (P = .164) and the MCI distribution (P = .13) were similar in both groups.


      Evaluating the radiomorphometric indices of inferior PMI and AI on the DPRs of patients with HT who are at high risk of secondary osteoporosis could be helpful in the early diagnosis of osteoporotic changes and in formulating surgical treatment plans.
      To read this article in full you will need to make a payment


        • Painter SE
        • Kleerekoper M
        • Camacho PM.
        Secondary osteoporosis: a review of the recent evidence.
        Endocr Pract. 2006; 12: 436-445
        • Bauer DC
        • Ettinger B
        • Nevitt MC
        • Stone KL.
        Risk for fracture in women with low serum levels of thyroid-stimulating hormone.
        Ann Intern Med. 2001; 134: 561-568
        • Abrahamsen B
        • Jørgensen HL
        • Laulund AS
        • Nybo M
        • Brix TH
        • Hegedüs L.
        Low serum thyrotropin level and duration of suppression as a predictor of major osteoporotic fractures—the OPENTHYRO register cohort.
        J Bone Miner Res. 2014; 29: 2040-2050
        • Mosekilde L
        • Christensen MS.
        Decreased parathyroid function in hyperthyroidism: Interrelationships between serum parathyroid hormone, calcium-phosphorus metabolism and thyroid function.
        Acta Endocrinol (Copenh). 1977; 84: 566-575
        • Turkyilmaz I
        • McGlumphy EA.
        Influence of bone density on implant stability parameters and implant success: a retrospective clinical study.
        BMC Oral Health. 2008; 8: 32
        • Göller Bulut D
        • Bayrak S
        • Uyeturk U
        • Ankarali H
        Mandibular indexes and fractal properties on the panoramic radiographs of the patients using aromatase inhibitors.
        Br J Radiol. 2018; 91: 1-6
        • Ale AO
        • Ogbera AO
        • Ebili HO
        • Adeyemo OL
        • Afe TO.
        Prevalence, predictive factors, and characteristics of osteoporosis in hyperthyroid patients.
        Int J Endocrinol. 2018; 2018: 1-7
        • Nielsen H
        • Mosekilde L
        • Charles P.
        Bone mineral content in hyperthyroid patients after combined medical and surgical treatment.
        Acta Oncologica. 1979; 18: 122-128
        • Udayakumar N
        • Chandrasekaran M
        • Rasheed M
        • Suresh R
        • Sivaprakash S.
        Evaluation of bone mineral density in thyrotoxicosis.
        Singapore Med J. 2006; 47: 947
        • Meng Z
        • Liu M
        • Zhang Q
        • et al.
        Gender and age impacts on the association between thyroid function and metabolic syndrome in Chinese.
        Medicine (Baltimore). 2015; 94: 1-9
        • Gold EB.
        The timing of the age at which natural menopause occurs.
        Obstet Gynecol Clin North Am. 2011; 38: 425-440
        • Ledgerton D
        • Horner K
        • Devlin H
        • Worthington H.
        Radiomorphometric indices of the mandible in a British female population.
        Dentomaxillofac Radiol. 1999; 28: 173-181
        • Benson BW
        • Prihoda TJ
        • Glass BJ.
        Variations in adult cortical bone mass as measured by a panoramic mandibular index.
        Oral Surg Oral Med Oral Pathol. 1991; 71: 349-356
        • Dutra V
        • Devlin H
        • Susin C
        • Yang J
        • Horner K
        • Fernandes AR.
        Mandibular morphological changes in low bone mass edentulous females: evaluation of panoramic radiographs.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 663-668
        • Klemetti E
        • Kolmakov S
        • Kröger H.
        Pantomography in assessment of the osteoporosis risk group.
        Scand J Dent Res. 1994; 102: 68-72
        • Koo TK
        • Li MY.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Landis JR
        • Koch GG.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; : 159-174
      1. Ross DS, Muldr J. Bone disease with hyperthyroidism and thyroid hormone therapy. Available at: Accessed November 21, 2021

        • Carmo JZB
        • SFd Medeiros
        Mandibular inferior cortex erosion on dental panoramic radiograph as a sign of low bone mineral density in postmenopausal women.
        Rev Bras Ginecol Obstet. 2017; 39: 663-669
        • Biondi B
        • Wartofsky L.
        Treatment with thyroid hormone.
        Endocr Rev. 2014; 35: 433-512
        • Heemstra K
        • Hamdy N
        • Romijn J
        • Smit J.
        The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma.
        Thyroid. 2006; 16: 583-591
        • Sturtridge W
        • Lentle B
        • Hanley DA.
        Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 2. The use of bone density measurement in the diagnosis and management of osteoporosis.
        CMAJ. 1996; 155: 924-929
        • Dagistan S
        • Bilge OM.
        Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis.
        Dentomaxillofac Radiol. 2010; 39: 290-294
        • Halling A
        • Persson GR
        • Berglund J
        • Johansson O
        • Renvert S.
        Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly.
        Osteoporos Int. 2005; 16: 999-1003
        • Kribbs PJ.
        Comparison of mandibular bone in normal and osteoporotic women.
        J Prosthet Dent. 1990; 63: 218-222
        • Abdinian M
        • Salehi MM
        • Mortazavi M
        • Salehi H
        • Kazemi Naeini M.
        Comparison of dental and skeletal indices between patients under haemodialysis and peritoneal dialysis with healthy individuals in digital panoramic radiography.
        Dentomaxillofac Radiol. 2021; 50: 1-8
        • Limeira FIR
        • Rebouças PRM
        • Diniz DN
        • DPd Melo
        • Bento PM.
        Decrease in mandibular cortical in patients with type 1 diabetes mellitus combined with poor glycemic control.
        Braz Dent J. 2017; 28: 552-558
        • Mahl CRW
        • Licks R
        • Fontanella VRC.
        Comparison of morphometric indices obtained from dental panoramic radiography for identifying individuals with osteoporosis/osteopenia.
        Radiol Bras. 2008; 41: 183-187
        • Yalcin ED
        • Avcu N
        • Uysal S
        • Arslan U.
        Evaluation of radiomorphometric indices and bone findings on panoramic images in patients with scleroderma.
        Oral Surg Oral Med Oral Pathol. 2019; 127: 23-30
        • Ledgerton D
        • Horner K
        • Devlin H
        • Worthington H.
        Panoramic mandibular index as a radiomorphometric tool: an assessment of precision.
        Dentomaxillofac Radiol. 1997; 26: 95-100
        • Muramatsu C
        • Horiba K
        • Hayashi T
        • et al.
        Quantitative assessment of mandibular cortical erosion on dental panoramic radiographs for screening osteoporosis.
        Int J Comput Assist Radiol Surg. 2016; 11: 2021-2032
        • Kwon A-Y
        • Huh K-H
        • Yi W-J
        • Lee S-S
        • Choi S-C
        • Heo M-S
        Is the panoramic mandibular index useful for bone quality evaluation?.
        Imaging Sci Dent. 2017; 47: 87
        • Gulsahi A
        • Paksoy C
        • Ozden S
        • Kucuk N
        • Cebeci A
        • Genc Y.
        Assessment of bone mineral density in the jaws and its relationship to radiomorphometric indices.
        Dentomaxillofac Radiol. 2010; 39: 284-289
        • Knezović Zlatarić D
        • Celebić A
        • Lazić B
        • et al.
        Influence of age and gender on radiomorphometric indices of the mandible in removable denture wearers.
        Coll Antropol. 2002; 26: 259-266
        • Knezović-Zlatarić D
        • Čelebić A.
        Comparison of mandibular bone density and radiomorphometric indices in wearers of complete or removable partial dentures.
        Oral Radiol. 2005; 21: 51-55
        • Devi B
        • Rakesh N
        • Ravleen N.
        Diagnostic efficacy of panoramic mandibular index to identify postmenopausal women with low bone mineral densities.
        J Clin Exp Dent. 2011; 3: 456-461
        • Padbury Jr, AD
        • Tözüm TF
        • Taba Jr, M
        • et al.
        The impact of primary hyperparathyroidism on the oral cavity.
        J Clin Endocrinol Metab. 2006; 91: 3439-3445
        • Hansen D
        • Brandi L
        • Rasmussen K.
        Treatment of secondary hyperparathyroidism in haemodialysis patients: a randomised clinical trial comparing paricalcitol and alfacalcidol.
        BMC Nephrol. 2009; 10: 1-6
        • Henriques JCG
        • de Melo Castilho JC
        • Jacobs R
        • Amorim JBO
        • Rosa RR
        • Matai CVB.
        Severe secondary hyperparathyroidism and panoramic radiography parameters.
        Clin Oral Invest. 2014; 18: 941-948
        • Xie Q
        • Wolf J
        • Tilvis R
        • Ainamo A.
        Resorption of mandibular canal wall in the edentulous aged population.
        J Prosthet Dent. 1997; 77: 596-600
        • Dagistan S
        • Miloglu O
        • Caglayan F.
        Changes in jawbones of male patients with chronic renal failure on digital panoramic radiographs.
        Eur J Dent. 2019; 10: 64
        • Kiswanjaya B
        • Yoshihara A
        • Deguchi T
        • Hanada N
        • Miyazaki H.
        Relationship between the mandibular inferior cortex and bone stiffness in elderly Japanese people.
        Osteoporos Int. 2010; 21: 433-438
        • Leite AF
        • PTdS Figueiredo
        • Guia CM
        • Melo NS
        • de Paula AP.
        Correlations between seven panoramic radiomorphometric indices and bone mineral density in postmenopausal women.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 449-456
        • Hastar E
        • Yilmaz HH
        • Orhan H.
        Evaluation of mental index, mandibular cortical index and panoramic mandibular index on dental panoramic radiographs in the elderly.
        Eur J Dent. 2011; 5: 60-67
        • Amorim MAL
        • Takayama L
        • Jorgetti V
        • Pereira RMR.
        Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants.
        Osteoporos Int. 2006; 17: 1494-1500
        • Karayianni K
        • Horner K
        • Mitsea A
        • et al.
        Accuracy in osteoporosis diagnosis of a combination of mandibular cortical width measurement on dental panoramic radiographs and a clinical risk index (OSIRIS): The OSTEODENT project.
        Bone. 2007; 40: 223-229