Fractal dimension in CBCT images as predictor for MRONJ: a retrospective cohort study
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ORIGINAL ARTICLE
Fractal dimension in CBCT images as predictor for MRONJ: a retrospective cohort study R. Bachtler 1 & Ch. Walter 2 & Ralf K. W. Schulze 1 Received: 14 May 2020 / Accepted: 11 August 2020 # The Author(s) 2020
Abstract Objective To estimate boxcounting fractal dimension in a standardized approach in CBCT images of the mandible and maxilla in a group of patients with MRONJ in comparison to a healthy control group. Material and methods From our records, a study group consisting of 80 maxillary and mandibular CBCTs in 77 cases of patients having MRONJ was collected. The control group consisted of 84 mandibular and maxillary CBCTs in a total of 78 patients. Using the boxcounting method, fractal dimension (FD) was estimated in a standardized fashion either cranially to the apex of the canine (maxilla) or beneath the tooth apices of the lower molars in the bone area above the mandibular canal (mandible). Intraobserver reproducibility of the FD-measurements was assessed by 6 repeated measurements in 10 individuals. FD values were correlated to age and sex of the individuals as well as to region of interest (ROI) sizes. Results FD in the study group (1.684 ± 0.051) was roughly 3.5 % lower than in the control group (1.745 ± 0.026, p < 0.0001). Sex and age had a significant (p < 0.001) influence on FD values in the study group, yet not in the control group. FD values increased with age (study group, spearman-rho: 0.2895, p < 0.05) and also ROI size (both groups, p < 0.0001). Reproducibility was good (intra-class correlation coefficient (ICC): 0.87). Conclusions Fractal dimension as assessed by boxcounting seems to be a good descriptor for MRONJ in jaw bones. Influence of age and sex on the outcome values needs to be further investigated in future studies. Clinical relevance CBCTs could be assessed with respect to FD to obtain an overview of the disease status of MRONJ patients. Keywords CBCT . MRONJ . Fractal dimension
Introduction Medication-related osteonecrosis of the jaw (MRONJ) is the common term for a group of diseases that are side effects of antiresorptive and antiangiogenic agents. According to the position paper of the American Association of Oral and Maxillofacial Surgeons [1], MRONJ is considered to be present in patients with the following criteria [1]:
* Ralf K. W. Schulze [email protected] 1
Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University, Augustusplatz 2, 55131 Mainz, Germany
2
MKG-Chirurgie, Medi+ Zahnärztliche Praxisklinik, Mainz, Germany
1. Current or previous treatment with antiresorptive or antiangiogenic agents 2. Plus have no history of radiation therapy to the jaws or obvious metastatic disease to the jaw 3. Plus who exhibit probably exposed bone of the jaws for a minimum period of 8 weeks The main share of the cases is caused by antiresorptive drugs (including bisphosphonates and denosumab) [2], with prevalence rates in patients treated for malignancies as high as 21% [3]. Early-stage id
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