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Systematic review with hierarchical clustering analysis for the fractal dimension in assessment of skeletal bone mineral density using dental radiographs

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Abstract

Objectives

To systematically review the relationship between the fractal dimension (FD) on jaw bones and skeletal bone mineral density (BMD), focusing on the different methodologies and results in the existing literature.

Methods

An electronic literature search was performed to identify articles that evaluated the relationship between the mandibular and maxillary FD and BMD up to February 2014. After selecting the articles, a hierarchical clustering analysis was performed to verify the dissimilarity of the studies. The following variables were grouped into clusters, and assessed for reliability of the cluster distribution: kind of study, method for calculating FD, relationship between FD and low BMD, digital imaging, and kind of dental radiography. The relative frequencies of the categories of variables were calculated and compared.

Results

Only 15 studies were selected and three clusters were obtained. Most articles were in the third cluster, and primarily consisted of clinical studies that used the box-counting method to calculate FD on panoramic radiographs. A significant association was found for the variable relationship between FD and low BMD and the clusters. Most of the clinical studies were performed on trabecular bone, but three studies found differences in FD between individuals with normal mandibular cortex and individuals with cortical porosity.

Conclusions

The kind of study, method for calculating FD, relationship between FD and low BMD, and imaging modality should be better standardized to minimize the controversies found in published studies. The performance of FD on the cortical and trabecular bone for osteoporosis screening deserves further investigation.

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Conflict of interest

André Ferreira Leite, Paulo Tadeu de Souza Figueiredo, Hugo Caracas, Rafael Sindeaux, Ana Tereza Bittencourt Guimarães, Leonardo Lazarte, Ana Patrícia de Paula, and Nilce Santos de Melo declare that they have no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Oral Radiology, Department of Dentistry, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, 70910-900, Brazil

    André Ferreira Leite & Paulo Tadeu de Souza Figueiredo

  2. Private Practice, SCN Qd 02 Bl D ent A sala 911, Brasília DF, 70712-903, Brazil

    Hugo Caracas

  3. Post-graduation Program, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro, Brasília, 70910-900, Brazil

    Rafael Sindeaux

  4. Biostatistics, Biological Sciences Department, State University of West Paraná, Rua Universitária, 2069, Cascavel, Paraná, 85819-110, Brazil

    Ana Tereza Bittencourt Guimarães

  5. Department of Mathematics, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, 70910-900, Brazil

    Leonardo Lazarte

  6. Rheumatology. Hospital de Base of Federal District, SMHS, Área Especial, Q. 10, Brasília, 70330-150, Brazil

    Ana Patrícia de Paula

  7. Oral Pathology, Department of Dentistry, Faculty of Health Science, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, 70910-900, Brazil

    Nilce Santos de Melo

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  1. André Ferreira Leite
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  2. Paulo Tadeu de Souza Figueiredo
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  7. Ana Patrícia de Paula
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  8. Nilce Santos de Melo
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Correspondence to André Ferreira Leite.

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Leite, A.F., de Souza Figueiredo, P.T., Caracas, H. et al. Systematic review with hierarchical clustering analysis for the fractal dimension in assessment of skeletal bone mineral density using dental radiographs. Oral Radiol 31, 1–13 (2015). https://doi.org/10.1007/s11282-014-0188-y

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  • DOI: https://doi.org/10.1007/s11282-014-0188-y

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