Jawbone changes in chronic kidney disease patients in pretransplant stage: A radiomorphometric analysis using panoramic radiography

Thaís Feitosa de Oliveira; Mariana Quirino Silveira Soares; Izabel Regina Rubira-Bullen; Viviane Sarmento; Walmyr Mello; Maria Fernanda Camargo; Heitor Marques Honório; Paulo Sérgio da Silva Santos

doi:10.17126/joralres.2025.039

Thaís Feitosa de Oliveira Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil. http://orcid.org/0000-0003-1953-7409
Mariana Quirino Silveira Soares Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil http://orcid.org/0000-0002-9387-3729
Izabel Regina Rubira-Bullen Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil http://orcid.org/0000-0002-5069-9433
Viviane Sarmento Department of Propedeutics and Integrated Clinic, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil http://orcid.org/0000-0002-1594-5192
Walmyr Mello Renal Transplant Unit, Hospital Samaritano, São Paulo, São Paulo, Brazil. http://orcid.org/0000-0003-1155-6189
Maria Fernanda Camargo Renal Transplant Unit, Hospital Samaritano, São Paulo, São Paulo, Brazil. http://orcid.org/0000-0002-8254-0056
Heitor Marques Honório Department of Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil http://orcid.org/0000-0003-0231-3409
Paulo Sérgio da Silva Santos Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil. http://orcid.org/0000-0003-1280-0817

DOI: https://doi.org/10.17126/joralres.2025.039

Keywords: Kidney disease, Chronic kidney disease-mineral and bone disorder, Panoramic radiography, Retrospective study, Bone density, Transplants

Abstract

Aim: Chronic kidney disease is characterized by several systemic complications that result from a profound hydroelectrolytic, metabolic, and immunological imbalance. Abnormalities in the calcium and phosphorus metabolism are highly prevalent among renal patients and increase the systemic complications. This study aimed to assess the risk of low bone density in renal patients through evaluation of panoramic radiographic exams by radiomorphometric indices: mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular alveolar bone reabsorption degree (M/M Ratio).
Material and Methods: A sample of 60 panoramic radiographs: 20 adult pre-transplant renal patients, case group (G1) and 40 controls, paired by sex and age (G2) were evaluated. The morphometric measurements MCW, PMI and M/M ratio were measured. The radiographs were analyzed regarding dental absence, calcification of the style-hyoid ligament (CSHL), and idiopathic radiopaque areas.
Results: Radiomorphometric indices were significantly lower among pre-transplant females (p<0.05) and no significant difference was observed between males in the test and control group. A higher frequency of enostoses was observed among females and of CSHC calcification among males was observed in the pre-transplant patients (p>0.05).
Conclusions: These results suggest that pre-transplant females may present with more pronounced jawbone osteopenia.

References

Nakanishi T, Nanami M, Kuragano T. The pathogenesis of CKD complications; Attack of dysregulated iron and phosphate metabolism. Free Radic Biol Med. 2020; 157:55-62. https://orcid.org/10.1016/j.freeradbiomed.2020.01.024.

Cannata-Andía JB, Martín-Carro B, Martín-Vírgala J, Rodríguez-Carrio J, Bande-Fernández JJ, Alonso-Montes C, Carrillo-López N. Chronic Kidney Disease-Mineral and Bone Disorders: Pathogenesis and Management. Calcif Tissue Int. 2021;108(4):410-422. https://orcid.org/10.1007/s00223-020-00777-1. Epub 2020 Nov 15. PMID: 33190187.

GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020 Feb 29;395(10225):709-733. https://orcid.org/10.1016/S0140-6736(20)30045-3.

Dannewitz B, Sommerer C, Stölzel P, Baid-Agrawal S, Nadal J, Bärthlein B, Wanner C, Eckardt KU, Zeier M, Schlagenhauf U, Krane V, Jockel-Schneider Y. Status of periodontal health in German patients suffering from chronic kidney disease-Data from the GCKD study. J Clin Periodontol. 2020;47(1):19-29. https://orcid.org/10.1111/jcpe.13208.

Kansu O, Ozbek M, Avcu N, Aslan U, Kansu H and Genctoy G. Can dental pulp calcification serve as a diagnostic marker for carotid artery calcification in patients with renal diseases? Dento maxillo facial radiology. 2009;38:542-5.

Patil S, Khaandelwal S, Doni B, Rahuman F and Kaswan S. Oral manifestations in chronic renal failure patients attending two hospitals in North Karnataka, India. Oral health and dental management 2012;11:100-6.

Trzcionka A, Twardawa H, Mocny-Pachońska K, Tanasiewicz M. Oral cavity status of long-term hemodialized patients vs. their socio-economic status. Med Pr. 2020;71(3):279-288. https://orcid.org/10.13075/mp.5893.00948.

Bossola M and Tazza L. Xerostomia in patients on chronic hemodialysis. Nature reviews. Nephrology 2012;8:176-82.

Palmeira E, de Liz Pérez-Losada F, Díaz-Flores-García V, Segura-Sampedro JJ, Segura-Egea JJ, López-López J. Prevalence of oral infections in chronic kidney disease patients: A cross-sectional study. Oral Dis. 2023. https://orcid.org/10.1111/odi.14663.

Mupparapu M, Akintoye SO. Application of Panoramic Radiography in the Detection of Osteopenia and Osteoporosis-Current State of the Art. Curr Osteoporos Rep. 2023;21(4):354-359. https://orcid.org/10.1007/s11914-023-00807-5.

Artese HP, de Sousa CO, Torres MC, Silva-Boghossian CM and Colombo. Effect of non-surgical periodontal treatment on the subgingival microbiota of patients with chronic kidney disease. Brazilian oral research

Taguchi A, Tanaka R, Kakimoto N, Morimoto Y, Arai Y, Hayashi T, Kurabayashi T, Katsumata A, Asaumi J; Japanese Society for Oral and Maxillofacial Radiology. Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis. Oral Radiol. 2021;37(2):189-208. https://orcid.org/10.1007/s11282-021-00518-6.

Gumussoy I, Miloglu O, Cankaya E, Bayrakdar IS. Fractal properties of the trabecular pattern of the mandible in chronic renal failure. Dentomaxillofac Radiol. 2016;45(5):20150389. https://orcid.org/10.1259/dmfr.20150389.

Dilek F, Coşgunarslan A, Canger EM. Evaluation of alterations in length and calcification of the styloid process in patients with end-stage renal failure. Oral Surg Oral Med Oral Pathol Oral Radiol. 2023;136(4):508-517. https://orcid.org/10.1016/j.oooo.2023.05.013.

Scutellari PN, Orzincolo C, Bedani PL, Romano C. Manifestazioni radiografiche dei denti e dei mascellari nell'insufficienza renale cronica [Radiographic manifestations in teeth and jaws in chronic kidney insufficiency]. Radiol Med. 1996;92(4):415-20.

Schmalz G, Patschan S, Patschan D, Ziebolz D. Oral health-related quality of life in adult patients with end-stage kidney diseases undergoing renal replacement therapy - a systematic review. BMC nephrology. 2020; 21:154. https://orcid.org/10.1186/s12882-020-01824-7.

Ostovarrad F, Aghajanzadeh P, Kashi F, Sheykholeslami Kandelousi M. The Evaluation of Correlation Between Serum PTH and Dentoskeletal Changes in Panoramic Imaging of Hemodialysis Patients. Iran J Kidney Dis. 2022;16(3):203-208.

Mizutani K, Mikami R, Gohda T, Gotoh H, Aoyama N, Matsuura T, Kido D, Takeda K, Izumi Y, Sasaki Y, Iwata T. Poor oral hygiene and dental caries predict high mortality rate in hemodialysis: a 3-year cohort study. Sci Rep. 2020;10(1):21872. https://orcid.org/10.1038/s41598-020-78724-1.

Abdinian M, Mortazavi M, Jandaghian Z. Com-parison of skeletal changes related to patients with chronic kidney disease and healthy individuals in digital panoramic radiography. Indian J Dent Res. 2019;30(3):358-362. https://orcid.org/10.4103/ijdr.IJDR_175_18.

Moest T, Jahn AE, Heller K, Schiffer M, Adler W, Rohde M, Weber M, Kesting MR, Lutz R. Peculiarities in the panoramic radiograph of patients with secondary hyperparathyroidism due to terminal renal disease: a radiologic controlled comparative study. Oral Radiol. 2023;39(1):125-132.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology. 2007; 18(6):800-4. https://orcid.org/10.1097/EDE.0b013e3181577654.

Taguchi, A., Tanimoto, K., Suei, Y., Otani, K., & Wada, T. Oral signs as indicators of possible osteoporosis in elderly women. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 1995;80(5):612-616.

Clark R, Burren CP, John R. Challenges of delivery of dental care and dental pathologies in children and young people with osteogenesis imperfecta. European archives of paediatric dentistry: official journal of the European Academy of Paediatric Dentistry. 2019; 20:473-80. https://orcid.org/10.1007/s40368-019-00424-w

Taguchi A, Tanaka R, Kakimoto N, Morimoto Y, Arai Y, Hayashi T, Kurabayashi T, Katsumata A, Asaumi J; Japanese Society for Oral and Maxillofacial Radiology. Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis. Oral Radiol. 2021;37(2):189-208. https://orcid.org/10.1007/s11282-021-00518-6

Nakamoto T, Taguchi A, Kakimoto N. Osteo-porosis screening support system from pano-ramic radiographs using deep learning by convolutional neural network. Dentomaxillofac Radiol. 2022 1;51(6):20220135. https://orcid.org/10.1259/dmfr.20220135.

Alam T, AlShahrani I, Assiri KI, Almoammar S, Togoo RA, Luqman M. Evaluation of Clinical and Radiographic Parameters as Dental Indicators for Postmenopausal Osteoporosis. Oral Health Prev Dent. 2020;18(1):499-504. https://orcid.org/10.3290/j.ohpd.a44688.

Kiswanjaya B, Bachtiar-Iskandar HH, Yoshihara A. Correlations of the Osteoporosis Self-Assessment Tool for Asians (OSTA) and Three Panoramic Indices Using Quantitative Ultrasound (QUS) Bone Densitometry. Dent J (Basel). 2023;11(2):34. https://orcid.org/10.3390/dj11020034. PMID: 36826179; PMCID: PMC9955170.

Hsu CY, Chen LR, Chen KH. Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review. Int J Mol Sci. 2020;21(18):6846. https://orcid.org/10.3390/ijms21186846. PMID: 32961953; PMCID: PMC7555655.

Kinalski MA, Boscato N, Damian MF. The accuracy of panoramic radiography as a screening of bone mineral density in women: a systematic review. Dentomaxillofac Radiol. 2020;49(2):20190149. https://orcid.org/10.1259/dmfr.20190149. Epub 2019 Oct 23. PMID: 31596133; PMCID: PMC7026932.