Impact of radiotherapy on mandibular bone: A retrospective study of digital panoramic radiographs

Abstract

Purpose: The purpose of this study was to investigate the impact of radiotherapy on mandibular bone tissue in head and neck cancer patients through an analysis of pixel intensity and fractal dimension values on digital panoramic radiographs. Materials and Methods: Thirty patients with radiographic records from before and after 3-dimensional (3D) conformational radiotherapy were selected. A single examiner carried out digital analyses of pixel intensity values and fractal dimensions, with the areas of interest unilaterally located in the right angle medullary region of the mandible below the mandibular canal and posterior to the molar region. Results: Statistically significant decreases were observed in the mean pixel intensity (P = 0.0368) and fractal dimension (P = 0.0495) values after radiotherapy. Conclusion: The results suggest that 3D conformational radiotherapy for head and neck cancer negatively affected the trabecular microarchitecture and mandibular bone mass.

Head and neck radiotherapy-induced changes in dentomaxillofacial structures detected on panoramic radiographs: A systematic review

“…A total of 13,261 research articles were initially found in the databases after searching for all keywords. After applying the eligibility criteria and removing overlapping studies, 13,228 investigations were excluded, and a total of 33 studies 5 , 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 on the oral and maxillofacial effects of radiotherapy, as assessed by panoramic radiographs, were included. Table 1 summarizes the details of the selected studies.…”

“…The oldest study was published in 1980, 40 while the most recent ones were published in 2020. 9 10 The number of participants evaluated in the sample studied ranged from 8 37 to 176, 31 and the samples included were highly heterogeneous. Patients with head and neck cancer were often included in the investigated samples, 5 17 19 22 24 28 29 30 31 32 33 34 35 36 37 40 as were patients with hematopoietic neoplasms (such as leukemia), 12 18 23 28 33 although those with neck cancer were also studied independently.…”

“… 17 31 The effects on oral structures such as teeth in children survivors of head and neck rhabdomyosarcoma was the subject of 4 investigations. 10 14 22 33 Surgical outcomes or complications in patients who received radiotherapy were evaluated in 10 studies, 9 11 13 15 19 25 26 27 34 37 while changes in marginal bone levels or survival rates of implants were investigated in 2 studies. 21 24 Lastly, the appearance of the mandible, 20 29 apical periodontitis, 5 and dental abnormalities or dental status alterations due to radiotherapy 18 23 28 30 32 33 were also assessed using panoramic radiographs.…”

Radiographic analysis of the management of tooth extractions in head and neck-irradiated patients: a case series

“… 12 However, few studies have demonstrated evidence of such damage through panoramic image evaluations of HNRT patients. 4 5 6 …”

“…Studies that analyzed panoramic images of HNRT patients revealed alterations such as a widened periodontal ligament space, 4 reduced thickness of the mandibular canal and cortex, 5 and decreased mean pixel intensity and fractal dimension values of the mandibular bone as side effects of ionizing irradiation on bone tissue. 6 These results suggests that research into post-radiotherapy jaw changes on imaging exams may predict ORN risk and provide insights into the need for conservative dental treatment or other preventive measures. However, the imaging profile of bone repair processes after invasive procedures, such as tooth extractions, in HNRT patients remains unknown.…”