Title Mandibular Cortical Index Is an Applicable Method for Measuring Osteoporosis Level in Chronic Kidney Disease Patients
Clinical Question In adult patients with chronic kidney disease, can the Mandibular Cortical Index (MCI) in panoramic radiographs be used as ancillary method for observing bone changes?
Clinical Bottom Line Mandibular cortical index in panoramic radiographs is a reliable and valid tool for assessing bone changes in patients with chronic kidney disease, but studies with larger samples are needed to further support this conclusion.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
31397408Abdinian/201960 subjects: 30 CKD patients in stages 3-5 and 30 healthy controlsCross-sectional study
Key resultsThe amount of bony changes according the Mandibular Cortical Index (MCI) assessment based on Kelemetti classification was found to be more evident in patients with chronic kidney disease than in healthy individuals. MCI was statistically different between two groups (P = 0.038). The C3 classification indicating the highest level of porosity was observed in a number of CKD patients, while none of the healthy individuals were classified as C3. On the other hand, the C1 classification indicating a sharp and even cortex was observed in frequent numbers of healthy patients compared to C2.
Evidence Search Pubmed: ("Bone Density"[Mesh]) OR "Renal Insufficiency, Chronic"[Mesh] OR "renal insufficiency, chronic"[MeSH Terms]) AND ("Radiography, Dental, Digital"[Mesh] OR "panoramic"[All Fields]) AND mandible"[MeSH Terms])
Comments on
The Evidence
The authors did compare two groups of patients. One group had 30 CKD stage 3-5 patients and the other had 30 healthy controls. The inclusion and exclusion criteria for patient selection were clear, and the two groups were age and gender matched. Two oral and maxillofacial radiologists measured the parameters with good interobserver agreement (kappa = 0.78). However, it was unclear if observers were blinded. The study did not account for all stages of chronic kidney disease and included a number of elderly patients who might have been prone to osteoporosis due to age and not a disease, without adjusting for such a variable. Studies with larger samples, and designed to overcome these limitations, are needed to further support the conclusion.
Applicability Chronic kidney disease (CKD) affects bone metabolism and demonstrates oral symptoms such as demineralization and reduced trabeculation. Due to the high prevalence of osteoporosis associated with CKD and the frequent usage and prescription of panoramic radiographic images as a screening tool in dentistry, dentist awareness of this radiographic parameter and how to evaluate it in images could provide a non-costly, non-invasive method for detecting osteoporosis in CKD patients.
Specialty (Oral Medicine/Pathology/Radiology) (General Dentistry)
Keywords Chronic kidney disease, CKD, panoramic, radiology, Mandibular Cortical Index, MCI, Osteoporosis.
ID# 3476
Date of submission 11/30/2021
E-mail Alshehris@uthscsa.edu
Author Shatha Alshehri
Co-author(s) Tsu Laura
Co-author(s) e-mail tsu@uthscsa.edu
Faculty mentor Dr. Hassem Geha, D.D.S., M.D.S.
Faculty mentor e-mail geha@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available