Validation of dental X-ray by cytokine RANTES – comparison of X-ray findings with cytokine overexpression in jawbone

Clinical, Cosmetic and Investigational Dentistry Dovepress open access to scientific and medical research Original Research Clinical, Cosmetic and Investigational Dentistry downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Open Access Full Text Article Validation of dental X-ray by cytokine RANTES – comparison of X-ray findings with cytokine overexpression in jawbone This article was published in the following Dove Press journal: Clinical, Cosmetic and Investigational Dentistry 21 August 2014 Number of times this article has been viewed Johann Lechner Clinic for Integrative Dentistry, Munich, Germany Introduction All X-ray findings of the jawbone are obtained by means of an optical and visual assessment by the observer. The risk of subjective distortion of the assessment is large, and it generally diminishes with the establishment of reliable criteria of a scientifically objectified procedure. Fatty degenerative osteolytic or chronically osteonecrotic changes of jawbone (FDOJ) seem to present particular problems in dental X-ray diagnostics, which is why they often go undetected in terms of etiology and pathogenesis.1 Undetected FDOJ might also be a problem for the long-term stability of dental implants.2 By comparing X-ray findings with the corresponding expression of proinflammatory mediator regulated on activation, normal T-cell expressed and secreted (RANTES)/C-C motif ligand 5 (CCL5) in the same area of jawbone, this study tries to elucidate whether important silent inflammation in the jawbone remains undetected. Correspondence: Johann Lechner Clinic for Complementary Dentistry, 10A Gruenwalder St, 81547 Munich, Germany Tel +49 89 697 0055 Fax +49 89 692 5830 Email Limitations of X-ray diagnostics in dentistry The limitations of two-dimensional panoramic tomography (2D-OPG) have been sufficiently proven scientifically: apical changes cannot be reliably assessed in 2D-OPG; and 34% of these changes are not detected. One-third to one-half of all 2D-OPG images are therefore not sufficiently informative for dental diagnostics.3 ln dentistry, 71 submit your manuscript | www.dovepress.com Clinical, Cosmetic and Investigational Dentistry 2014:6 71–79 Dovepress © 2014 Lechner. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/CCIDE.S69807 Powered by TCPDF (www.tcpdf.org) Introduction: There is a need to clarify the extent to which the most common diagnostic tool in dentistry – two-dimensional panoramic tomography (2D-OPG) – is suitable for identifying fatty degenerative osteolysis of jawbone (FDOJ). Materials and methods: To obtain a qualitative assessment of edentulous jawbone sections, the results from 2D-OPG with a defined X-ray density (XrDn), expression of the cytokine RANTES (regulated on activation, normal T-cell expressed and secreted), and a transalveolar ultrasound system for measuring jawbone density were compared. Results: The difference in the XrDn of healthy jawbone and FDOJ are minimal, whereas RANTES is up to 25-fold higher in FDOJ. In contrast to 2D-OPG, transalveolar ultrasound showed coincidental findings in FDOJ areas. Discussion: Comparisons of the data revealed a discrepancy between the XrDn of 2D-OPGs and the medullary osteopathies in the jawbone like FDOJ. Conclusion: The data suggest that there is a critical attitude toward the use of 2D-OPG as a sole imaging diagnostic tool for assessing chronic inflammatory processes in the jawbone. Specifically, 2D-OPG is objectively not suitable for depicting FDOJ. Keywords: osteonecrotic jawbone, silent inflammation, RANTES, bone density measurement Dovepress Lechner Clinical, Cosmetic and Investigational Dentistry downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. the structure of the jawbone is often assessed by 2D-OPG with reliable results if there is cortical damage. However, significant limitations in the assessment of medullary bone must be taken into account.3–5 Imaging FDOJ with X-ray A typical case of FDOJ shows little formation of new bone and little sign of healing. In the area affected by FDOJ, there are medullary cavities. The cortical bone is generally intact, and during operation, a clear demarcation can be observed between the cortical bone not involved and the medullary bone eroded by the cavities. FDOJ often presents as fatty clumps of tissue.6 Figure 1 shows one such tissue sample where the majority of the cancellous bone has been converted into fat. FDOJ is characterized by the absence of typical signs of inflammation and by typical fatty erosion and cavities in the medullary jawbone.6 FDOJ must not be confused with classic osteomyelitis. For FDOJ, the etiology is still largely unknown.7 Radiographic symptoms can be so subtle that they are almost impossible to identify without extensive diagnostic experience.8 The problem of X-ray imaging contributes to the neglect of FDOJ as a pathological and pathogenetic change in the jawbone. Other authors also pointed out a significant discrepancy between X-ray findings and the structural abnormality of FDOJ.9 To elucidate this problem, this study examines the reliability of 2D-OPG and attempts to shed light on this with the following questions: is dental 2D-OPG a reliable parameter for identifying medullar changes in the context of FDOJ? Or is it possible that changes in the metabolism of the jawbone may go undetected by 2D-OPG? Is FDOJ eventually connected with systemic diseases? Material and methods This study was performed as a randomized controlled trial. As we showed in an earlier publication,6 the defining feature of areas of FDOJ include overexpression of the proinflammatory messenger RANTES, which is in contrast to what is seen in normal jawbone. In this study, we will compare areas of FDOJ defined by high levels of RANTES with the corresponding X-ray density (XrDn) in 2D-OPG. In addition, XrDn is compared with transalveolar ultrasound (TAU) images. Research is based on data retrieved from patients during normal dental surgery. All patients gave their written informed consent. Groups of patients examined The cases examined consisted of two groups. FDOJ was found in 31 patients. The age range of this group of patients extended from 27–87 years, with an average age of 57 years and a sex ratio (female/male) of 21/10. The age range of the control group that consisted of 19 patients w (...truncated)