Mandibular bone imaging assessment in thalassemia - a systematic review.

Objective: This systematic review aimed to verify if individuals with thalassemia present changes in radiomorphometric indices and fractal analysis that can be accessed using panoramic radiographs.

Material and methods: Observational studies that evaluated cortical and trabecular bone patterns in dental routine radiographs were selected from six bibliographic databases. Risk of bias was analyzed using the Joanna Briggs Institute Critical Appraisal Checklists. Quality of evidence was verified using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results: Two hundred three studies were initially retrieved from databases. Three cross-sectional studies, encompassing a total of 129 thalassemic patients, were deemed eligible after applying the inclusion criteria. Bone mineral density (BMD) evaluations were performed using panoramic radiographs and considered the following radiomorphometric indexes: mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI). Fractal dimension analysis (FDA) and simple visual estimation (SVE) were also employed. Overall, FDA and MCW from thalassemia individuals were lower than controls.

Conclusion: FDA and MCW are frequently altered in patients with thalassemia and may be employed as screening tools for reduced BMD. However, the certainty of evidence for this outcome was very low, mainly due to methodological flaws.