Amaç: Çalışmanın amacı, panoramik radyograflar üzerinden fraktal analiz metodu ile yapılacak olan inceleme ile kronik böbrek hastalığına (KBH) sahip olan kişiler ile sağlıklı kişilerin mandibular kemik yapılarının karşılaştırılmasıdır. Gereç ve Yöntemler: Hasta grubuna son evre kronik böbrek hastalığına sahip olup, iki yılı aşkın zamandır diyaliz tedavisi gören 62 hasta dahil edildi. Kontrol grubu ise kemik yapısını etkileyebilecek herhangi bir sistemik hastalığı bulunmayan 62 sağlıklı bireyden oluşturuldu. 124 panoramik radyograf incelendi. İncelenecek alanlar panoramik radyografiler üzerinden belirlendi, ilgili alan 1 (İA1) süngerimsi kemik içinden olacak şekilde seçilirken, İA2 kortikal kemik içinde olacak şekilde seçildi. İlgili alanlara fraktal analiz uygulandı. Bulgular: Kontrol ve hasta grubunu ortalama İA1 fraktal boyut (FB) değerleri sırası ile 1,28±0,1 ve 1,17±0,08 idi. İki grup arasında istatistiksel olarak anlamlı bir farklılık bulundu (p<0,001). Kontrol ve hasta grubunun ortalama İA2 FB değerleri de sırası ile 1,41 ±0,1 ve 1,33±0,07 idi. İki grup arasında istatistiksel olarak anlamlı bir farklılık bulundu (p<0,001). Sonuç: KBH kaynaklı kemik ve mineral bozuklukları ve renal osteodistrofi, kemik fizyolojisini hacim ve mineralizasyon açısından etkiler. Bu durumdan etkilenen çene kemiklerinin, diş çekimi, ortodontik tedavi ve implant tedavisi gibi dental işlemlerin başarısı üzerine önemli klinik etkileri olabilir. KBH-mineral ve kemik bozukluğunun (KBH-MKB) çene kemiği üzerine olan olası etkisinin değerlendirilmesi ve takip edilmesi için, kemiğin radyolojik kontrolü ve kemiğin iç yapısının fraktal analiz ile değerlendirilmesi kullanışlı bir yöntem olabilir.
Anahtar Kelimeler: Böbrek yetmezliği, kronik; radyografi, panoramik; benzer elemanlarin oluşturduğu şekiller; mandibula; kronik böbrek hastaliği- mineral ve kemik bozukluğu
Objectives: The aim of this study was to compare the mandibular bone structure of patients with chronic kidney disease (CKD) and healthy subjects by using fractal analysis method on panoramic radiographs. Material and Methods: 62 patients with end-stage CKD who had been on dialysis treatment for more than two years were included in the study group. The control group consisted of 62 healthy individuals without any systemic disease. 124 panoramic radiographs were evaluated. Areas to be examined were determined through panoramic radiographs, region of interest 1 (ROI1) was selected within the trabecular bone while ROI2 was selected within the cortical bone. Fractal analysis was conducted on the selected ROIs. Results: The mean fractal dimension (FD) values of the control and study groups were 1.28±0.1 and 1.17±0.08 for the ROI1, respectively. The mean FD values of the control and study groups were 1.41±0.1 and 1.33±0.07 for the ROI2, respectively. There was a statistically significant difference between the two groups for each ROI (p<0.001 and p<0.001). Conclusions: CKD related bone mineral disorders and renal osteodystrophy affect bone physiology through bone volume and mineralization. The affected jawbones can have significant clinical effects on the success of dental procedures such as tooth extraction, orthodontic treatment, and implant treatment. Radiological control of the bone and evaluation of the internal structure of the bone by fractal analysis may be a useful method for evaluating and monitoring possible effect of CKD-Mineral and Bone Disorder (CKD-MBD) on the jawbone.
Keywords: Renal insufficiency, chronic; radiography, panoramic; fractals; mandible; chronic kidney disease- mineral and bone disorder
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