Association Between Nutrient Canal Presence and Trabecular Bone Changes Around Jaw Cysts: A Comparative CBCT Study
Abstract
Objective: This study aimed to investigate the relationship between the presence of nutrient canals and potential trabecular bone changes in jaws with or without cysts, using two different classification methods.
Materials and Methods: CBCT images from 60 patients with unilateral jaw cysts located in either the maxilla or mandible were reviewed retrospectively. Cyst-affected sides with or without nutrient canals were grouped and compared to all unaffected sides combined. Trabecular bone quality was assessed both qualitatively (visual trabecular pattern classification) and quantitatively (modified Lekholm and Zarb classification based on HU ranges). Fisher’s Exact and Fisher-Freeman-Halton tests were used to compare frequencies between groups. Intra-observer reliability was assessed using Kappa statistics. Significance was set at p < 0.05.
Results: Nutrient canals were significantly associated with sclerotic trabecular bone patterns in cyst-affected regions (p = 0.001), with nutrient canals more frequent in areas of “average” or “above-average” trabecular density. Nutrient canals also showed a significant association with the highest bone density category (Q1) in both cystic (p < 0.001) and non-cystic regions (p = 0.003). A significant association was observed between qualitative and quantitative classifications (p < 0.001). Intra-observer reliability was moderate for visual trabecular assessments and high for the quantitative classification.
Conclusion: Sclerotic changes in the trabecular bone around jaw cysts are closely associated with occurrence of nutrient canals, potentially reflecting compensatory vascular adaptation. Nutrient canals should be clearly documented in CBCT reports. The modified Lekholm and Zarb classification may serve as a reliable alternative to visual methods for assessing bone quality on CBCT images.
Ethical Statement
This observational study was approved by the Institutional Review Board of Sivas Cumhuriyet University (No. 2023-06/09) and conducted in accordance with the principles of the Declaration of Helsinki.
Supporting Institution
Sivas Cumhuriyet University
Project Number
2023-06/09
References
- 1. Hirschfeld I. A study of skulls in the American Museum of Natural History in relation to periodontal disease. J Dent Res 1923;5:241-265.
- 2. Pandarinath BG. A radiographic study of mandibular nutrient canals in patients with periodontal diseases. Int Arab J Dent 2013;4:24-31.
- 3. Singh G, Rawson K, Kumar S, Srivastava A, Balakrishnan S, Sinha A. Evaluation of mandibular anterior nutrient canals in periodontal diseases: a prospective case control radiographic study. J Indian Acad Oral Med Radiol 2011;23:5-8.
- 4. Aps JK. Number of accessory or nutrient canals in the human mandible. Clin Oral Invest 2014;18:671-676.
- 5. Reddy VG, Ali I, Shashikanth M. An intraoral periapical radiographic study of nutrient canals as a diagnostic aid in systemic diseases and pathological conditions. J Indian Acad Oral Med Radiol 2008;20:49-53.
- 6. Kishi K, Nagaoka T, Gotoh T, Imai K, Fujiki Y. Radiographic study of mandibular nutrient canals. Oral Surg Oral Med Oral Pathol 1982;54:118-122.
- 7. Rathod SR, Lathiya V, Rathod Y, Bhide A. Assessment of mandibular anterior nutrient canals in patients with and without periodontal disease: a cone beam computed tomographic study. J Indian Acad Oral Med Radiol 2022;34:329-332.
- 8. Tumer H, Orhan K, Aksoy S, Berberoglu A. Cone beam computed tomography evaluation of mandibular nutrient canals in patients with periodontal diseases. Niger J Clin Pract 2023;26:59-64.
- 9. Kaur S, Verma P, Saigal A. Evaluation of mandibular anterior nutrient canals in hypertensive and diabetes mellitus patients: a comparative radiographic study. Tzu Chi Med J 2019;31:118-123.
- 10. Patel J, Wuehrmann A. A radiographic study of nutrient canals. Oral Surg Oral Med Oral Pathol 1976;42:693-701.
- 11. Ryder Jr WB. The significance of “circulatory canals” in roentgenograms of the alveolar process. Am J Orthod Oral Surg 1942;28:640-651.
- 12. Seriwatanachai D, Kiattavorncharoen S, Suriyan N, Boonsiriseth K, Wongsirichat N. Reference and techniques used in alveolar bone classification. J Interdiscipl Med Dent Sci 2015;3:172.
- 13. Al-Ekrish AaA, Widmann G, Alfadda SA. Revised, computed tomography-based Lekholm and Zarb jawbone quality classification. Int J Prosthodont 2018;31:342-345.
- 14. De Oliveira RCG, Leles CR, Normanha LM, Lindh C, Ribeiro-Rotta RF. Assessments of trabecular bone density at implant sites on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:231-238.
- 15. Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 2001;12:79-84.
- 16. Lam E, Mallya S. White and Pharoah's oral radiology: principles and interpretation. 9 ed, Elsevier Health Sciences, 2024.
- 17. Etöz M, Amuk M, Avcı F, Yabacı A. Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas. Oral Radiol 2021;37:109-117.
- 18. Haylaz E, Geduk G, Şeker Ç, İçen M. Jaw cysts: a retrospective study in a Turkish subpopulation. Cumhuriyet Dent J 2022;25:1-6.
- 19. Oliveira MR, Gonçalves A, Gabrielli MAC, de Andrade CR, Vieira EH, Pereira-Filho VA. Evaluation of alveolar bone quality: correlation between histomorphometric analysis and Lekholm and Zarb classification. J Craniofacial Surg 2021;32:2114-2118.
- 20. Rosas-Díaz JC, Córdova-Limaylla NE, Palomino-Zorrilla JJ, Guerrero ME, Carreteros R, Cervantes-Ganoza LA, et al. Repeatability and reproducibility of a modified Lekholm and Zarb bone quality classification based on cone beam computed tomography. J Int Soc Prev Community Dent 2022;14:278-286.
- 21. Morar L, Băciuț G, Băciuț M, Bran S, Colosi H, Manea A, et al. Analysis of CBCT Bone Density Using the Hounsfield Scale. Prosthesis 2022;4:414-423.
- 22. Razi T, Niknami M, Ghazani FA. Relationship between Hounsfield unit in CT scan and gray scale in CBCT. J Dent Res Dent Clin Dent Prospects 2014;8:107-110.
- 23. Selvaraj A, Jain RK, Nagi R, Balasubramaniam A. Correlation between gray values of cone-beam computed tomograms and Hounsfield units of computed tomograms: a systematic review and meta-analysis. Imaging Sci Dent 2022;52:133-140.
- 24. Mah P, Reeves T, McDavid W. Deriving Hounsfield units using grey levels in cone beam computed tomography. Dentomaxillofacial Radiol 2010;39:323-335.
- 25. Yadegari A, Safi Y, Shahbazi S, Yaghoutiazar S, Ghazizadeh Ahsaie M. Assessment of CBCT gray value in different regions-of-interest and fields-of-view compared to Hounsfield unit. Dentomaxillofacial Radiol 2023;52(8):20230187
- 26. Orhan AI, Cesur E, Bezgin T, Orhan K. Knowledge and attitudes of paediatric dentists in Turkey regarding cone beam computed tomography (CBCT). Cumhuriyet Dent J 2021;24:206-215.
- 27. Al-Jamal MFJ, Al-Jumaily HA. Can the bone density estimated by CBCT predict the primary stability of dental implants? A new measurement protocol. J Craniofacial Surg 2021;32:e171-e174.
- 28. Dahiya K, Kumar N, Bajaj P, Sharma A, Sikka R, Dahiya S. Qualitative assessment of reliability of cone-beam computed tomography in evaluating bone density at posterior mandibular implant site. J Contemp Dent Pract 2018;19:426-430.
- 29. Singh N, Sonkesriya S, Bagewadi SB, Anwar S, Abraham S, Parihar AS, et al. Clinical Assessment of bone quality at implant site using CBCT and Hounsfield Unit. J Pharm Bioallied Sci 2023;15:S1305-S1307.
- 30. Kim TH, Lee DY, Jung SK. Comparison of Trabecular bone mineral density measurement using Hounsfield Unit and trabecular microstructure in orthodontic patients using cone-beam computed tomography. Appl Sci 2021;11:1028.
Çene Kistleri Çevresindeki Trabeküler Kemik Değişiklikleri ile Besin Kanalı Varlığı Arasındaki İlişki: Karşılaştırmalı CBCT Çalışması
Abstract
Amaç: Bu çalışma, iki farklı sınıflandırma yöntemi kullanarak, kistli veya kistsiz çenelerde besin kanallarının varlığı ile potansiyel trabeküler kemik değişiklikleri arasındaki ilişkiyi araştırmayı amaçlamıştır.
Materyal ve Metot: Maksilla veya mandibulada tek taraflı çene kistleri bulunan 60 hastanın CBCT görüntüleri retrospektif olarak incelendi. Kistten etkilenen, beslenme kanalı olan ve olmayan taraflar gruplandırıldı ve etkilenmemiş tüm taraflarla karşılaştırıldı. Trabeküler kemik kalitesi hem kalitatif (görsel trabeküler patern sınıflandırması) hem de kantitatif (HU aralıklarına dayalı modifiye Lekholm ve Zarb sınıflandırması) olarak değerlendirildi. Gruplar arasındaki sıklıkları karşılaştırmak için Fisher’ın Kesin Testi ve Fisher-Freeman-Halton testi kullanıldı. Gözlemci içi güvenilirlik Kappa istatistiği kullanılarak değerlendirildi. Anlamlılık düzeyi p < 0,05 olarak belirlendi.
Bulgular: Besin kanalları, kistten etkilenen bölgelerde sklerotik trabeküler kemik paternleriyle anlamlı bir şekilde ilişkiliydi (p = 0,001), besin kanalları “ortalama” veya “ortalamanın üzerinde” trabeküler yoğunluğa sahip bölgelerde daha sık görülmekteydi. Besin kanalları da hem kistik (p < 0,001) hem de kistik olmayan bölgelerde (p = 0,003) en yüksek kemik yoğunluğu kategorisi (Q1) ile önemli bir ilişki gösterdi. Kalitatif ve kantitatif sınıflandırmalar arasında anlamlı bir ilişki gözlemlenmiştir (p < 0,001). Görsel trabeküler değerlendirmelerde gözlemci içi güvenilirlik orta düzeyde, kantitatif sınıflandırmada ise yüksek düzeydeydi.
Sonuç: Çene kistlerinin çevresindeki trabeküler kemikteki sklerotik değişiklikler, besin kanallarının oluşumuyla yakından ilişkilidir ve bu durum, telafi edici vasküler adaptasyonu yansıtıyor olabilir. Besin kanalları, CBCT raporlarında açıkça belgelenmelidir. Modifiye Lekholm ve Zarb sınıflandırması, CBCT görüntülerinde, kemik kalitesini değerlendirmek için görsel yöntemlere güvenilir bir alternatif olabilir.
Ethical Statement
Bu gözlemsel çalışma Sivas Cumhuriyet Üniversitesi Kurumsal İnceleme Kurulu tarafından onaylanmış (No. 2023-06/09) ve Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür.
Supporting Institution
Sivas Cumhuriyet Üniversitesi
Project Number
2023-06/09
References
- 1. Hirschfeld I. A study of skulls in the American Museum of Natural History in relation to periodontal disease. J Dent Res 1923;5:241-265.
- 2. Pandarinath BG. A radiographic study of mandibular nutrient canals in patients with periodontal diseases. Int Arab J Dent 2013;4:24-31.
- 3. Singh G, Rawson K, Kumar S, Srivastava A, Balakrishnan S, Sinha A. Evaluation of mandibular anterior nutrient canals in periodontal diseases: a prospective case control radiographic study. J Indian Acad Oral Med Radiol 2011;23:5-8.
- 4. Aps JK. Number of accessory or nutrient canals in the human mandible. Clin Oral Invest 2014;18:671-676.
- 5. Reddy VG, Ali I, Shashikanth M. An intraoral periapical radiographic study of nutrient canals as a diagnostic aid in systemic diseases and pathological conditions. J Indian Acad Oral Med Radiol 2008;20:49-53.
- 6. Kishi K, Nagaoka T, Gotoh T, Imai K, Fujiki Y. Radiographic study of mandibular nutrient canals. Oral Surg Oral Med Oral Pathol 1982;54:118-122.
- 7. Rathod SR, Lathiya V, Rathod Y, Bhide A. Assessment of mandibular anterior nutrient canals in patients with and without periodontal disease: a cone beam computed tomographic study. J Indian Acad Oral Med Radiol 2022;34:329-332.
- 8. Tumer H, Orhan K, Aksoy S, Berberoglu A. Cone beam computed tomography evaluation of mandibular nutrient canals in patients with periodontal diseases. Niger J Clin Pract 2023;26:59-64.
- 9. Kaur S, Verma P, Saigal A. Evaluation of mandibular anterior nutrient canals in hypertensive and diabetes mellitus patients: a comparative radiographic study. Tzu Chi Med J 2019;31:118-123.
- 10. Patel J, Wuehrmann A. A radiographic study of nutrient canals. Oral Surg Oral Med Oral Pathol 1976;42:693-701.
- 11. Ryder Jr WB. The significance of “circulatory canals” in roentgenograms of the alveolar process. Am J Orthod Oral Surg 1942;28:640-651.
- 12. Seriwatanachai D, Kiattavorncharoen S, Suriyan N, Boonsiriseth K, Wongsirichat N. Reference and techniques used in alveolar bone classification. J Interdiscipl Med Dent Sci 2015;3:172.
- 13. Al-Ekrish AaA, Widmann G, Alfadda SA. Revised, computed tomography-based Lekholm and Zarb jawbone quality classification. Int J Prosthodont 2018;31:342-345.
- 14. De Oliveira RCG, Leles CR, Normanha LM, Lindh C, Ribeiro-Rotta RF. Assessments of trabecular bone density at implant sites on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:231-238.
- 15. Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 2001;12:79-84.
- 16. Lam E, Mallya S. White and Pharoah's oral radiology: principles and interpretation. 9 ed, Elsevier Health Sciences, 2024.
- 17. Etöz M, Amuk M, Avcı F, Yabacı A. Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas. Oral Radiol 2021;37:109-117.
- 18. Haylaz E, Geduk G, Şeker Ç, İçen M. Jaw cysts: a retrospective study in a Turkish subpopulation. Cumhuriyet Dent J 2022;25:1-6.
- 19. Oliveira MR, Gonçalves A, Gabrielli MAC, de Andrade CR, Vieira EH, Pereira-Filho VA. Evaluation of alveolar bone quality: correlation between histomorphometric analysis and Lekholm and Zarb classification. J Craniofacial Surg 2021;32:2114-2118.
- 20. Rosas-Díaz JC, Córdova-Limaylla NE, Palomino-Zorrilla JJ, Guerrero ME, Carreteros R, Cervantes-Ganoza LA, et al. Repeatability and reproducibility of a modified Lekholm and Zarb bone quality classification based on cone beam computed tomography. J Int Soc Prev Community Dent 2022;14:278-286.
- 21. Morar L, Băciuț G, Băciuț M, Bran S, Colosi H, Manea A, et al. Analysis of CBCT Bone Density Using the Hounsfield Scale. Prosthesis 2022;4:414-423.
- 22. Razi T, Niknami M, Ghazani FA. Relationship between Hounsfield unit in CT scan and gray scale in CBCT. J Dent Res Dent Clin Dent Prospects 2014;8:107-110.
- 23. Selvaraj A, Jain RK, Nagi R, Balasubramaniam A. Correlation between gray values of cone-beam computed tomograms and Hounsfield units of computed tomograms: a systematic review and meta-analysis. Imaging Sci Dent 2022;52:133-140.
- 24. Mah P, Reeves T, McDavid W. Deriving Hounsfield units using grey levels in cone beam computed tomography. Dentomaxillofacial Radiol 2010;39:323-335.
- 25. Yadegari A, Safi Y, Shahbazi S, Yaghoutiazar S, Ghazizadeh Ahsaie M. Assessment of CBCT gray value in different regions-of-interest and fields-of-view compared to Hounsfield unit. Dentomaxillofacial Radiol 2023;52(8):20230187
- 26. Orhan AI, Cesur E, Bezgin T, Orhan K. Knowledge and attitudes of paediatric dentists in Turkey regarding cone beam computed tomography (CBCT). Cumhuriyet Dent J 2021;24:206-215.
- 27. Al-Jamal MFJ, Al-Jumaily HA. Can the bone density estimated by CBCT predict the primary stability of dental implants? A new measurement protocol. J Craniofacial Surg 2021;32:e171-e174.
- 28. Dahiya K, Kumar N, Bajaj P, Sharma A, Sikka R, Dahiya S. Qualitative assessment of reliability of cone-beam computed tomography in evaluating bone density at posterior mandibular implant site. J Contemp Dent Pract 2018;19:426-430.
- 29. Singh N, Sonkesriya S, Bagewadi SB, Anwar S, Abraham S, Parihar AS, et al. Clinical Assessment of bone quality at implant site using CBCT and Hounsfield Unit. J Pharm Bioallied Sci 2023;15:S1305-S1307.
- 30. Kim TH, Lee DY, Jung SK. Comparison of Trabecular bone mineral density measurement using Hounsfield Unit and trabecular microstructure in orthodontic patients using cone-beam computed tomography. Appl Sci 2021;11:1028.
Details
| Primary Language | English |
|---|---|
| Subjects | Oral and Maxillofacial Surgery, Oral and Maxillofacial Radiology, Oral Medicine and Pathology |
| Journal Section | Research Article |
| Authors | |
| Project Number | 2023-06/09 |
| Submission Date | August 28, 2025 |
| Acceptance Date | December 28, 2025 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1771581 |
| IZ | https://izlik.org/JA59FB97MR |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.
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