Mandibular Radiographic Assessment in Sickle Cell Disease: A Systematic Review of Radiomorphometric Indices and...

Area of Science:

• Oral Radiology
• Hematology
• Bone Metabolism

Background:

• Sickle cell disease (SCD) is associated with systemic complications, including potential bone density reduction.
• Assessing bone mineral density (BMD) in SCD patients is crucial for managing skeletal health.
• Dental radiographic images offer a potential, non-invasive method for evaluating bone health.

Purpose of the Study:

• To systematically review the association between sickle cell disease (SCD) and reduced bone mineral density (BMD).
• To evaluate the utility of radiomorphometric indices (RMI) and fractal dimension analysis (FDA) on dental radiographs for assessing BMD in SCD.
• To synthesize evidence on the diagnostic potential of these dental imaging techniques in SCD.

Main Methods:

• Systematic review of observational studies evaluating BMD in SCD individuals using RMI or FDA.
• Comprehensive literature search across six databases and grey literature.
• Risk of bias assessed using Joanna Briggs Institute tools; certainty of evidence evaluated with GRADE.

Main Results:

• Five cross-sectional studies (2008-2024) from Turkey and Brazil were included, involving 199 SCD patients.
• Radiomorphometric indices (mandibular cortical index, width, panoramic index) and fractal dimension analysis were assessed.
• All included studies exhibited a high risk of bias (>25%), indicating low methodological quality.

Conclusions:

• Radiomorphometric indices and fractal dimension analysis show promise as supplementary screening tools for bone mineral density in sickle cell disease patients.
• The clinical applicability of these dental radiographic methods is currently limited due to significant methodological heterogeneity and very low certainty of evidence.
• Further high-quality research is needed to validate these techniques for routine clinical use in SCD management.