Evaluation of Bone Healing After Enucleation of Jaw Cysts Using Region of Interest (ROI)-Based Gray Value Analysis on...

The aim of this study is to evaluate bone healing after enucleation of cystic jaw lesions using region of interest (ROI)-based gray value analysis on panoramic radiographs. Additionally, this study aims to quantitatively assess early postoperative changes in the lesion area and to determine whether grayscale values approach those of the contralateral healthy bone. Furthermore, it seeks to investigate the applicability of panoramic radiography as a reliable and accessible tool for objective radiographic follow-up in routine clinical practice. Therefore, grayscale analysis provides an indirect, quantitative surrogate of bone healing based on relative pixel intensity changes, rather than a direct histological or volumetric assessment of bone healing.

In this retrospective study, 15 patients were selected from approximately 200 patients who presented to our clinic between June 1, 2025, and February 15, 2026, with cystic lesions ≥1.5 cm treated solely by enucleation. Postoperative panoramic radiographs were obtained three to six months after surgery. All images were acquired using the same digital panoramic system under fixed parameters (65 kVp, 5 mA, 17 s). Diagnosis was confirmed histopathologically, and all cases were radicular or dentigerous cysts. Image analysis was performed using ImageJ software (v1.54k; National Institutes of Health, Bethesda, MD). Standardized ROIs (60 × 60 pixels) were defined in the lesion area and the contralateral control area on pre- and postoperative radiographs. Gray values were measured twice and averaged.

The mean grayscale value of the lesion area increased from 77.54 ± 31.19 preoperatively to 94.57 ± 34.05 postoperatively, representing an approximate 22% increase (P < 0.001). In addition, postoperative grayscale values in the lesion region approached those of the contralateral control areas. The observed change demonstrated a large effect size, indicating that the radiographic improvement was not only statistically significant but also clinically meaningful.

ROI-based grayscale analysis is a practical, reproducible, and cost-effective method for assessing postoperative radiographic changes related to bone healing after enucleation of cystic jaw lesions. This analysis, performed via panoramic radiographs, provides objective and reliable data for clinical follow-up. Furthermore, this approach may serve as a cost-effective and accessible alternative for quantitative monitoring of early bone healing in routine clinical practice, especially when advanced imaging modalities are not readily available.