Comparative Analysis of Panoramic Radiographic Indices for Detecting Secondary Osteodystrophy

This article aims to evaluate the diagnostic performance of panoramic radiomorphometric indices in detecting mandibular cortical bone loss in renal osteodystrophy patients as a follow-up investigation to prior research. A retrospective case–control imaging study was conducted in accordance with STROBE guidelines. Panoramic radiographs of 11 patients with renal osteodystrophy (mean age: 30.3 ± 5.5 years) and 33 age- and gender-matched healthy controls (mean age: 30.6 ± 5.5 years) were analyzed. Cortical thickness was measured bilaterally at three standardized mandibular sites: gonion region (gonial index [GI]), mental foramen region (mental index [MI]), and molar region (mandibular molar index [MMI]) using the MicroDicom imaging software. Intra-rater reliability was assessed via intraclass correlation coefficient (ICC). Statistical analysis included Welch's t-tests, Cohen's d effect sizes, and receiver operating characteristic (ROC) analysis. All three panoramic indices demonstrated significant reductions in osteodystrophy patients compared to controls (p < 0.01). The GI showed the most pronounced decrease (mean difference: –1.90 mm, 95% CI: –2.15 to –1.65 mm, Cohen's d = 5.87), exceeding reductions in MI (–2.22 mm, d = 1.28) and MMI (–1.85 mm, d = 1.40). Intra-rater reliability was excellent (ICC = 0.905, 95% CI: 0.792–0.958). ROC analysis for GI showed perfect discrimination (AUC = 1.00), with an optimal cutoff >1.27 mm yielding 100% sensitivity and 100% specificity. No significant correlation was observed between mandibular indices and dialysis duration in this small cohort. Panoramic radiographic indices, particularly the GI, are sensitive markers for mandibular cortical bone loss in renal osteodystrophy. In settings where only panoramic radiographs are available—owing to their low cost and wide availability—these measurements may serve as a practical, noninvasive adjunct for detecting skeletal manifestations of chronic kidney disease–mineral and bone disorder. Prospective validation in larger, multicenter cohorts is required before clinical translation.