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Application of fractal analysis in hyperparathyroidism

S Ergün¹, A Saraçolu², P Güneri¹ and B Özpnar²

¹Department of Oral Diagnosis and Radiology, Ege University School of Dentistry, Izmir, Turkey; ²Department of Prosthodontics, Ege University School of Dentistry, Izmir, Turkey

*Correspondence to: Dr Selin Ergün, Ege University, Faculty of Dentistry, Department of Oral Diagnosis and Radiology, Bornova 35100, Izmir, Turkey; E-mail: seling77{at}yahoo.com; selin.gogus{at}ege.edu.tr

Received 3 March 2008; revised 20 May 2008; accepted 23 May 2008

Objectives: Primary hyperparathyroidism (HPT) is a condition caused by an overproduction of parathormone, in excess of the amount required by the body. Its most common cause is a parathyroid gland adenoma and parathyroidectomy is currently the only curative treatment for primary HPT. We present a case history of a 65-year-old patient who was diagnosed with primary HPT after the recognition of dental problems.

Methods: Dental complaints of the patient alerted the dentists, and the patient was referred for further medical evaluation. In addition to his current medical status, his medical records including the biochemical parameters of bone metabolism recorded between 2001 and 2006 were reviewed. The panoramic films of the patient obtained between 1997 and 2008 were also assessed with the fractal analysis method.

Results: After consideration of the radiographical, biochemical and clinical evaluations of the patient, the final diagnosis was made as hyperparathyroid adenoma and surgical removal was scheduled. Soon after surgery, alkaline phosphatase, calcium and intact parathormone levels returned to normal. The fractal analysis value of the mandibular alveolar bone also increased.

Conclusions: Dentoalveolar changes observed in HPT include alveolar bone demineralization. The fractal dimension (FD) analysis of the bone tissue has been introduced as an alternative method to investigate the quality of the alveolar bone. FD values of the patient showed osteoporotic bone characteristics between 1997 and 2006 until the date of parathyroidectomy. Mandibular bone FD analyses revealed a prominent development, which was also observed in dual energy X-ray absorptiometry values.

Keywords: primary hyperparathyroidism, parathyroid adenoma, digital radiography, fractals