Evaluation of mandibular bone characteristics on panoramic radiographs using radiomorphometric indices in obese children with and without vitamin D deficiency

Background: Obesity can affect bone structure through various metabolic disturbances, including inflammatory processes, altered mechanical loading, hormonal imbalances, and vitamin D deficiency. This study aimed to evaluate mandibular bone density in obese children, both with and without vitamin D deficiency, compared to healthy children, using radiomorphometric indices. Methods: A total of 120 panoramic radiographs were analyzed, equally divided into three groups (n = 40 each): obese children with vitamin D deficiency, obese children without the deficiency, and healthy controls. Radiomorphometric indices included the mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI). Statistical analyses were performed using SPSS V23 and R 4.4.1. Results: PMI and MI values were significantly higher in both obese groups than in the healthy control group (p < 0.001), whereas no meaningful differences were observed between obese children with and without vitamin D deficiency. MCI distribution did not differ significantly among the groups (p = 0.152). Conclusions: MI and PMI values were higher in obese children than in healthy controls, whereas no meaningful differences were observed between obese children with and without vitamin D deficiency. These findings suggest that quantitative radiomorphometric indices obtained from panoramic radiographs may provide supportive information for the assessment of mandibular bone characteristics in pediatric patients.

Panoramic radiography; Radiomorphometric indices; Vitamin D; Obesity; Children

[1] NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. The Lancet. 2017; 390: 2627–2642.

[2] World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO consultation. World Health Organization: Geneva. 2000.

[3] López-Gómez JJ, Castrillón JLP, de Luis Román DA. Impact of obesity on bone metabolism. Endocrinología y Nutrición. 2016; 63: 551–559.

[4] Ducy P, Amling M, Takeda S, Priemel M, Schilling AF, Beil FT, et al. Leptin inhibits bone formation through a hypothalamic relay: a central control of bone mass. Cell. 2000; 100: 197–207.

[5] Klein KO, Larmore KA, de Lancey E, Brown JM, Considine RV, Hassink SG. Effect of obesity on estradiol level, and its relationship to leptin, bone maturation, and bone mineral density in children. The Journal of Clinical Endocrinology & Metabolism. 1998; 83: 3469–3475.

[6] Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. The Angle Orthodontist. 1994; 64: 175–188.

[7] Vranić L, Mikolašević I, Milić S. Vitamin D deficiency: consequence or cause of obesity? Medicina. 2019; 55: 541.

[8] Holick MF. Vitamin D deficiency. The New England Journal of Medicine. 2007; 357: 266–281.

[9] Riggs BL, Melton LJ III. The prevention and treatment of osteoporosis. The New England Journal of Medicine. 1992; 327: 620–627.

[10] Kwon AY, Huh KH, Yi WJ, Lee SS, Choi SC, Heo MS. Is the panoramic mandibular index useful for bone quality evaluation? Imaging Science in Dentistry. 2017; 47: 87–92.

[11] Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporosis International. 2002; 13: 373–378.

[12] Altunok Ünlü N, Coşgun A, Altan H. Evaluation of bone changes on dental panoramic radiography using mandibular indexes and fractal dimension analysis in children with familial Mediterranean fever. Oral Radiology. 2023; 39: 312–320.

[13] Temur KT, Magat G, Yılmaz M, Ozcan S. Evaluation of the effect of sickle cell disease on the mandibular bone of children and adolescents by image texture and radiomorphometric analysis. Oral Radiology. 2023; 39: 792–801.

[14] Yasa Y, Buyuk SK, Genc E. Comparison of mandibular cortical bone among obese, overweight, and normal weight adolescents using panoramic mandibular index and mental index. Clinical Oral Investigations. 2020; 24: 2919–2924.

[15] Bayrak S, Göller Bulut D, Orhan K, Sinanoğlu EA, Kurşun Çakmak EŞ, Mısırlı M, et al. Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis. Oral Radiology. 2020; 36: 18–24.

[16] Neyzi O, Günöz H, Furman A, Bundak R. Weight, height, head circumference and body mass index references for Turkish children. Journal of Child Health and Diseases. 2008; 51: 1–14.

[17] Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004. Pediatrics. 2009; 124: e362–e370.

[18] Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Scandinavian Journal of Dental Research. 1994; 102: 68–72.

[19] Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofacial Radiology. 1997; 26: 95–100.

[20] Benson BW, Prihoda TJ, Glass BJ. Variations in adult cortical bone mass as measured by a panoramic mandibular index. Oral Surgery, Oral Medicine, Oral Pathology. 1991; 71: 349–356.

[21] Zihni Korkmaz M, Yemenoğlu H, Günaçar DN, Ustaoğlu G, Ateş Yildirim E. The effects of vitamin D deficiency on mandibular bone structure: a retrospective radiological study. Oral Radiology. 2023; 39: 67–74.

[22] Temur KT, Magat G, Onsuren AS, Ozcan S. Comparison of obese and nonobese children and adolescents regarding trabeculation and cortex of the mandibular jaw bone. Nigerian Journal of Clinical Practice. 2025; 28: 331–338.

[23] Dimitri P, Jacques RM, Paggiosi M, King D, Walsh J, Taylor ZA, et al. Leptin may play a role in bone microstructural alterations in obese children. The Journal of Clinical Endocrinology & Metabolism. 2015; 100: 594–602.

[24] Väänänen HK, Härkönen PL. Estrogen and bone metabolism. Maturitas. 1996; 23: S65–S69.

[25] Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. The Journal of Clinical Endocrinology & Metabolism. 2004; 89: 2548–2556.

[26] Jonasson G, Bankvall G, Kiliaridis S. Estimation of skeletal bone mineral density by means of the trabecular pattern of the alveolar bone, its interdental thickness, and the bone mass of the mandible. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2001; 92: 346–352.

[27] Jeddi M, Dabbaghmanesh MH, Ranjbar Omrani G, Ayatollahi SM, Bagheri Z, Bakhshayeshkaram M. Relative importance of lean and fat mass on bone mineral density in Iranian children and adolescents. International Journal of Endocrinology and Metabolism. 2015; 13: e25542.

[28] van Leeuwen J, Koes BW, Paulis WD, van Middelkoop M. Differences in bone mineral density between normal-weight children and children with overweight and obesity: a systematic review and meta-analysis. Obesity Reviews. 2017; 18: 526–546.

[29] Manzoni P, Brambilla P, Pietrobelli A, Beccaria L, Bianchessi A, Mora S, et al. Influence of body composition on bone mineral content in children and adolescents. The American Journal of Clinical Nutrition. 1996; 64: 603–607.

[30] Ding C, Gao D, Wilding J, Trayhurn P, Bing C. Vitamin D signalling in adipose tissue. British Journal of Nutrition. 2012; 108: 1915–1923.

[31] Saggese G, Vierucci F, Boot AM, Czech-Kowalska J, Weber G, Camargo CA III, et al. Vitamin D in childhood and adolescence: an expert position statement. European Journal of Pediatrics. 2015; 174: 565–576.

[32] Laird E, Ward M, McSorley E, Strain JJ, Wallace J. Vitamin D and bone health: potential mechanisms. Nutrients. 2010; 2: 693–724.

[33] Önsüren AS, Temur KT. Evaluation of fractal and radiomorphometric measurements of mandibular bone structure in pediatric patients with molar-incisor hypomineralization. International Journal of Paediatric Dentistry. 2025; 35: 945–953.

[34] Frascino AV, Costa C, Salgado DMRA, Coracin FL, Fava M, Odone-Filho V. Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation. Clinics. 2019; 74: e929.

[35] Seki K, Kashima M, Akiyama T, Kobayashi A, Dezawa K, Takeuchi Y, et al. Reproducibility of mandibular cortical index classification among dental examiners and a single generative AI platform: an observer agreement study. Clinics and Practice. 2026; 16: 142.

[36] Knezović Zlatarić D, Meštrović S, Kostelac D. The comparison of cortical thickness of the lower border of the mandible in three malocclusion groups dependent on age and gender. Acta Stomatologica Croatica. 2006; 40: 116–125.

[37] Tayebi A, Tofangchiha M, Fard MA, Gosili A. The relationship of mandibular radiomorphometric indices to skeletal age, chronological age and skeletal malocclusion type. Journal of Clinical and Experimental Dentistry. 2017; 9: e970–e975.

[38] Sghaireen MG, Alam MK, Patil SR, Rahman SA, Alhabib S, Lynch CD, et al. Morphometric analysis of panoramic mandibular index, mental index, and antegonial index. Journal of International Medical Research. 2020; 48: 300060520912138.

[39] Günen-Yılmaz S, Aytekin Z. Evaluation of jaw bone changes in patients with asthma using inhaled corticosteroids with mandibular radiomorphometric indices on dental panoramic radiographs. Medicina Oral, Patología Oral y Cirugía Bucal. 2023; 28: e285–e292.