{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:46:25Z","timestamp":1788540385611,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Osteoporosis is a widespread and chronic systemic bone disease that affects the jaws and teeth and, therefore, also dentistry. Osteoporosis can be diagnosed by different radiological methods. Dental cone beam computed tomography (CBCT) plays an important role in dentistry imaging. The aim of our retrospective pilot study was to find criteria in CBCT that point to the possible existence of osteoporosis. Methods: Pilot study. The hard palate thickness (HPT) of the patients was measured at a defined location in the CBCT. Additionally, the CBCT images were presented to a radiologist for visual assessment. Both results were compared with the DXA measurements\u2014as the \u201cgold standard\u201d\u2014and patient history. Results: We found a consistent correlation between the visual assessments using established radiological criteria, including the new criterion of hard palate thickness (HPT), and the diagnosis of normal or pathological bone density. Secondly, for the HPT measurement all \u201cpathologic\u201d CBCT had an HPT of \u22640.9 mm, and all normal patients had an HPT of \u22650.9 mm. Conclusions: Despite the small sample size, this CBCT pilot study showed a correlation between HPT and systemic bone disease. Therefore, as our main result, we found a new CBCT diagnostic criterion, which quickly and uncomplicatedly points to the possible existence of bone disease, especially osteoporosis. We propose HPT as a new criterion in the evaluation of CBCT images. A threshold of &lt;0.9 mm may be indicative for osteoporosis or osteopenia, indicating a need for further evaluation.<\/jats:p>","DOI":"10.3390\/diagnostics15131603","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T03:53:02Z","timestamp":1750823582000},"page":"1603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Early Detection of Osteoporosis Through the Measurement of Hard Palate Thickness (HPT) Using Dental Cone Beam Computed Tomography (CBCT): A New Indicator for Osteoporosis?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7041-6592","authenticated-orcid":false,"given":"Margrit-Ann","family":"Geibel","sequence":"first","affiliation":[{"name":"Dento-Maxillofacial Radiology, Department of Maxillofacial Surgery, University Hospital Ulm, 89070 Ulm, Germany"},{"name":"Center for Oral and Maxillofacial Surgery, Department of Dentistry, Danube University, 3500 Krems an der Donau, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7311-3191","authenticated-orcid":false,"given":"Dritan","family":"Turhani","sequence":"additional","affiliation":[{"name":"Center for Oral and Maxillofacial Surgery, Department of Dentistry, Danube University, 3500 Krems an der Donau, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilmann","family":"Blasenbrey","sequence":"additional","affiliation":[{"name":"Dento-Maxillofacial Radiology, Department of Maxillofacial Surgery, University Hospital Ulm, 89070 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7523-1979","authenticated-orcid":false,"given":"Meinrad","family":"Beer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89070 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Kildal","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89070 Ulm, Germany"},{"name":"Radiology, Upper Valais Hospital Center (SZO), H\u00f4pital du Valais, 3900 Brig, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bartl, R. (2014). Klinische Osteologie, Thieme-Verlag. [1st ed.].","DOI":"10.1055\/b-002-95259"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s11657-020-00800-w","article-title":"Estimated epidemiology of osteoporosis diagnoses and osteoporosis-related high fracture risk in Germany: A German claims data analysis","volume":"15","author":"Hadji","year":"2020","journal-title":"Arch. Osteoporos."},{"key":"ref_3","first-page":"665","article-title":"Inzidenz von Frakturen in der Erwachsenenpopulation in Deutschland Dtsch \u00c4rztebl","volume":"118","author":"Pfeifer","year":"2021","journal-title":"Dtsch. \u00c4rzteblatt Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00129-012-3086-6","article-title":"Osteoporose","volume":"46","author":"Ziller","year":"2013","journal-title":"Gyn\u00e4kologe"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00259-024-06912-6","article-title":"International Working Group on DXA Best Practices. Updated practice guideline for dual-energy X-ray absorptiometry (DXA)","volume":"52","author":"Slart","year":"2025","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.ajog.2005.08.047","article-title":"Epidemiology, etiology, and diagnosis of osteoporosis","volume":"194","author":"Lane","year":"2006","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_7","unstructured":"(2023). Prophylaxe, Diagnostik und Therapie der OSTEOPOROSE bei postmenopausalen Frauen und bei M\u00e4nnern ab dem 50.Lebensjahr. Leitlinie des Dachverbands der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaften e.V., Available online: https:\/\/leitlinien.dv-osteologie.org\/wp-content\/uploads\/2025\/05\/05-2025_DVO-Leitlinie-zur-Diagnostik-und-Therapie-der-Osteoporose-Version-2.2.-2023-25.pdf."},{"key":"ref_8","first-page":"68","article-title":"Pantomography in assessment of the osteoporosis risk group","volume":"102","author":"Klemetti","year":"1994","journal-title":"Scand. J. Dent. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jocd.2015.06.012","article-title":"Clinical Use of Quantitative Computed Tomography (QCT) of the Hip in the Management of Osteoporosis in Adults: The 2015 ISCD Official Positions-Part I","volume":"18","author":"Engelke","year":"2015","journal-title":"J. Clin. Densitom."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2707","DOI":"10.1007\/s00330-010-1845-0","article-title":"Radiation exposure in X-ray-based imaging techniques used in osteoporosis","volume":"20","author":"Damilakis","year":"2010","journal-title":"Eur. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bartl, R., and Bartl, C. (2011). Pr\u00e4vention, Diagnostik, Therapie. Osteoporose, Thieme. [4th ed.].","DOI":"10.1055\/b-001-1073"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/j.1600-051X.2008.01365.x","article-title":"Tooth loss and osteoporosis. the OSTEODENT study","volume":"36","author":"Tzoutzoukos","year":"2009","journal-title":"J. Clin. Periodontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6831-8-32","article-title":"Influence of bone density on implant stability parameters and implant success: A retrospective clinical study","volume":"8","author":"Turkyilmaz","year":"2008","journal-title":"BMC Oral Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1111\/j.1708-8208.2011.00350.x","article-title":"Peri-implant bone density in senile osteoporosis-changes from implant placement to osseointegration","volume":"15","author":"Kensuke","year":"2013","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/cid.12290","article-title":"Influence of Skeletal and Local Bone Density on Dental Implant Stability in Patients with Osteoporosis","volume":"18","author":"Merheb","year":"2016","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_16","unstructured":"Stein, J.M., Conrads, G., G\u00fcntsch, A., Kindermann, T., Kleber, B.M., Klinger, G., and Seltmann, T. (2010). Moderne Parodontologie in der Praxis: Band 1: Grundlagen, Klassifikation und Diagnostik, Spitta Verlag."},{"key":"ref_17","unstructured":"Riether, T. (2023). Fr\u00fcherkennung von Osteoporose im CT als diagnostisches Mittel in Form einer Kurz-Screening Methode am Palatum Durum. [Ph.D. Thesis, Universit\u00e4t Ulm]."},{"key":"ref_18","unstructured":"Kalter, L. (2025, February 01). The 5 Things Dentists Wished Doctors Weren\u2019t Missing. Available online: https:\/\/www.mdedge.com\/familypracticenews\/article\/266826\/preventive-care\/5-things-dentists-wished-physicians-werent-missing."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1038\/sj.dmfr.4600674","article-title":"Oral radiographic predictors of osteoporosis","volume":"31","author":"White","year":"2002","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s001980200042","article-title":"Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density","volume":"13","author":"Devlin","year":"2002","journal-title":"Osteoporos Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1111\/j.1601-0825.2009.01615.x","article-title":"Triage screening for osteoporosis in dental clinics using panoramic radiographs","volume":"16","author":"Taguchi","year":"2010","journal-title":"Oral Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5624\/isd.2011.41.3.101","article-title":"Utility of the computed tomography indices on cone beam computed tomography images in the diagnosis of osteoporosis in women","volume":"41","author":"Koh","year":"2011","journal-title":"Imaging Sci. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Alshomrani, F. (2024). Cone-Beam Computed Tomography (CBCT)-Based Diagnosis of Dental Bone Defects. Diagnostics, 14.","DOI":"10.3390\/diagnostics14131404"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1259\/dmfr\/30424604","article-title":"Osteoporosis detection using intraoral densitometry","volume":"37","author":"Nackaerts","year":"2008","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/j.1447-0594.2009.00518.x","article-title":"Dental and radiographic findings as predictors of osteoporosis in postmenopausal women","volume":"9","author":"Erdogan","year":"2009","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.tripleo.2004.11.020","article-title":"Age and trabecular features of alveolar bone associated with osteoporosis","volume":"100","author":"Lee","year":"2005","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/0030-4220(91)90314-3","article-title":"Variations in adult cortical bone mass as measured by a panoramic mandibular index","volume":"71","author":"Benson","year":"1991","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1007\/s00132-016-3340-z","article-title":"Osteoporoseerkennung mittels digitaler Volumentomographie","volume":"45","author":"Geibel","year":"2016","journal-title":"Orthop\u00e4de"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s00198-004-1796-x","article-title":"Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly","volume":"16","author":"Halling","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.bone.2006.07.025","article-title":"Accuracy in osteoporosis diagnosis of a combination of mandibular cortical width measurement on dental panoramic radiographs and a clinical risk index (OSIRIS): The OSTEODENT project","volume":"40","author":"Karayianni","year":"2007","journal-title":"Bone"},{"key":"ref_31","unstructured":"L\u00f6ffler, F. (2017). Osteoporoseerkennung Mittels Digitaler Volumentomographie (DVT). [Ph.D. Thesis, University of Ulm]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1007\/s00198-021-05887-6","article-title":"Application of artificial intelligence in diagnosis of osteoporosis using medical images: A systematic review and meta-analysis","volume":"32","author":"Gao","year":"2021","journal-title":"Osteoporos. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00198-024-07229-8","article-title":"Diagnostic accuracy of artificial intelligence models in detecting osteoporosis using dental images: A systematic review and meta-analysis","volume":"36","author":"Khadivi","year":"2025","journal-title":"Osteoporos. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.3390\/tomography9050141","article-title":"Modular Neural Networks for Osteoporosis Detection in Mandibular Cone-Beam Computed Tomography Scans","volume":"9","author":"Namatevs","year":"2023","journal-title":"Tomography"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/S0009-9260(60)80012-8","article-title":"The radiological diagnosis of osteoporosis: A new approach","volume":"11","author":"Barnett","year":"1960","journal-title":"Clin. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1259\/0007-1285-35-417-632","article-title":"Cortical thickness as an estimate of mineral content of human humerous and femur","volume":"35","author":"Virtama","year":"1962","journal-title":"Br. J. Radiol."},{"key":"ref_37","first-page":"457","article-title":"Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. The Journal of bone and joint surgery","volume":"52","author":"Singh","year":"1970","journal-title":"Am. Vol."},{"key":"ref_38","first-page":"281","article-title":"Morphometrie und Bestimmung kortikodiaphyser Indizes der Klavikula im konventionellen Thoraxr\u00f6ntgenbild bei Gesunden und Knochenerkrankungen","volume":"137","author":"Hermanutz","year":"1982","journal-title":"R\u00f6Fo"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/2229-516X.149228","article-title":"Tibial cortical thickness: A dependable tool for assessing osteoporosis in the absence of dual energy X-ray absorptiopmetry","volume":"5","author":"Elshaboury","year":"2015","journal-title":"Int. J. Appl. Basic Med. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s00117-024-01318-9","article-title":"Thickness of the hard palate","volume":"64","author":"Kildal","year":"2024","journal-title":"Die Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S1795","DOI":"10.4103\/jpbs.jpbs_1145_23","article-title":"Comparing Radiation Doses in CBCT and Medical CT Imaging for Dental Applications","volume":"16","author":"Khader","year":"2024","journal-title":"J. Pharm. Bioallied. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S883","DOI":"10.4103\/jpbs.jpbs_1077_23","article-title":"Comparing Radiation Doses in CBCT and Medical CT Imaging for Dental Applications","volume":"16","author":"Zaman","year":"2024","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Steegman, R.M., Klein Meulekamp, A.F., Renkema, A.-M., Janssen, K.I., Kuijpers-Jagtman, A.M., and Ren, Y. (2024). Three-Dimensional Cone Beam Computed Tomography (CBCT)-Derived Soft Tissue Changes in Patients with Unilateral Cleft Lip, Alveolus, and Palate with Midfacial Deficiency after 1.5 Years of Bone-Anchored Maxillary Protraction. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102890"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Poiana, I.R., Dobre, R., Popescu, R.-I., Pituru, S.-M., and Bucur, A. (2023). Utility of Cone-Beam Computed Tomography in the Detection of Low Bone Mass\u2014A Systematic Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185890"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Isayev, A., Velieva, N., Isedisha, L., Isayeva, Z., Kamburo\u011flu, K., and Kuyumcu, F. (2023). Cone-Beam Computed Tomography as a Prediction Tool for Osteoporosis in Postmenopausal Women: A Systematic Literature Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13061027"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"20120273","DOI":"10.1259\/dmfr.20120273","article-title":"Assessment of the effective doses from two dental cone beam CT devices","volume":"42","author":"Schilling","year":"2013","journal-title":"Dentomaxillofac. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/13\/1603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:58:04Z","timestamp":1760032684000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/13\/1603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":46,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15131603"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15131603","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]}}}