Quantitative Assessment of Bone Density at the Borders of Radiolucent Mandibular Lesions Using Cone-Beam Computed Tomography: Correlations With Lesion Aggressiveness.

INTRODUCTION: Radiolucent mandibular lesions present diagnostic challenges owing to their diverse nature, ranging from benign cysts to aggressive neoplasms, with varying impacts on the surrounding bone. This study aimed to evaluate bone density variations at the borders of these lesions using cone-beam computed tomography (CBCT) and to correlate these findings with histopathological indicators of lesion aggressiveness to identify quantitative imaging markers for improved diagnosis and treatment planning.

MATERIALS AND METHODS: A retrospective cross-sectional study was conducted, involving 125 patients with histopathologically confirmed unilocular or multilocular radiolucent mandibular lesions. High-resolution CBCT scans (voxel size ≤0.2 mm) were acquired using a standardized protocol, and bone density was measured in Hounsfield Units (HU) at the anterior, posterior, inferior, superior, buccal, and lingual borders. Regions of interest (1 mm³) were systematically placed with adjacent normal bone as a reference, and measurements were averaged from three repetitions by two trained observers to ensure reliability (intraclass correlation coefficient of 0.87). Descriptive statistics, the Mann-Whitney U test, and linear regression (p < 0.05) were used to analyze bone density differences and associations with lesion characteristics.

RESULTS: Significant bone density variations were noted, with inferior regions showing the highest density (1557.92 HU) and buccal regions the lowest (605.2 HU). Aggressive lesions and the absence of root resorption were strongly associated with reduced bone density across all regions (p < 0.001), except in the buccal region (p = 0.256). The absence of cortical perforation increased buccal density (p < 0.001) but reduced density elsewhere (p ≤ 0.027). Unilocular lesions correlated with higher density in the posterior, superior, and lingual regions (p ≤ 0.024), whereas smooth-bordered lesions were associated with lower density in most regions (p ≤ 0.002) but higher buccal border density (p = 0.035). Female sex was associated with a reduced density at the inferior border (p = 0.001).

CONCLUSION: These findings suggest that CBCT-based bone density measurements can differentiate lesion aggressiveness, with regional variations reflecting biomechanical and pathological interactions, potentially guiding targeted diagnostic and therapeutic strategies.