Mandibular Radiographic Assessment in Sickle Cell Disease: A Systematic Review of Radiomorphometric Indices and Fractal Dimension

Santos DBDN, Santos BCOD, Silva LCD, Santos MPAD, Munhoz L, Andrade BAB, Tenório JR

Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 2026

Abstract

Aim: This systematic review aimed to investigate the association between sickle cell disease (SCD) and reduced bone mineral density (BMD) using radiomorphometric indices (RMI) and fractal dimension analysis (FDA) on dental radiographic images.

Methods and results: Observational studies evaluating BMD in individuals with SCD through RMI or FDA were included. A comprehensive search was conducted across six databases and grey literature in March 2025. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool for cross-sectional studies, and certainty of the evidence was assessed using the GRADE approach. Five cross-sectional studies published between 2008 and 2024, conducted in Turkey and Brazil, were included. One hundred ninety-nine SCD individuals were evaluated and the samples varied in terms of SCD genotype. The RMIs assessed were the mandibular cortical index, mandibular cortical width (MCW), panoramic mandibular index (PMI). FDA was applied in 03 studies. All studies had a risk of bias exceeding 25%, indicating low methodological quality.

Conclusions: RMI and FDA show potential as adjunctive screening tools in patients with SCD. However, due to methodological heterogeneity and very low certainty of evidence, their clinical applicability remains limited.

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