Investigation of the Effect of Periodontitis on Trabecular Bone Structure by Fractal Analysis.

Abstract

Objective: This study aimed to evaluate the trabecular microarchitecture in the interdental region of panoramic radiographs from periodontally healthy individuals and those with stage III/IV periodontitis using fractal analysis (FA), while also assessing the relationship between clinical periodontal parameters and FA outcomes.

Study design: Clinical and radiographic records of 20 periodontally healthy individuals and 19 individuals with stage III/IV periodontitis were included. Clinical measurements including the plaque score, bleeding on probing, probing pocket depth, and clinical attachment level were recorded. A region of interest was selected on panoramic radiographs from the mesial aspect of the mandibular first molar and the distal aspect of the second premolar. The fractal dimension (FD) values for this region were calculated using the box-counting method. The statistical significance of the difference was evaluated at P<0.05.

Results: There was no significant statistical difference in sex between the groups (p > 0.05). Conversely, individuals in the periodontitis group had a significantly higher mean age compared to those in the healthy group (p < 0.01). Clinical measurements were significantly higher in the periodontitis group (p < 0.01). However, no significant differences in FD values were observed between the groups (p > 0.05). In the healthy group, moderate negative correlations were found between FD and clinical parameters (with all p < 0.05), while no such correlations were identified in the periodontitis group (with all p > 0.05).  Conclusion: FA demonstrates potential as a complementary diagnostic tool when used alongside clinical periodontal measurements. However, its effectiveness as a standalone method for reliably distinguishing between healthy individuals and those with periodontitis remains limited. Advanced radiographic analysis can further enhance the identification of anatomical details, thereby improving the accuracy of periodontal evaluations and diagnostics.