Evaluation of trabecular bone in individuals with periodontitis using fractal analysis: An observational cross-sectional study

BACKGROUND: It is very difficult to objectively evaluate the negative changes in bone structure due to periodontitis. The present study was aimed to evaluate the trabecular bone structure between healthy individuals and periodontitis patients by fractal analysis (FA) on digital panoramic radiographs. MATERIAL AND METHODS: The study included 50 periodontally healthy individuals (control group), 50 individuals with Stage 1 periodontitis (S1-P group), 50 individuals with Stage 2 periodontitis (S2-P), and 50 individuals with Stage 3 periodontitis (S3-P), a total of 200 individuals were included. The fractal dimension (FD) value of the trabecular bone in the interdental space between mandibular first molar and second premolar tooth roots was evaluated using Image J program. The mean FD values of the two regions were calculated by box counting method. RESULTS: There was a statistically significant difference between the groups in terms of all periodontal parameter values (p<0.05). The mean FD values of individuals diagnosed with periodontitis were 1.36±0.08 in the S1-P group, 1.35±0.07 in the S2-P group, 1.28±0.15 in the S3-P group, and 1.44±0.06 in the control group. When the FD values between the groups were examined, it was seen that there was a statistically significant difference between the control and individuals with periodontitis, and the mean FD values were significantly higher in the healthy group (p<0.05). The best receiver operator curve was identified for periodontitis at the ≤1.409 cut-off FD value (area under the curve: 0.828; 95% CI: 0.758-0.899); p=0.000, p<0.001). CONCLUSIONS: FD evaluation can give an objective result about the effect of periodontitis on alveolar bone. The FD values of trabecular bone are different in healthy individuals and individuals with different stages of periodontitis. The findings suggested that a negative correlation between the periodontal data with the sites in which FD was measured and as the periodontitis stage progresses, FD decreases. Key words:Diagnosis, Periodontal Diseases, Radiographic Evaluation.