Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis

The effect of mentoplate application on the condyle

BACKGROUND

The aim of the study was to investigate the changes occurring in the mandibular condyle by using mentoplate together with rapid maxillary expansion (MP-RME) treatment in the correction of skeletal class III relationship, using fractal analysis (FA).

METHODS

The sample consisted of 30 individuals (8-11 years) diagnosed with skeletal Class III malocclusion who underwent MP-RME treatment. Archival records provided cone-beam computed tomography (CBCT) images taken at two intervals: before MP-RME treatment (T0) and after treatment (T1). The CBCT images were obtained using standardized settings to ensure consistency in image quality and resolution. The trabecular structures in the bilateral condyles at both T0 and T1 were analyzed using FA. The FA was performed on these condylar images using the Image J software. The region of interest (ROI) was carefully selected in the condyle to avoid overlapping with cortical bone, and the box-counting method was employed to calculate the fractal dimension (FD). Statistical analysis was conducted to compare the FD values between T0 and T1 and to evaluate gender differences. The statistical significance was determined using paired t-tests for intra-group comparisons and independent t-tests for inter-group comparisons, with a significance level set at p < 0.05.

RESULTS

The analysis revealed no statistically significant differences in the trabecular structures of the condyles between T0 and T1 (p > 0.05). However, a significant gender difference was observed in FA values, with males exhibiting higher FA values in the left condyle compared to females at both T0 and T1 (p < 0.05). Specifically, the FA values in the left condyle increased from a mean of 1.09 ± 0.09 at T0 to 1.13 ± 0.08 at T1 in males, whereas in females, the FA values remained relatively stable with a mean of 1 ± 0.09 at T0 and 1.03 ± 0.11 at T1.

CONCLUSION

The findings indicate that MP-RME therapy does not induce significant alterations in the trabecular structure of the mandibular condyle. These results suggest the treatment's safety concerning the structural integrity of the condyle, although the observed gender differences in FA values warrant further investigation.

Evaluation of mandibular trabecular bone structure in growing children with Class I, II, and III malocclusions using fractal analysis: A retrospective study

OBJECTIVE

The present study aimed to evaluate the mandibular bone structure of patients with different malocclusions by using fractal dimension (FD) analysis on dental panoramic radiographic images.

MATERIAL AND METHODS

Pre-treatment panoramic radiographic images of 103 patients were included in the study and divided into 3 groups as Class I (group 1: 0

RESULTS

FD values were lower in Class I sagittal skeletal pattern than Class II and III groups in anterior ROI FD, premolar ROI FD, angulus ROI FD, and mean FD values. There were differences between Class I and Class III skeletal patterns (P=0.023 for anterior ROI FD, P=0.016 for premolar ROI FD, P=0.034 for angulus ROI FD, and P=0.014 for mean FD). Class I and II malocclusions differed in anterior ROI FD (P=0.029) and also Classes II and III showed differences in angulus ROI FD (P=0.029).

CONCLUSION

Sagittal skeletal patterns may result in differences in the structure of the mandibular trabecular bone.

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Key Words

• Fractal dimension analysis
• Orthodontics
• Panoramic radiography
• Sagittal skeletal malocclusions

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Affiliation(s)

Hümeyra Tercanlı Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, 07058 Antalya, Turkey
Esra Bolat Gümüş Department of Orthodontics, Faculty of Dentistry, Akdeniz University, 07058 Antalya, Turkey.

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Assessment of jaw bone mineral density, resorption rates, and oral health in patients with severe hemophilia: a case-control study

OBJECTIVE

Knowledge about oral hygiene, gingival bleeding, mineral density, and resorption of jaw bones in patients with hemophilia is limited. We evaluated the periodontal and bone status in such patients.  Material and methods: Forty-eight patients with severe type A/B hemophilia and 49 age- and sex-matched controls were included. Assessments included simplified oral hygiene index (OHI-S), calculus index, debris index, gingival index (GI), gingival bleeding time index (GBTI), and decayed, missing, and filled teeth index (DMFTI). Bone resorption was evaluated using panoramic mandibular index (PMI), mental index (MI), and alveolar crest ratio (ACR). Mineral density in the condyle, angulus, and premolar areas was assessed using fractal analysis, with fractal dimensions denoted as condyle fractal dimension (CFD) for the condyle, angulus fractal dimension (AFD) for angulus, and premolar fractal dimension (PFD) for premolar region.

RESULTS

The mean scores were DMFTI = 11.77, OHI-S = 2.44, PMI = 0.268, MI = 5.822, GI = 3.02, GBTI = 2.64, ACR = 2.06, CFD = 1.31, AFD = 1.31, and PFD = 1.17 in the hemophilia group and DMFTI = 11.449, PMI = 0.494, MI = 7.43, GI = 0.67, GBTI = 0.98, OHI-S = 1.45, ACR = 2.87, CFD = 1.35, AFD = 1.35, and PDF = 1.23 in the control group. Differences were significant for all parameters (p < 0.005) except for the DMFTI index.  Conclusions: Because of poor oral hygiene, high bone resorption, and low bone mineral density in these patients, clinicians should consider potential bone changes when planning to treat these patients.

Degenerative Temporomandibular Disorders: An Assessment of Bone Trabecular Structure Using Fractal Analysis in Digital Panoramic Radiographs

Introduction Fractal analysis has proved to be a salient tool to quantitatively assess the qualitative changes in the bone trabeculae of patients with hyperparathyroidism, osteoporosis, and various temporomandibular disorders, including osteoarthritis (OA) and rheumatoid arthritis of temporomandibular joint (TMJ), in several previous studies. The purpose of this study was to use fractal analysis to assess alterations in the trabecular pattern of the mandibular condyle in patients with degenerative temporomandibular disorders. Materials and methods This study comprised 98 subjects with 49 subjects in the study group and 49 subjects in the control group, aged 18-50 years. Age and sex in the control group were matched to those in the case group. The subjects were assessed clinically with the Diagnostic Criteria for Temporomandibular Disorders. Digital panoramic X-ray equipment with set parameters of 70 kvp, 8 mA, and 16-second exposure duration was used to take panoramic radiographs. Fractal analysis was done and the calculated fractal dimension value was obtained using ImageJ version 1.48 software (National Institutes of Health, Bethesda, MD). The same observer used Muir and Goss's method to rate the total degenerative changes in the condylar surfaces, which were substantiated by the calculated fractal dimension value. The data were statistically analyzed. Results The results revealed a significant difference (p-value = 0.041) between the mean fractal value in the case group's (1.35) and the control group's (1.38) left sides whereas the differences in the mean fractal values between the case and control groups on the right side was not significant (p-value = 0.49). Conclusion It is recommended to use the fractal dimension value and the total degenerative severity score together to quantify degenerative changes in the TMJ OA rather than exclusively relying on fractal value.

Evaluation of Jaw Bone Change in Children and Adolescents with Rheumatic Heart Disease by Fractal Analysis

BACKGROUND

Recognizing the oral needs of people living with rheumatic heart disease (RHD), particularly in relation to their jaws, is of paramount importance.

AIMS

This study aimed to evaluate potential jaw bone changes in children and adolescents diagnosed with RHD and compare them with a group of healthy children and adolescents.

METHODS AND MATERIAL

The dental panoramic radiographs (DPRs) of 32 children and adolescents diagnosed with RHD comprised the case group. In contrast, the control group consisted of DPRs from 32 children and adolescents without any known diseases. Two regions of interest (ROI1 and ROI2) of trabecular bone and a separate region of interest (ROI3) of cortical bone were selected for fractal analysis. The mandibular cortical index (MCI) was evaluated.

RESULTS

The ROI1 fractal dimension (FD) value of the individuals in the case group was statistically higher in the right jaw than in the left jaw (P < 0.01). Significant differences were determined between the case and control groups regarding the left ROI1, and the left and the right ROI2 (P < 0.05). No significant difference was found between the patient and control groups regarding the MCI value (P > 0.05).

CONCLUSIONS

The results of this study showed that bone metabolism was affected unilaterally in the condyle region and bilaterally in the gonial region of patients with RHD. It also revealed that the cortical layer was not affected.

Assessment of mandibular trabecular structure and cervical vertebral maturation using fractal analysis

BACKGROUND

Changes in bone trabeculae occur during skeletal maturation. Fractal analysis is a technique for assessing changes in the internal structure of the bone.

OBJECTIVE

The aim of this study was to investigate correlation of bone trabeculation measured on panoramic and lateral cephalometric radiographs with cervical vertebral maturation stages (CVMS).

METHODS

CVMS was evaluated on lateral cephalometric radiographs of 120 individuals aged 6 to 18 years. The subjects were divided into 6 groups (n= 20 each) according to CVMS. On panoramic and lateral cephalometric radiographs, fractal dimension (FD) analyses were performed in mandibular corpus, gonial and condylar regions and cervical vertebral bodies (C2, C3, C4).

RESULTS

FD measurements from the mandibular corpus region bilaterally and C2-C4 vertebral bodies showed significant positive correlations with CVMS (r= 0.418, r= 0.412, r= 0.324, r= 0.304, r= 0.263, respectively). Significant differences were found in the FD values of the right/left mandibular corpus and C2 and C3 vertebrae compared to CVMS (P< 0.001, P< 0.001, P= 0.005, P= 0.019, respectively).

CONCLUSION

Significant positive moderate correlations between the FD values of the right and left mandibular corpus and CVMS suggest that fractal analysis may be useful in determining skeletal maturity stage. The significant FD values obtained from the right/left mandibular corpus, and C2 and C3 vertebra indicate that the complexity of the internal trabecular structure increases with maturation.

Influence of binarization methods on the fractal dimension of alveolar bone using digital radiographs

OBJECTIVE

The aim of this study was to evaluate the influence of binarization methods (BnMs) on the fractal dimension (FD) of the alveolar bone in digital radiographic images.

STUDY DESIGN

Five identical periapical radiographs were obtained from each of 20 anatomic regions. Using ImageJ/Fiji software, a standardized region of interest was positioned in the trabecular bone of all radiographs, 14 BnMs were independently applied, and FD was calculated. The Friedman test and Dunn post hoc tests were used to evaluate the influence of BnMs on FD (α = 0.05). The intraclass correlation coefficient (ICC) was used to assess correlation among BnMs.

RESULTS

No significant differences were observed in the threshold value between the BnMs. No significant differences in FD were observed among 9 BnMs (Default, Huang, Iso Data, Li, Mean, Min Error[I], Moments, Otsu, and Shanbhag). These methods presented significantly higher FDs than those from 3 other BnMs (Max Entropy, Renyi Entropy, and Yen), which did not significantly differ from each other. The Triangle method significantly differed from all BnMs, and the Percentile method produced significantly higher FDs than Huang, IsoData, Li, Moments, Otsu, and Shanbhag. Most BnMs presented good or excellent correlation (ICC ≥ 0.76).

CONCLUSIONS

Binarization methods influence FD of the alveolar bone from digital periapical radiographs; thus, this technical aspect is relevant for comparison purposes and should be standardized. For comparison of published FD research, the Default method is recommended.

Evaluation of mandibular osseous structure in patients with mandibular asymmetry: a fractal analysis study

OBJECTIVE

We evaluated the effect of mandibular asymmetry on the trabecular structure of the mandible as measured through fractal analysis (FA).

STUDY DESIGN

We divided a sample of 105 patients with skeletal class I occlusion, cervical vertebral maturation CS6, and skeletal vertical dimension ratios within normal limits into right asymmetric, left asymmetric, and symmetric groups. We performed FA on 6 bilateral regions of interest on panoramic radiographs of the patients and calculated the mean fractal dimension (FD) for each region. We performed the Wilcoxon signed-rank and paired t tests to compare the significance of differences in FD between sides within each group and between groups for all regions. Statistical significance was established at P < .05.

RESULTS

We found statistically significant differences in mean FD values between the right and left condyles of the 2 asymmetric patient groups. The FD was greater in the left condyle of patients with right asymmetry and in the right condyle of patients with left asymmetry. The right condyle had a significantly greater FD in left asymmetric patients than in right asymmetric patients.

CONCLUSIONS

The results of FA indicate that asymmetry is characterized by an increase in the mean FD of the condyle that is responsible for the asymmetry. Fractal analysis can be a valuable diagnostic technique in distinguishing trabecular differences in the condylar areas of asymmetric individuals.

Evaluation of the mandibular condyles trabecular structure in patients with severe class III pattern: a computed tomography (CT) fractal analysis study

Class III malocclusion is a combination of dental and skeletal disorders that causes discrepancies in occlusion. Malocclusion can affect the structure of the Temporomandibular joint (TMJ) resulting in many problems, one of which is affecting the internal structure of the bone. This study aimed to examine the morphological features of class III patients' trabecular structure of the mandibular condyle in comparison with normal class I individuals using fractal analysis (FA). To study the internal structure of the mandibular condyle bone, Computed Tomography (CT) scans of 45 severe class III patients (age: 16-46) who were the candidates for orthognathic surgery were selected and matched by age and sex with 45 normal class I individuals. The trabecular bone structure of the left and right mandibular condyles in three CT planes of the study group and control group were evaluated employing the FA. The result of the present study indicated that the fractal dimensions (FD) values of class III patients were lower than those of the normal class I individuals in axial (class I: 1.31 ± 0.02, class III: 1.28 ± 0.02), sagittal (class I: 1.25 ± 0.03, class III: 1.19 ± 0.08), and coronal (class I: 1.5 ± 0.06, class III: 1.45 ± 0.07) planes (P < 0.001). There were no significant differences between the FD values of the males and females. The intra-group evaluation revealed that there was no correlation between age and FD values. No evidence of laterality was found regarding the FD values of the right and left condyles. Given the noticeable differences between the FD values, it can be implied that severe class III malocclusion may affect the trabecular pattern of the cancellous bone of the mandibular condyle compared to class I individuals. Therefore, due to the altered trabecular structure, clinicians should be cautious when planning treatments for these patients.

Influence of edentulism on the structure and function of temporomandibular joint

Background

With the acceleration of the aging process of the population, the number of edentulous patients continuously increased. Edentulism induces the loss of occlusal relationship and cause adverse effects on the stomatognathic system. Temporomandibular joint (TMJ), as a significant component of this system, may also be affected by edentulism in the process of supporting mandibular movement.

Purpose

Provide a comprehensive review of the structure and function of TMJ in the edentulous population, as well as the prevalence of temporomandibular joint disorder (TMD) in edentulous group.

Study selection

An electronic search was conducted on articles prior to December 2022 to filter all papers relevant to the structure and function of TMJ in edentulous population. The internet databases (PubMed, Cochrane Library, Embase) were searched using various combinations of keywords for "edentulism" or "edentulous" and "TMJ" or "TMD".

Results

Firstly, 522 articles were selected from the internet database, and finally, a total of 44 articles met the inclusion and exclusion criteria. The research content of these articles mainly focuses on the structure and function of TMJ in edentulous patients, as well as the clinical signs and symptoms of TMD.

Conclusions

Edentulous arch induces the loss of occlusal relationship, which may lead to degenerative changes of TMJ components consisting of changes in morphology and bone mass density of condyle, articular fossa, and articular eminence. In addition, the condyle could be shifted backward and upward, and displacement of the articular disc may occur after dentition loss. And the condyle and the articular disc may be guided back to the normal position after effective prosthodontic treatment. But the conclusions of the study on the function of TMJ and the prevalence of TMD in edentulous people are inconsistent. The condition of TMJ, especially the position of condyle-fossa and the symptoms and signs of TMD should not be ignored. If necessary, radiographic examinations should be performed.

Effects of functional orthopedic treatment on mandibular trabecular bone in class II patients using fractal analysis

PURPOSE

The aim of this retrospective study was to evaluate the effects of functional orthopedic treatment on mandibular bone structure using fractal dimension (FD) analysis of panoramic radiographs.

METHODS

The study material consisted of the pre- and posttreatment digital panoramic radiographs of 80 patients (mean age 10.1 ± 2.01 years; 45 girls, 35 boys) with class II malocclusion who were treated with the monoblock or twin block appliances. The following regions of interest (ROI) were selected: ROI1, condylar process; ROI2, angulus mandibulae; ROI3, corpus mandibulae; and ROI4, mental foramen. Pre- and posttreatment FD values were compared for each ROI.

RESULTS

FD values of the mandibular condyle did not change with the functional orthodontic treatment. FD values of the mandibular corpus region had the highest pretreatment values and significantly decreased with treatment (p < 0.05).

CONCLUSION

Functional orthopedic treatment altered the trabeculation of the mandibular bone, but it is speculated that the changes in the occlusal forces seemed to be of primary significance for this effect.

Comparative evaluation of the trabecular structure of the mandibular condyle, the levels of salivary cortisol, MMP-3, TNF-α, IL-1β in individuals with and without temporomandibular joint disorder

OBJECTIVE

Temporomandibular disorder (TMD) is still a challenge in terms of diagnosis and management. The aim of this study is to explore if the evaluation of salivary biomarkers and fractal dimension (FD) of mandibular condyle could be useful for interpreting early degenerative changes and the effectiveness of salivary cortisol in determining the stress levels of TMD patients.

MATERIALS AND METHODS

34 patients with TMD, and 34 healthy controls were included in this study. Saliva samples were obtained from all participants between 09:00-12:00 am. Salivary cortisol, IL-1β, TNF-α, and MMP-3 levels were evaluated with ELISA method. FD of the mandibular condyle was determined by means of box-counting method. Depression and anxiety were determined with PHQ-9 and GAD-7 questionnaires.

RESULTS

The salivary cortisol and depression/anxiety were higher in study group; however, not significant (p>0.05). FD of the study group was found significantly lower than the control group (p<0.01). Salivary TNF-α, IL-1β and MMP-3 levels were showed no significant difference between the two groups (p>0.05). There were no significant correlations between the evaluated parameters.

CONCLUSION

Salivary cortisol seems to be a non-invasive way of measuring physiological stress of TMD patients. Fractal analysis may be a useful tool in detecting early structural changes in mandibular condyle. Salivary TNF-α. IL-1β and MMP-3 have not a diagnostic value in terms of interpreting early degenerative changes.

Evaluation of bony changes observed in mandibular osteotomy lines and mandibular condyles following bilateral sagittal ramus osteotomy by fractal analysis

OBJECTIVES

This study aimed to evaluate the surgically impacted trabecular changes in mandibular osteotomy lines and mandibular condyles after bilateral sagittal split ramus osteotomy using the fractal analysis method.

MATERIALS AND METHOD

The study population consisted of 30 patients (9 male, 21 female) diagnosed with mandibular prognathism and operated with bilateral sagittal split ramus osteotomy under general anesthesia. Fractal analyses observed the alterations on the trabecular structure of osteotomy lines, and mandibular condyles on panoramic radiographs obtained preoperatively, postoperatively, 1st week, 6th month, and 12th month. The box-counting method was used to evaluate the changes in trabecular structure by fractal analysis. P-values of less than 0.05 were considered significant.

RESULTS

The fractal dimension values in both osteotomy lines and mandibular condyles were significantly decreased on postoperative 1st week regarding preoperative values. However, fractal dimension values commenced increasing in the following postoperative period. The fractal dimension values of the horizontal and vertical osteotomy lines reached their preoperative values on postoperative 6th and 12th month, respectively. The decreased fractal dimension values observed in the early postoperative period in the right and left condyles reached their preoperative values at the 6th postoperative month.

CONCLUSION

Fractal analyses performed postoperatively can provide information about trabecular changes and bone healing of structures such as osteotomy lines directly affected by bilateral sagittal split ramus osteotomy and indirectly affected mandibular condyles. The results support that fractal analysis can be used together with clinical data in the evaluation of bone healing process.

Evaluation of mandibular trabecular and cortical bone by fractal analysis and radiomorphometric indices in bruxist and non-bruxist patients

BACKGROUND

The aim of this study was to evaluate the effect of bruxism on the cortical and trabecular bone of the mandible using the radiomorphometric indexes and fractal analysis (FA) additionally to examine the efficiency of FA as diagnostic test for bruxism.

METHODS

Evaluation was performed on panoramic radiographs of 94 bruxists and 94 non-bruxist individuals with the ImageJ program. Cortical bone was assessed with mandibular cortical index, mental index, and panoramic mental index. Trabecular bone in the condyle, gonial, and corpus region was evaluated by FA. An independent sample t and Mann-Whitney-U tests and Pearson and Spearman rank correlations were conducted for statistical analysis.

RESULTS

A total of 188 participants, 112 female, and 76 male, were included in the study. The sample age ranged from 18 to 43, with a mean of 27.55 (± 7.022) years. FA values of the angulus were significantly higher than those of the condyle and corpus, and the mean of the sample for the angulus, condyle, and corpus, respectively, were; 1.36 (± 10), 1.10 (± 0.9), 1.13 (± 0.8). There was a positive correlation between FA of the mandibular corpus and age (r = .163, p = .025). Females' values were smaller than males' in the FAs of three regions, and significant differences were found in FA of the condyle and angulus of the mandible, MCI, and PMI according to gender. There was no statistically significant difference between bruxist and non-bruxist patients in term of FAs of three regions, MCI, MI, and PMI values (p > .05).

CONCLUSIONS

FA of the condyle and angulus of the mandible, MCI, and PMI are significantly affected by gender. However bruxism doesn't cause a significant change in the fractal dimensions of the bone in the mandible and doesn't change substantially MCI, MI, and PMI.

Morphological evaluation of gonial and antegonial regions in bruxers on panoramic radiographic images

BACKGROUND

This is the first study to report both cortical and trabecular bone evaluation of mandibles in bruxers, within the knowledge of the authors. The purpose of this study was to evaluate the effects of bruxism on both the cortical and the trabecular bone in antegonial and gonial regions of the mandible, which is the attachment of the masticatory muscles, by using panoramic radiographic images.

METHODS

In this study, the data of 65 bruxer (31 female, 34 male) and 71 non-bruxer (37 female, 34 male) young adult patients (20-30 years) were evaluated. Antegonial Notch Depth (AND), Antegonial-Index (AI), Gonial-Index, Fractal Dimension (FD) and Bone Peaks (BP) were evaluated on panoramic radiographic images. The effects of the bruxism, gender and side factors were investigated according to these findings. The statistical significance level was set atP ≤ 0.05.

RESULTS

The mean AND of bruxers (2.03 ± 0.91) was significantly higher than non-bruxers (1.57 ± 0.71; P < 0.001). The mean AND of males was significantly higher than females on both sides (P < 0.05). The mean AI of bruxers (2.95 ± 0.50) was significantly higher than non-bruxers (2.77 ± 0.43; P = 0.019). The mean FD on each side was significantly lower in bruxers than in non-bruxers (P < 0.05). The mean FD of males (1.39 ± 0.06) was significantly higher than females (1.37 ± 0.06; P = 0.049). BP were observed in 72.5% of bruxers and 27.5% of non-bruxers. The probability of existing BP, in bruxers was approximately 3.4 times higher than in non-bruxers (P = 0.003), in males was approximately 5.5 times higher than in females (P < 0.001).

CONCLUSION

According to the findings of this study, the morphological differences seen in cortical and trabecular bone in the antegonial and gonial regions of the mandible in bruxers can be emphasized as deeper AND, higher AI, increased of existing BPs, and lower FD, respectively. The appearance of these morphological changes on radiographs may be useful for indication and follow-up of bruxism. Gender is an effective factor on AND, existing BP and FD.

Radiomorphometric indices and fractal dimension of the mandible in individuals with osteogenesis imperfecta: a matched cross-sectional study

OBJECTIVE

The objective was to analyze radiomorphometric indices (RMIs) of mandibular cortical bone and fractal dimension (FD) of trabecular bone of individuals with osteogenesis imperfecta (OI) and compare the findings to those of individuals without OI.

METHODS

Digital panoramic radiographs of 20 individuals with OI (case group) and 40 individuals without OI (control group) were examined. The RMIs of mandibular cortical index (MCI) and mandibular cortical thickness (MCT) were analyzed. FD of mandibular trabecular bone was calculated bilaterally in 3 regions. The chi-squared test and paired t test were used to compare the significance of differences between the groups. The effect size and minimal clinically important difference (MCID) were also determined. Significance was established at P < .05.

RESULTS

Categories C2 and C3 of the MCI were more frequent in individuals with OI (P < .001). The Mean MCT was 2.08 ± 0.79 in the OI case group and 2.91 ± 0.60 in the control group (P < .001). Mean FD in the condylar region was significantly lower in the OI case group (P = .002). The effect size for these 2 measures was large, and the difference between groups was greater than the MCID.

CONCLUSION

Radiographs of individuals with OI exhibited more porosity and diminished thickness of the mandibular cortical bone and lower FD values in the condylar trabecular bone.

Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders

OBJECTIVE

This study aimed to explore the quantitative and qualitative condylar changes following stabilization splint (S.S) therapy, including condylar position, morphology, and bone mineral density (BMD) in subjects with temporomandibular disorders (TMD).

MATERIALS AND METHODS

In this retrospective clinical study, we enrolled 40 TMD subjects (80 joints) aged 18 to 35 years, for whom a S.S was used to treat TMD. The 80 TMD consists of 32 masticatory muscle disorders (myalgia) and 48 TMJ disorders (arthralgia). Cone beam computed tomography (CBCT) was used to scan the TMJs of subjects pre- and post-treatment for three-dimensional analysis (3D). Using Mimics software v.21.0, quantitative (3D condylar and joint spaces dimensions parameters were measured using linear measurements in millimeters, according to the Kamelchuk method and Ikeda method, while the assessment of anteroposterior condyle position within the glenoid fossa was based on the method of Pullinger and Hollender), and qualitative (a round bone tissue with an area of 2 mm² in three representative areas according to the Kamelchuk method to measure condylar BMD) pre- and post-treatment. Intra- and inter-group statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal-Wallis test, respectively.

RESULTS

The course of treatment was 6-12 months, with an average of 9.1 months. For the pre- and post-treatment quantitative comparisons, there was a statistically significant difference in the anterior joint space (AJS) and coronal medial space, as well as the condyle length in the myalgia group and condylar width in the arthralgia group. For qualitative measurements, a significant difference was observed in the posterior slope of the myalgia group and the arthralgia group's anterior, superior, and posterior slopes. The inter-group comparisons revealed significant differences in AJS, condylar length, and anterior slope density.

CONCLUSION

In short-term follow-up, the S.S influenced patients with TMD from different origins; it changes anterior and coronal medial joint space, condyle length in myalgia, and width in arthralgia. Furthermore, it improved the condyle bone density more evidently in arthralgia.

CLINICAL RELEVANCE

This study highlights the influence of S.S on symptomatic populations with TMD of different origins from a qualitative and quantitative perspective.

Evaluation of trabecular changes following advancement genioplasty combined with or without bilateral sagittal split osteotomy by fractal analysis: a retrospective cohort study

BACKGROUND

It is aimed to investigate whether there was a difference in radiographic changes in the operational areas between genioplasty alone and genioplasty combined with mandibular advancement and to evaluate the fractal dimension (FD) to assess trabecular changes after genioplasty surgery.

METHODS

Preoperative-(T0) and postoperative-(T1) panoramic radiographs of 26 patients without any complications who underwent genioplasty combined with bilateral sagittal osteotomy and mandibular advancement or genioplasty alone were selected. In the panoramic radiographs of both groups, the genial segment, mandibular angulus, and surgical osteotomy line were examined using FD. The box-counting method was used for FD evaluation.

RESULTS

It was determined that FD values before and after treatment were similar in both groups for all regions where measurements were made. After surgery, the FD values of the middle region of the genial segment were found to be significantly lower than the other regions. At T1, the FD values at the osteotomy area were found to be significantly higher than those in the middle region of the genial segment.

CONCLUSION

Trabecular structure does not differ in patients undergoing genioplasty alone or in combination with mandibular advancement osteotomy. The middle region of the genial segment heals later than other regions.

Comparison of trabecular bone structure in individuals with healthy periodontium and stage III/IV, grade C periodontitis by fractal analysis

OBJECTIVE

The aim was to perform fractal analysis (FA) to compare differences in trabecular microarchitecture in interdental and antegonial regions on panoramic radiographs in periodontally healthy patients and those with stage III/IV, grade C periodontitis, and to compare the effects of patient age and sex on FA results.

STUDY DESIGN

Clinical and radiographic records from 33 periodontally healthy individuals and 28 individuals with aggressive periodontitis were obtained from the faculty archives. Three regions of interest (ROIs) were chosen bilaterally from interdental bone around the mandibular first molar and canine and the antegonial region. The mean fractal dimension (FD) values of the ROIs were calculated. Significance of differences was established at P < .05.

RESULTS

FD values of all 3 ROIs in the periodontitis group were significantly lower than values in the control group (P ≤ .004). FD was not affected by patient age (P = .357) or sex (P = .216). There were no significant correlations between FD and age in either group (P ≥ .093). FD values differed significantly between sexes in only one ROI.

CONCLUSIONS

FA can effectively detect trabecular microarchitectural differences in patients with aggressive periodontitis compared to periodontally healthy individuals. This technique might be useful in predicting the susceptibility of patients to periodontal disease.

Comparative evaluation of trabecular bone structures of bruxist and non-bruxist individuals with bone apposition in the mandible angle region by fractal analysis

OBJECTIVE

This study aimed to compare the trabecular internal structure of different regions of the mandible according to the grades of appositional classification in the mandible angle region in probable bruxist individuals and non-bruxist G0(Convex course of the basal cortex, no directional change, no bone apposition) individuals by measuring fractal dimension (FD) on panoramic radiographs.

METHODS

200 sample jaws, bilaterally, of 80 probable bruxists and 20 non-bruxist G0 individuals were included in the study. According to the classification in the literature, each mandible angle apposition severity was classified as G0-G1-G2-G3. FD was calculated by selecting the region of interest (ROI) area of 7 regions from each sample. Gender differences in changes between ROIs in radiographs and independent samples t-test were evaluated. Relation between categorical variables was determined by chi-square test (p < .05).

RESULTS

In the comparison of the probable bruxist and non-bruxist G0 groups, FD was found to be statistically significantly higher in the mandible angle (p = 0.013) and cortical bone (p = 0.000) regions in the probable bruxist group than in the non-bruxist G0 group. There is a statistically significant difference between probable bruxist G0 and non-bruxist G0 grades in terms of FD averages in cortical bone (p < 0.001). A statistically significant difference was found in the relationship of ROIs with gender in canine apex (p = 0.021) and canine distal (p = 0.041) regions.

CONCLUSION

FD was found to be higher in the mandibular angle region and cortical bone in probable bruxist individuals than in non-bruxist G0 individuals. Morphological changes seen in the mandible angulus region may be a finding that may raise suspicion for bruxism for clinicians.

Magnetic resonance imaging and fractal analysis findings in temporomandibular joints with disk perforation

OBJECTIVE

This study compared magnetic resonance imaging (MRI) findings and fractal dimension (FD) values in the temporomandibular joints (TMJs) of study patients with disk perforation vs control patients.

STUDY DESIGN

Of 75 TMJs examined with MRI for characteristics of the disk and condyle, 45 were included in the study group and 30 in the control group. MRI findings and FD values were compared for significance of differences between the groups. The frequency of subclassifications was analyzed for differences between the two forms of disk configuration and grades of effusion. Mean FD values were analyzed for differences among subclassifications of MRI findings and between groups.

RESULTS

Examination of MRI variables revealed that the study group had significantly greater frequencies of flattened disks, disk displacement, flattening and combined defects in condylar morphology, and grade 2 effusion (P = .001) Joints with perforated disks had a large percentage of normal disk-condyle relationships (73.3%). Significant differences were discovered between biconcave and flattened disk configuration in the frequencies of internal disk status and condylar morphology. FD values of all patients varied significantly among the subclassifications of disk configuration, internal disk status, and effusion. Mean FD values were significantly lower in the study group with perforated disks (1.07) compared with the control group (1.20, P = .001).

CONCLUSIONS

MRI variables and FD can be useful in investigating intra-articular TMJ status.

Evaluation of temporomandibular joint components and mandibular bone structure in ankylosing spondylitis patients

OBJECTIVES

The study aimed to investigate the mandible and temporomandibular joint (TMJ) in patients with ankylosing spondylitis (AS) who had no signs or symptoms of TMJ-related disease and compare them with a control group.

STUDY DESIGN

In total, 128 panoramic radiographs (63 patients with AS, 65 controls) were evaluated. Fractal analysis was conducted on the mandibular condyle (ROI1), angle of the mandible (ROI2), and the area adjacent to the mental foramen (ROI3). Articular eminence inclination (AEI) values were measured. Klemetti index (KI) evaluation of the mandibular cortex was also performed.

RESULTS

Fractal dimension (FD) values were significantly lower in the patients with AS than the controls in ROI1 and ROI2 (P = .001), but there were no significant differences between groups for FD in ROI3, AEI, or KI (P ≥ .09). No significant differences were found in any parameters between patients with AS with different disease durations (P ≥ .06).

CONCLUSIONS

Patients with AS displayed significantly lower FD values in condyles and the angle of the mandible and slightly lower AEI values; therefore, they should be examined routinely for TMJ disorders. Clinicians should be aware of the possibility of secondary osteoporosis in patients with AS and consider its probable effects on the mandible.

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users

We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Evaluation of mandibular trabecular bone by fractal analysis on panoramic radiograph in paediatric patients with sleep bruxism

OBJECTIVE

To evaluate the trabecular bone density in the mandible of paediatric patients diagnosed with sleep bruxism (SB) using the fractal analysis method on panoramic radiographs.

METHODS

A total of 37 patients whose anamnesis and clinical signs were compatible with SB were diagnosed with SB using BiteStrip^® . Three areas were identified on the panoramic radiographs of the patients: the geometric center of the condyle, the angulus region under the mandibular canal, and the distal region of the mental foramen. Regions of interest (ROIs) of 60 × 60 pixels were selected in these three locations, and fractal dimensions (FDs) were calculated. Results were compared with the control group.

RESULTS

There was no statistically significant difference between the right and left FD values, and male and female FD values in all regions and both groups (p > .05). In the angulus (p = .03) and condyle (p = .03) regions, the SB group had a significantly higher FD value than the control group. There was no statistically significant difference between the SB and control groups in the corpus region (p = .98). A moderate negative correlation arose between age and condyle FD values among controls (r = -0.38, p = .02).

CONCLUSION

Fractal dimension values evaluating trabeculation of the mandibular bone are affected by SB in the angulus and condyle regions.

Does Fractal Analysis Have a Role in Diagnosis of Langerhans Cell Histiocytosis?

PURPOSE

Langerhans cell histiocytosis (LCH) of the jaws is a rare disease and is often diagnosed at an advanced stage. This study aims to assess the trabecular pattern of jaws via fractal analysis (FA) on initial panoramic radiographs (OPG) of the patients with LCH to facilitate interpretation of the radiographic changes.

METHODS

A case-control study investigated LCH cases with jaw involvement retrieved from the databases of Istanbul and Kocaeli Universities between 2010 and 2021. Initial OPGs of LCH cases and OPGs of healthy sex- and age-matched controls were investigated with FA. All images were assessed using ImageJ software. On each OPG, a total of 6 regions of interest (ROIs) located on the mandible were investigated bilaterally. The independent variables were the trabecular patterns of jaws of LCH cases and their control matches. The outcome variables were the fractal dimension (FD) values obtained from the ROIs on OPGs. Data were analyzed using the Mann-Whitney U test and Student's t test.

RESULTS

Fifteen LCH-control pairs were investigated. In one ROI located in the supracortical area above the left mandibular angle, FD values of LCH cases (1.273 ± 112.8) were significantly lower than controls (1.308 ± 85.3; P < .05). Lower FD values were also calculated for some of the remaining ROIs, but there was no significant difference between groups (P > .05).

CONCLUSIONS

Regarding our results, FA was not a useful parameter to discern radiographical trabecular changes between LCH cases and controls. Multicenter studies with larger populations are needed to investigate the potential of FA in the identification of this rare disease.

Assessment of the relationship between fractal analysis of mandibular bone and orthodontic treatment duration : A retrospective study

PURPOSE

This retrospective study aimed to determine whether a correlation exists between the fractal dimension value and overall orthodontic treatment duration in children and young adults.

METHODS

The study included a total of 643 patients (age: 10-25 years) who received orthodontic treatment between January 2015 and March 2020. Patient records and pretreatment panoramic radiographs were evaluated. The regions of interest selected for calculating fractal dimension were the bilateral mental foramen regions of the mandible. Fractal dimension was set in relation to orthodontic treatment duration using a linear regression model which was also adjusted for potential confounding variables. Total treatment duration was the outcome variable of interest used as a continuous variable. The predictor variables of interest included age, gender, type of dental and skeletal malocclusion, vertical growth pattern, extraction type, and fractal dimension.

RESULTS

The mean age, treatment duration, and fractal dimension were 14.56 years, 27.01 months, and 1.23 mm, respectively. Multiple linear regression analysis showed that the fractal dimension had a significant influence on overall treatment duration (P < 0.001). From the other variables, Angle class II malocclusion significantly influenced treatment duration (P < 0.01), age showed a significant negative correlation with treatment duration (P < 0.01), and treatment duration significantly increased for patients with tooth extractions (P < 0.001).

CONCLUSION

There was a negative correlation between fractal dimensions at the mandibular mental region and total orthodontic treatment duration. Fractal dimension analysis may help to understand physiologic features of alveolar bone and predict orthodontic tooth movement.

Effects of reverse headgear therapy on mandibular trabecular structure: A fractal analysis study

OBJECTIVES

The aim of this study was to assess the effects of reverse headgear (RHG) treatment combined with rapid maxillary expansion (RME) on the trabecular structure of the mandibula using fractal dimension (FD) analysis.

METHODS

Forty-four individuals with skeletal Class III malocclusion were selected from the archives and divided into two groups as patients who underwent treatment with RME + RHG (RHG-G, 22 patients) and untreated control group (C-G, 22 patients). The before (T0) and after (T1) treatment lateral cephalometric and panoramic radiographs were collected in the RHG-G and in the control group, radiographs obtained with similar time intervals were grouped as T0 and T1. Cephalometric and FD analysis was conducted on T0 and T1 lateral cephalometric and panoramic radiographs. The intragroup comparison of cephalometric and FD data was performed using paired t test and Wilcoxon Signed Ranks test, while independent t test and Mann-Whitney U test were used for intergroup comparison.

RESULTS

C-G had higher FD values in the right mandibular corpus and left mandibular ramus values at T0 (P < .05). The only significant difference in the intragroup comparisons was detected in the FD values of the right mandibular corpus in the C-G (P < .05). No significant differences were found in the FD between the groups in any of the areas measured (P > .05).

CONCLUSIONS

RME + RHG therapy did not cause any significant trabecular changes in the mandibula when compared to the control group.

Pamidronate Therapy Increases Trabecular Bone Complexity of Mandibular Condyles in Individuals with Osteogenesis Imperfecta

Patients with Osteogenesis Imperfecta (OI) present extra-skeletal manifestations, including important orodental and craniofacial features as dentinogenesis imperfecta, dental agenesis, failure of maxilla growth and hypotonia of masticatory muscles. These features may compromise vital functions speech and mastication. Studies have demonstrated that cyclic pamidronate infusion, the standard therapy for patients with moderate to severe OI, influences the histomorphometric pattern of different body bones. The present study aimed to investigate the condyle trabecular bone pattern in OI patients. We used fractal dimension (FD) analysis on dental panoramic radiographic images to characterize the mandibular condyle trabecular bone in adolescents diagnosed with OI and treated with pamidronate. Imaging exam of 33 adolescents of both sexes, aged between 12 and 17 years, were analyzed and compared with 99 age- and sex-matched healthy adolescents. FD in patients was significantly lower (1.23 ± 0.15) than in healthy controls (1.29 ± 0.11; p < 0.01). Type of OI, age at treatment onset, and the duration of therapy were variables that showed a statistically significant effect on the FD results. This study demonstrated that the bone architecture of mandibular condyles may be altered in pediatric patients with moderate and severe forms of OI. Also, pamidronate treatment seems to have a positive effect on condyle trabecular bone in these patients. This is supported by our finding that FD values were positively influenced by the length of cyclic pamidronate treatment at the time of imaging, as well as by the age of the individual at treatment onset.

Evaluation of the effects of prolotherapy on condyles in temporomandibular joint hypermobility using fractal dimension analysis

Objectives

Prolotherapy is a method that has gained popularity in recent years and has been reported to have positive short-term and long-term clinical results in maxillofacial surgery, especially temporomandibular joint (TMJ) hypermobility. This study aimed to evaluate the changes in the trabecular structure of mandibular condyles in patients who underwent prolotherapy due to TMJ hypermobility using the fractal analysis method.

Materials and Methods

Forty-five patients who received dextrose prolotherapy at a concentration of 20% and fifteen control patients were included in the study. All patients had panoramic radiographs just before (T0) and six months after treatment (T1). The patients who received treatment were divided into three groups according to the number of prolotherapy injections. The regions of interest were selected from bone areas close to the articular surfaces of the condyles. The fractal dimension (FD) values were calculated.

Results

The main effect of time on the FD value was significant [F (1, 56)=86.176, P<0.001]. This effect was qualified by a significant time×group interaction effect [F (3, 56)=9.023, P<0.001]. The decreases in FD values in all treatment groups between T0 and T1 times were significant (P=0.004). However, changes in FD values were not significant in the control group (P=0.728).

Conclusion

Dextrose prolotherapy without the effect of the number of injections caused a decrease in FD values in the mandibular condyles over time.

Evaluation of architectural changes in mandibular trabecular and cortical bone pattern after functional treatment

Purpose:

To assess the changes in mandibular trabecular and cortical bone following functional appliance treatment through fractal dimension (FD) and cortical thickness (CorT) measurements.

Material and methods

The study was performed on 45 mandibular retrognathia cases. While the treatment group (T) comprised 30 patients treated using a functional appliance for one year during puberty, the control group (C) consisted of 15 patients who did not receive any orthodontic treatment due to insufficient oral hygiene. FD and CorT analyses were bilaterally evaluated for each mandible. FD measurements were performed on the condylar process, the antegonial notch, and ramus regions on panoramic radiographs. A paired t-test was applied for group analysis, before (T1) and after treatment (T2) and, correspondingly, before (C1) and after (C2) controls. In addition, an independent t-test was used to determine differences between the treatment (∆T = T2−T1) and the control group (∆C = C2−C1).

Results

Statistically significant differences were found in the treatment group between the initial and post-treatment FD values of the right (p < 0.05) and left condyles (p < 0.05), and the CorT measurements on the right (p < 0.01) and the left sides (p < 0.05). There was no statistically significant difference in FD parameters in the control group and a significant difference was only found in the left CorT (p < 0.05). A comparison of the treatment and control groups revealed that the changes in FD and CorT measurements were not statistically significantly different between the groups (p > 0.05).

Conclusion:

Mandibular protraction appliances do not produce trabecular bone alteration in the mandibular condyles, the antegonial notch and ramus over a 12-month time period.

Structural complexity of the craniofacial trabecular bone in multiple myeloma assessed by fractal analysis

Purpose

This study aimed to evaluate the structural complexity of craniofacial trabecular bone in multiple myeloma by fractal analysis of panoramic and lateral skull radiography, and to compare the fractal dimension values of healthy patients (HPs), pre-treatment patients (PTPs), and patients during bisphosphonate treatment (DTPs).

Materials and Methods

Pairs of digital panoramic and lateral skull radiographs of 84 PTPs and 72 DTPs were selected. After application of exclusion criteria, 43 panoramic and 84 lateral skull radiographs of PTPs, 56 panoramic and 72 lateral skull radiographs of DTPs, and 99 panoramic radiographs of age- and sex-matched HPs were selected. The fractal dimension values from panoramic radiographs were compared among HPs, PTPs, and DTPs and between anatomical locations within patient groups using analysis of variance with the Tukey test. Fractal dimension values from lateral skull radiographs were compared between PTPs and DTPs using the Student t-test. Pearson correlation coefficients were used to assess the relationship between the mandible from panoramic radiographs and the skull from lateral skull radiographs. Intra-examiner agreement was assessed using intraclass correlation coefficients (α=0.05).

Results

The fractal dimension values were not significantly different among HPs, PTPs, and DTPs on panoramic radiographs or between PTPs and DTPs on lateral skull radiographs (P>0.05). The mandibular body presented the highest fractal dimension values (P≤0.05). The fractal dimension values of the mandible and skull in PTPs and DTPs were not correlated.

Conclusion

Fractal analysis was not sensitive for distinguishing craniofacial trabecular bone complexity in multiple myeloma patients using panoramic and lateral skull radiography.

Application of Fractal Analysis in Detecting Trabecular Bone Changes in Periapical Radiograph of Patients with Periodontitis

Introduction

Evaluation of detailed features of the supporting bone is an important step in diagnosis and treatment planning for teeth with clinical attachment loss. Fractal analysis can be used as a method for evaluating the complexity of trabecular bone structures. The aim of this study was to evaluate the trabecular bone changes in periapical radiographs of patients with different stages of periodontitis using fractal analysis.

Methods

This comparative cross-sectional study was performed on patients with and without clinical attachment loss in mandibular first molars. Teeth with clinical attachment loss were divided into mild, moderate, and severe periodontitis groups. Digital periapical radiographs were obtained from the mandibular first molars using the same exposure parameters. DICOM file of the radiographs was exported to ImageJ software for fractal analysis. Three regions of interest (ROIs) were considered in each radiograph: two proximal ROIs mesial and distal to the mandibular first molar and one apical ROI. Fractal dimension (FD) values were calculated using the fractal box counting approach. Statistical analysis was performed using the chi-square test, Mann–Whitney test, intraclass correlation coefficient, and ANOVA (α = 0.05).

Results

FD values were significantly different between moderate and severe periodontitis and healthy periodontal bone (P < 0.05), except for the distal ROI for moderate periodontitis cases (P=0.280). However, FD values of the supporting bone in periodontally healthy teeth and teeth with mild periodontitis did not show a statistically significant difference (P > 0.05).

Conclusion

Fractal analysis is a useful tool for evaluation of bone alterations in moderate and severe periodontitis, but was not able to detect the most initial radiographic bone signs of mild periodontitis.

Fractal analysis and periapical index evaluation of multivisit nonsurgical endodontic retreatment: A retrospective study

OBJECTIVE

This retrospective study compared changes in periapical trabecular patterns using fractal analysis and the periapical index (PAI) on the periapical radiographs of patients who underwent multivisit nonsurgical endodontic retreatment of persistent periapical disease.

STUDY DESIGN

In total, 50 participants were included in the study. For each patient, baseline periapical radiographs were acquired just before retreatment and postoperative radiographs were acquired 1 year later. The region of interest, located in the abnormal tissue around the root apex, was selected from each of the paired radiographs and the fractal dimension (FD) was calculated. Periapical status was classified using the PAI as "healed" (PAI <3) or "unhealed" (PAI ≥3).

RESULTS

According to the PAI scores, retreatment after 1 year had a healing rate of 70%. In healed cases, the FD values increased significantly (P < .001), whereas FD decreased significantly in unhealed cases (P = .021). Change in FD was significantly different between healed and unhealed cases (P < .001). However, change in FD did not have a significant correlation with PAI in either healed or unhealed cases (P > .05). There was no significant effect of sex on the change in FD values in either healed or unhealed cases (P ≥ .690).

CONCLUSIONS

The significant differences in FD suggest that this parameter may be useful in detecting increased trabeculation and estimating retreatment prognosis.

Evaluation of mandibular condyle trabecular structure in patients with rheumatoid arthritis using fractal analysis

OBJECTIVES

The aim of this study was to compare the fractal dimension (FD) of trabecular structure of the mandibular condyles in patients with rheumatoid arthritis (RA) to patients without RA. Correlations between condylar FD and bone mineral density T-scores in the femoral neck and lumbar spine were also examined.

STUDY DESIGN

The RA study group patients were divided into 3 categories (33 normal, 33 osteopenic, and 34 osteoporotic) according to T-scores. The control group without RA was sex- and age-matched with the study group. FD was calculated from panoramic radiographs and compared between the study and control groups. The relationships between FD values and femoral neck and L1-L4 lumbar spine T-scores were investigated for study and control groups. Significance was established at P < .05.

RESULTS

The mean FD values of the entire study group and of each category in the study group were significantly lower than those of the control group (P < .001). There were no significant differences in FD values among the 3 RA categories (P > .05). No significant correlations appeared between FD and femoral neck or lumbar spine T-scores (P ≥ .063).

CONCLUSIONS

Fractal analysis of the condyles on panoramic radiographs can distinguish RA from healthy condyles, even if the patients with RA have normal bone mineral density T-scores.

Treatment and posttreatment effects of Herbst appliance therapy on trabecular structure of the mandible using fractal dimension analysis

OBJECTIVES

This controlled study aimed to evaluate the effects of Herbst therapy on the trabecular structure of the condyle and angulus mandible using fractal dimension analysis (FD-A) accompanied by skeletal cephalometric changes.

MATERIAL AND METHOD

The panoramic and cephalometric radiographs of 30 patients with skeletal Class II malocclusion treated with the Herbst appliance (C II-H group, mean age: 15.23 ± 1.08), 30 patients with skeletal Class II malocclusion that received fixed orthodontic treatment (C II-C group, mean age: 15.73 ± 1.38), and 30 patients with skeletal Class I malocclusion (C I-C group, mean age: 15.90 ± 1.30) were selected. FD-A was performed on the superoposterior region (C-SP) and centre of the condyles (C-C) and the mandibular angulus (Ang) on the panoramic radiographs taken at the pretreatment (T0), intermediate stage of treatment (T1), and posttreatment (T2) timepoints just like cephalometric analysis.

RESULTS

Herbst therapy provided a statistically significant increase in SNB, ANS-Me, Na-Me, S-Go, Co-Gn and a decrease in ANB and overjet (P < 0.05). All skeletal changes remained stable during the fixed appliance treatment after Herbst. The FD values in C-C increased (P < 0.05), and C-SP values decreased (P < 0.05) during Herbst therapy, while after removal of the Herbst appliance, no significant change was observed despite an increase in C-SP. The Ang value did not change during Herbst treatment, but then increased significantly (P < 0.05). There was no significant change in the FD values of the C I-C and C II-C groups at any stage of treatment. The C-C and C-SP changes at T1-T0 period, C-SP and Ang changes at T2-T1 period, and C-C, C-SP, and Ang values at T2-T0 period were found higher in C II-H group compared with the C II-C group significantly (P < 0.05).

CONCLUSION

Herbst therapy changed the trabecular structure of the condyles in different directions at the superoposterior and central regions of the condyles, while the structural complexity of the angulus mandible, which did not change during the Herbst treatment, increased during the fixed orthodontic treatment after Herbst.

Retrospective fractal analyses of one-year follow-up data obtained after single-visit nonsurgical endodontic retreatment on periapical radiographs

OBJECTIVES

The aim of retrospective study was to evaluate the changes to the periapical bone sites after non-surgical endodontic retreatment by using fractal analysis on periapical radiographs.

MATERIALS AND METHODS

Thirty patients whose teeth had periapical lesions and underwent primary endodontic treatment were selected for nonsurgical single-visit endodontic retreatment. Two radiographs were taken, the first immediately after retreatment and the second at the 1-year follow-up. An identical region of interest close to the infected root apex was selected from each radiograph. FD was measured using the box-counting method. Periapical status was evaluated using the periapical index (PAI). Treatment outcomes were categorized into healed (PAI < 3), or not healed (PAI ≥ 3) based on radiographic criteria.

RESULTS

The mean FD value significantly increased at the 1-year follow-up compared to baseline. No significant sex biases were apparent. According to the PAI, retreatment after 1 year resulted in a 63.3% healed.

CONCLUSION

The extent of periapical trabecular bone evident radiographically increased, as revealed by FD data, 1 year after endodontic retreatment. Clinical relevance The use of fractal analysis as a quantitative method to evaluate changes in periapical trabecular bone (such as healing and inflammation) after endodontic retreatment can be an important marker in determining the prognosis of endodontic retreatment.

Structural changes in the trabecular bone of the mandibular condyle of growing patients with sagittal jaw discrepancy treated with the twin-block appliance

OBJECTIVE

The objective of this study was to evaluate the structural changes in the trabecular bone of the mandibular condyles in patients treated with the Twin-block functional orthopaedic appliance that act by promoting condylar growth and to compare the fractal dimension (FD) of condylar trabecular bone structure prior to treatment (T0) and after orthopaedic functional treatment (T1).

SETTING AND SAMPLE POPULATION

This retrospective study included panoramic images of 112 individuals with a mean age of 11.04 ± 1.30 years in the study group (32 girls and 24 boys) and 11.6 ± .80 years in the control group (29 girls and 27 boys).

MATERIALS AND METHODS

The standardized region of interest was selected as the right and left condylar areas close to the articulation surfaces from the twin-block (TB) group, which included patients who completed functional orthopaedic treatment and the control group, which included untreated individuals. FD values in the condylar region were analysed from the panoramic radiographs of both groups using a box-counting method with ImageJ software (version 1.52a, US National Institutes of Health).

RESULTS

There was a significant decrease in the FD values of the right (-.038) and left (-.022) condylar region at T0 and T1 in the TB group. Between-group FD comparisons demonstrated that the TB group showed changes in the condylar region (right, P = .004; left, P = .022) compared to the control group.

CONCLUSION

Functional orthopaedic forces caused a decrease in the trabecular structure of the condylar area examined.

Measurement of the trabecular bone structure of the TMJ region in patients with transverse maxillary deficiency: a CBCT fractal analysis study

OBJECTIVE

This study aimed to evaluate the effect of transverse maxillary deficiency on condylar morphology via visual examination and fractal analysis of cone beam computed tomography (CBCT) scans.

STUDY DESIGN

In total, 97 patients with posterior crossbite or maxillary narrowness and 36 control patients were included. The presence of degenerative changes in the bilateral condyles was evaluated with CBCT. Fractal dimension (FD) was calculated on the condylar images using ImageJ.

RESULTS

Degenerative bone changes were discovered in 38 of the 133 scans (28.6%). There was no significant difference between the groups in terms of the incidence of degenerative changes for either the right or left sides (P ≥ .670). In coronal sections and in mean measurements, FD was significantly lower in the control group compared with the other groups in the right condyle (P ≤ .031). No significant differences were found between the mean FD values of the condyles with degenerative bone changes or the mean FD values of the normal condyles (P ≥ .256).

CONCLUSIONS

In the presence of maxillary transverse deficiencies, degenerative bone changes in the mandibular condyle were not significantly different, but the FD of the right condyle was found to be higher compared with the control group.

Evaluation of trabecular bone healing using fractal dimension analysis after augmentation of alveolar crests with autogenous bone grafts: a preliminary study

OBJECTIVE

The aim of this study is to evaluate bone remodeling after alveolar crest augmentation with autogenous bone grafts.

METHODS

50 patients who were applied augmentation due to alveolar deficiency were included in this study. Fractal dimensions were measured on the radiographs in the preoperative, postoperative, follow-up periods. The ROI was selected specific to each patient, but repeated in a standardized manner on subsequent radiographs.

RESULTS

A total of 50 patients were included in the study; There were 31 females and 19 males. Implants were placed in all patients without any complications. The mean fractal dimensions on the graft recipient side were statistically higher in the postoperative 5th month compared to the postoperative 1st week (p = 0.002). The mean fractal dimensions on the donor side were statistically higher in the preoperative and postoperative 5th month compared to the postoperative 1st week (p < 0.001).

CONCLUSION

Any clinical imaging method cannot fully reflect the histological microstructures of the bone. Evaluating the fractal analysis together with the clinical results can demonstrate adequate bone healing and quality prior to implant placement. Fractal analysis is a non-invasive, reproducible, method but further, prospective, randomized, controlled clinical studies are needed to estimate bone quality prior to implant placement.

Investigation of mandibular fractal dimension on digital panoramic radiographs in bruxist individuals

OBJECTIVE

This study aimed to evaluate changes in mandibular trabecular bone structure in bruxism using fractal analysis on digital panoramic radiographs obtained with automatic dosing.

STUDY DESIGN

In this prospective study, fractal analysis was performed on radiographs of 126 bruxists and 126 non-bruxists. Eight paired mandibular regions of interest were selected: the bilateral condylar and gonial regions, and the bilateral dentate regions between the apical areas of the first molar and second premolar and between the first premolar and canine. Fractal dimensions (FDs) were calculated at each site.

RESULTS

Mean FD values in the bilateral gonial regions of the bruxists were significantly lower than those of controls (P ≤ .049). In both groups, FD values of the right dentate region anterior to the mental foramen were significantly lower than those on the left side (P ≤ .042). Females exhibited significantly lower FD values in both condylar regions in both groups (P ≤ .039) and in the right dentate regions in the controls (P ≤ .022). Correlations between age and FD in all regions were positive but nonsignificant in both groups (P > .05).

CONCLUSIONS

FD values of mandibular trabecular bone are affected by bruxism in the gonial region and by laterality and sex differences in the condylar and dentate regions.

Evaluation of different Apexification treatments of teeth with immature apices and apical periodontitis on the fractal dimensions of trabecular bone

The aim of the present study was to investigate in the fractal dimension (FD) time-dependent changes of periapical bone after two different apexification treatments in teeth with immature apices and apical periodontitis. This study included 55 cases treated with apexification. Cases were divided into two groups: a calcium hydroxide group and a mineral trioxide aggregate group. In each case, the lesion area was evaluated by fractal analysis on periapical radiographs obtained before and 1-year after treatment via Image-J program. The FD of each region of interest on the radiographs was calculated using the fractal analysis method. The data were statistically analysed. In both groups, the FD values increased compare to initial at 1-year follow-up after treatment (P < .05). There was no statistically significant difference between the groups in terms of the time-dependent increase in FD values (P = 0.118). In the present study, time-dependent changes in FD were independent of the apexification method.

Radiographic determination of trabecular bone change in 2- and 4-implant-supported overdenture prostheses

OBJECTIVE

The aim of this study was to compare the fractal dimensions (FDs) of peri-implant trabecular bone around 2-implant-supported overdentures with the FDs around 4-implant-supported overdentures at the time of implant placement (T0) and 1 year after placement (T1).

STUDY DESIGN

Standardized regions of interest were chosen at sites mesial and distal to 60 mandibular implants: 20 in 2-implant-supported prostheses (group 1) and 40 in 4-implant-supported prostheses (group 2), for a total of 120 measurements. FD values were calculated by using ImageJ software with the box-counting method.

RESULTS

The mean FD values of peri-implant bone were significantly lower at T1 than at T0 in both groups (P ≤ .001). Differences between the groups in the decrease in FD between T0 and T1 were mostly insignificant.

CONCLUSIONS

Within the limitations of this study, 2-implant and 4-implant-supported overdentures exhibited the same degree of reduction in peri-implant FD over time, suggesting similar risk of failure because FD is related to implant stability. Depending on the patient's residual ridge status and other factors, the 2-implant-supported overdenture may be preferred because it requires less surgery and is less costly.

Effect of total edentulism on the internal bone structure of mandibular condyle: a preliminary study

OBJECTIVE

The aim of this study was to assess the internal structure of the mandibular condyles in patients with total edentulism by applying fractal analysis on cone-beam computed tomography (CBCT) images and compare with dentate subjects.

METHODS

A total of 136 mandibular condyles were assessed. All CBCT images were prepared with 0.25-mm slice thickness and maximum magnification. A 64 × 64 pixel region of interest (ROI) within the trabecular bone in the center of the condyle was selected. Fractal analysis was performed using White and Rudolph's box-counting method.

RESULTS

Control and study groups were age and gender-matched. The mean fractal dimension (FD) value of the study group was significantly lower compared to the control group (p < 0.01). In the study group, the mean FD value of the females was significantly lower than males (p = 0.01). For the control group, there was no significant difference between the genders for FD (p = 0.11). There was no significant difference between the age subgroups of the female study group and the male control group for FD (p = 0.22, p = 0.33). The mean FD value of the younger age subgroup was significantly higher compared to the older age subgroup in the female control and male study group (p = 0.03, p = 0.01).

CONCLUSION

The internal bone structure of mandibular condyles in edentulous patients was found to be affected by edentulism. Fractal analysis can be used as an effective method for assessing temporomandibular joint health.