Fractal and Morphometric Analysis of Mandibular Bone in Periodontitis

Completed

• Conditions: Periodontitis; Panoramic Radiography

• Registration Number: NCT07209579
• Lead Sponsor: Istanbul University

Brief Summary

This retrospective study aims to evaluate the differences in mandibular bone structure between individuals with periodontitis and healthy controls using panoramic radiographs. Fractal analysis and radiomorphometric indices, such as the mental index (MI) and panoramic mandibular index (PMI), will be applied to assess trabecular and cortical bone. The study population includes patients previously diagnosed and treated for periodontitis and healthy individuals with available panoramic radiographs. By comparing bone quality and microarchitecture between the groups, the study seeks to determine the diagnostic value of panoramic radiographs for detecting periodontal bone changes and to provide insights for early diagnosis and treatment planning in dental practice.

Detailed Description

Periodontitis is a common inflammatory disease characterized by the destruction of tooth-supporting tissues, often caused by specific microorganisms. In addition to clinical evaluation, radiographic assessment of alveolar bone loss is essential for the diagnosis, treatment planning, and prognosis of periodontal diseases. Panoramic radiography is widely used in oral and maxillofacial imaging and can provide valuable information about cortical and trabecular bone structures through quantitative methods.

Fractal analysis is a mathematical approach that measures the complexity and trabecular patterns of bone. It has been shown to be independent of projection geometry and is commonly applied in digital radiographs. The fractal dimension (FD) reflects the degree of trabecular complexity and can serve as a numerical indicator of bone microarchitecture. The box-counting method, as described by White and Rudolph, will be employed in this study using ImageJ software. In addition to fractal analysis, morphometric indices such as the mental index (MI) and panoramic mandibular index (PMI) will be calculated to assess mandibular cortical thickness and morphology.

This retrospective observational study will include 120 panoramic radiographs obtained from the archives of the Department of Oral and Maxillofacial Radiology, Istanbul University Faculty of Dentistry. The study group will consist of patients with a confirmed diagnosis of periodontitis according to the 2017 classification by the European Federation of Periodontology and the American Academy of Periodontology, while the control group will include systemically healthy individuals with no periodontal disease. Exclusion criteria include individuals under 18 years of age, those with systemic or syndromic conditions, and radiographs with diagnostic errors.

Radiographic measurements will be performed independently by two oral and maxillofacial radiologists, and intra- and inter-observer agreement will be tested through repeated evaluations. Statistical analyses will be conducted using NCSS 2007 software, applying descriptive statistics, Shapiro-Wilk test for normality, independent t-test or Mann-Whitney U test for group comparisons, and chi-square tests for categorical data, with a significance level of p\<0.05.

The study is expected to reveal quantitative differences in mandibular bone structure between individuals with periodontitis and healthy controls. The results may contribute to improved diagnostic accuracy of panoramic radiographs in periodontal disease and provide additional tools for early detection and risk assessment in clinical practice.

Study Timeline

• Study Start: 2023-04-15
• Primary Completion: 2023-05-15
• Study Completion: 2023-05-15
• Status Verified: 2025-09
• Study First Submitted: 2025-09-29
• Study First Submitted QC: 2025-09-29
• Last Update Submitted: 2025-09-29
• Study First Posted: 2025-10-07
• Last Update Posted: 2025-10-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

• Individuals aged 18 or older
• Patients with clinically and radiographically diagnosed periodontitis (case group)
• Periodontally and systemically healthy individuals (control group)

Exclusion Criteria

• Individuals younger than 18
• Patients with systemic or syndromic conditions affecting bone structure
• Panoramic radiographs with artifacts or diagnostic errors

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Difference in fractal dimension values between periodontitis and healthy groups	At baseline	Fractal dimension (FD) values of mandibular bone will be measured from panoramic radiographs using ImageJ software and compared between periodontitis patients and healthy controls.

Secondary Outcome Measures

Name	Time	Method
Differences in morphometric indices between groups	At baseline	Morphometric indices will be calculated and compared between periodontitis patients and healthy controls.

Trial Locations

Locations (1)

Istanbul University Faculty of Dentistry; Istanbul, Turkey (Türkiye)