Abstract
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.
Highlights
Evaluation of detailed features of the supporting bone is an important step in diagnosis and treatment planning for teeth with clinical attachment loss
Radiography is an important tool used in different phases of periodontal evaluation, and different imaging modalities can be used to monitor the status of periodontal tissues, including panoramic radiography, intraoral radiography, and cone beam computed tomography [5,6,7]
Discussion e findings of the present study indicated that fractal analysis can be used to distinguish between the periodontal
Summary
Periodontal disease is one of the most important causes of tooth loss and can be considered as a modifying factor in many systemic diseases [1,2,3,4]. Among the existing methods for calculating FD, the boxcounting approach explained by White and Rudolph is mostly used for binary images such as periapical radiographs. In this method, FD is basically a measure of the number of boxes needed to cover the trabecular pattern. A number of studies have been performed on evaluation of trabecular changes in the alveolar bone in patients with periodontitis [10, 13,14,15]. Erefore, the aim of the present study was to evaluate the trabecular bone changes in periapical radiographs of patients with different stages of periodontitis using fractal analysis None of these studies have separately assessed mild, moderate, and severe periodontitis. erefore, the aim of the present study was to evaluate the trabecular bone changes in periapical radiographs of patients with different stages of periodontitis using fractal analysis
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