Evaluation of scaling and root planing effect in generalized chronic periodontitis by fractal and multifractal analysis

Abstract

Fractal and multifractal analysis are useful additional non-invasive methods for quantitative description of complex morphological features. However, the quantitative and qualitative assessment of morphologic changes within human gingival cells and tissues are still unexplored. The aim of this work is to assess the structural gingival changes in patients with generalized chronic periodontitis (GCP), before and after scaling and root planing (SRP) by using fractal and multifractal analysis. Twelve adults with untreated chronic periodontitis were treated only by SRP. At baseline and after SRP, gingivomucosal biopsies were collected for histopathological examination. Fractal and multifractal analysis of digital images of the granular, spinous and basal and conjunctive layers structure, using the standard box-counting method was performed. The fractal dimension was determined for cell membrane, nuclear membrane of cell and nucleolus membrane of cell. In GCP a higher fractal dimension corresponds to a higher geometric complexity of cells contour, as its values increase when the contour irregularities increase. The generalized fractal dimensions were determined for the conjunctive layer structure of patients with GCP and patients with GCP and SRP. The fractal and multifractal analysis of gingival biopsies confirmed earlier findings that SRP reduces gingival injury in patients with GCP. It has been shown that fractal and multifractal analysis of tissue images as a non-invasive technique could be used to measure contrasting morphologic changes within human gingival cells and tissues and can provide detailed information for investigation of healthy and diseased gingival mucosa from patients with GCP.