Objective: The purpose of the study was to determine if there was a relationship between fractal dimension of trabecular bone and periodontal health. This would make it possible to quantify periodontal health from radiographs alone and could allow more precise identification of people at risk for bone disease.
Method: 108 randomly-selected subjects from the USC dental clinic were divided into three groups: healthy (n=36), moderate (n=36), and severe-periodontitis (n=36). A region of interest (ROI) was selected from the apical region in periapical radiographs. Image processing corrected for lighting irregularity and the box-counting-method found in the ImageJ software was used to calculate a fractal dimension for each ROI. This analysis provided a number which described the trabecular bone pattern. A one-way ANOVA test with post-hoc LSD was used to determine differences in paired groups, significance set at 0.05.
Results: When comparing patients diagnosed for moderate or severe periodontitis to healthy patients, healthier gingiva was associated with a higher fractal dimension (FD=1.726, SD= „b0.096). Lower fractal dimension was measured in patients affected by moderate periodontitis (FD=1.661, SD= „b0.105) compared to healthy patients (p<0.05). Lower fractal dimension was also measured in severe periodontitis patients (FD= 1.636 ,SD= „b0.095) in comparison to the control group (p< 0.0005).
Conclusion: Fractal analysis evidenced significant differences between patients affected or not affected by periodontitis. The box-counting method may provide a means for early identification of patients who are at a higher risk of developing maxillary or mandibular osteoporosis. The analysis could quantitatively describe the severity of bone disease with more accuracy than current techniques.