Correlation of Fractal Dimension Values with Implant Insertion Torque and Resonance Frequency Values at Implant Recipient Sites

Purpose: Fractal analysis is a mathematical method used to describe the internal architecture of complex structures such as trabecular bone. Fractal analysis of panoramic radiographs of implant recipient sites could help to predict the quality of the bone prior to implant placement. This study investigated the correlations between the fractal dimension values obtained from panoramic radiographs and the insertion torque and resonance frequency values of mandibular implants. Materials and Methods: Thirty patients who received a total of 55 implants of the same brand, diameter, and length in the mandibular premolar and molar regions were included in the study. The same surgical procedures were applied to each patient, and the insertion torque and resonance frequency values were recorded for each implant at the time of placement. The radiographic fractal dimensions of the alveolar bone in the implant recipient area were calculated from preoperative panoramic radiographs using a box-counting algorithm. The insertion torque and resonance frequency values were compared with the fractal dimension values using the Spearman test. Results: All implants were successful, and none were lost during the follow-up period. Linear correlations were observed between the fractal dimension and resonance frequency, between the fractal dimension and insertion torque, and between resonance frequency and insertion torque. Conclusion: These results suggest that the noninvasive measurement of the fractal dimension from panoramic radiographs might help to predict the bone quality, and thus the primary stability of dental implants, before implant surgery. Keywords: box-counting algorithm, dental implants, fractals, insertion torque, resonance frequency, trabecular bone