Comparative examination of trabecular bone structure in healthy and diabetic patients with periodontitis using fractal analysis

Objectives: Fractal analysis is a numerical method that indicates the structural patterns and complexity of the trabecular bone on radiographs. The aim of this cross-sectional study was to evaluate the trabecular bone structure in systemically healthy patients and diabetes mellitus patients with periodontitis using fractal analysis.
Method and materials: The study included 125 mandibular first molars of nonsmoker patients. The subjects were divided into five subgroups: diabetes mellitus patients with mild–moderate periodontitis, diabetes mellitus patients with advanced periodontitis, systemically healthy individuals with mild–moderate periodontitis, systemically healthy individuals with advanced periodontitis, and systemically healthy individuals with gingivitis (control group). Clinical periodontal parameters (pocket depth, bleeding on probing, clinical attachment loss, and bone loss) were recorded. Two specific sites located in the mesial–distal regions (n = 250) of the mandibular first molars were identified using periapical radiographs captured with a parallel technique. Fractal analysis values were calculated using the box-counting method. One-way analysis of variance (ANOVA), and Pearson correlation analysis were used for statistical evaluation.
Results: The highest fractal analysis values were observed in systemically healthy with gingivitis patients (mesial fractal analysis: 1.86 ± 0.01; distal fractal analysis: 1.85 ± 0.01). Patients with periodontitis (mesial fractal analysis: 1.78 ± 0.02; distal fractal analysis: 1.79 ± 0.01) exhibited lower fractal analysis values compared to the control group. There was no significant difference in mesial and distal fractal analysis values between all periodontitis groups. No correlation was found between age, sex, clinical attachment loss, bone loss, and fractal analysis (P > .05).
Conclusions: Although fractal analysis values were lower in the periodontitis groups compared to the control group, fractal analysis did not demonstrate any periodontitis-associated changes of bone trabeculation in diabetes at any stage of periodontitis. Furthermore, there was no significant association between fractal analysis values and age, sex, clinical attachment, and bone loss.