Fractal and Morphometric Analysis of Mandibular Bone in Individuals With Bruxism: A Retrospective Cross-Sectional Study Using Panoramic Radiographs.

BACKGROUNDS: To assess cortical and trabecular bone modifications in the mandible of persons with and without bruxism by panoramic radiography-based fractal analysis and morphometric assessments.

METHODS

This retrospective cross-sectional study examined panoramic radiographs of individuals diagnosed with bruxism and matched controls aged 18-50. Fractal dimension (FD) values were computed in three mandibular regions (condyle, molar, and angulus) utilising the box-counting method following image preprocessing. Morphometric measures, such as the antegonial index (AI) and antegonial notch depth (AND), were measured. The severity of bruxism was categorised using a four-tier (G0-G3) grading system predicated on the morphology of the mandibular angle. Statistical analyses were used to evaluate intergroup differences and geographical variations.

RESULTS

The FD values in the condylar region were substantially lower in the bruxist group (1.29 ± 0.05) compared to the controls (1.31 ± 0.04; p = 0.015), indicating microstructural degradation. No substantial variations were observed in the molar and angulus areas. The AI in the bruxist group (2.19 ± 0.45 cm) was substantially lower than that of the control group (2.40 ± 0.41 cm; p = 0.002), whereas AND showed no significant difference. Subgroup analysis indicated that G3 bruxists exhibited the lowest condylar FD values, suggesting structural compromise in advanced cases.

CONCLUSIONS

Bruxism, especially in its more severe manifestations, may cause microarchitectural alterations in the mandibular trabecular bone, particularly in the condylar area. Fractal analysis and morphometric indices obtained from panoramic radiographs may function as supplementary, non-invasive methods for detecting bruxism-related bone changes in clinical settings.