Assessment of fractal dimension changes in periapical trabecular patterns following single-visit and multi-visit nonsurgical endodontic treatment with different medicaments: a retrospective study.

OBJECTIVE

This study aimed to compare time-dependent changes in fractal dimension (FD) and periapical index (PAI) values of periapical trabecular bone in the lesion areas following single- and multi-visit end-odontic treatments using different intracanal medicaments.

MATERIAL AND

METHODS

Data from 62 mandibular molars treated between March and December 2023 were analyzed and assigned to three groups: Group 1, multi-visit treatment with calcium hydroxide [Ca(OH)₂] (n = 20); Group 2, multi-visit treatment with chlorhexidine (CHX) gel (n = 21); and Group 3, single-visit treat-ment without medicament (n = 21). Follow-up data were collected until December 2024. Three periapical radiographs, baseline, 6-months, and 12 months after treatment, were evaluated. Fractal analysis was per-formed on a region of interest (ROI) near the infected root apex, and periapical healing was also assessed using PAI scores. PAI scores were compared using the Kruskal-Wallis test; FD values and their correlation with PAI were analyzed by two-way analysis of variance (ANOVA) and Spearman's test. Categorical variables were compared using the chi-square and Fisher-Freeman-Halton tests.

RESULTS

PAI scores significantly decreased in all groups at 6 and 12 months compared with baseline (p < 0.001), with no intergroup differences (p > 0.05). FD values significantly increased over time in all groups (p < 0.001). The magnitude of FD change and gender-related differences were not significant (p > 0.05). No correlation was observed between PAI and FD values (p > 0.05).

CONCLUSIONS

Single- and multi-visit endodontic treatments resulted in similar periapical healing out-comes. The type of intracanal medicament did not influence FD or PAI values. Fractal analysis is a valuable, noninvasive tool for assessing periapical bone healing over time.