Assessment of Mandibular Bone Architecture in Patients with Endocrine Disorders Using Fractal Dimension and Histogram Analysis.

OBJECTIVE

Endocrine disorders, including diabetes mellitus and thyroid dysfunctions, can significantly impact bone metabolism and structure. This study aimed to assess mandibular trabecular architecture in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), hyperthyroidism, and hypothyroidism using fractal dimension (FD) and histogram analyses (HA), comparing the findings with a healthy control group.

METHODS

This retrospective study analyzed panoramic radiographs from 200 individuals, comprising 40 patients in each of the four endocrine disorder groups and 40 healthy controls. Fractal dimension and histogram-based pixel intensity analyses were conducted using ImageJ™ (version 1.53) software. Four standardized regions of interest (ROI) were evaluated on the right mandible, and statistical comparisons were conducted across groups using one-way analysis of variance (ANOVA), t-test, Mann-Whitney U, and Spearman correlation analyses.

RESULTS

Age and gender distributions did not differ significantly between groups. FD analysis revealed a significant reduction at ROI1 in the hyperthyroidism group compared to controls (p = 0.018); however, no other significant FD differences were observed among the remaining groups or ROIs. A significant positive correlation was found between FD and histogram values at ROI1 and ROI2 (p < 0.001), while pixel intensity values did not differ significantly across groups in any ROI.

CONCLUSION

Although no significant differences were found in diabetic groups, the decreased FD in hyperthyroid patients suggests that FD analysis may be a useful non-invasive method to detect subtle bone alterations. Further research with larger sample sizes and comprehensive biochemical analyses are needed to confirm these findings.