Evaluation of bone changes on dental panoramic radiographs using mandibular indices and fractal dimension analysis in obese children

Obesity may influence bone architecture through metabolic disturbances such as inflammatory interactions, increased mechanical loading, hormonal alterations, and vitamin D deficiency. Vitamin D deficiency can lead to reduced bone mineralization and impaired microarchitectural integrity, thereby decreasing bone strength and mechanical resilience. The aim of this study was to evaluate the bone microarchitecture and density among obese children with and without vitamin D deficiency and healthy children using fractal dimension analysis and mandibular indices. A total of 120 panoramic radiographs, obtained for diagnostic purposes from obese children without vitamin D deficiency, obese children with vitamin D deficiency, and healthy children who presented to the Department of Pediatric Dentistry, Faculty of Dentistry, Tokat Gaziosmanpaşa University, were included in this study. Patients were matched for age and gender. Radiomorphometric indices (mandibular cortical index, mental index, and panoramic mandibular index) were measured on the panoramic radiographs, and fractal dimension analysis was performed on ROIs obtained from six different regions (right condyle, right angulus, right interdental area, left condyle, left angulus, and left interdental area). Data were analyzed using IBM SPSS Statistics v23 (R 4.4.1), with a significance threshold of p < 0.05. Both obese groups—with and without vitamin D deficiency—demonstrated significantly higher panoramic mandibular index (PMI) and mental index (MI) values compared to healthy controls (p < 0.05). There was no significant difference among groups in the distribution of mandibular cortical index (MCI) types (p > 0.05). Obese children without vitamin D deficiency exhibited significantly higher FD values in the right interdental area than did those with vitamin D deficiency (p < 0.05). Although not reaching statistical significance, FD values in the left interdental area were also higher in obese children without vitamin D deficiency. No significant intergroup differences were observed for mean FD values at the right condyle, right angulus, left condyle, or left angulus (p > 0.05). Panoramic radiographic analysis indicates that obesity and vitamin D deficiency affect trabecular pattern, porosity, and bone mineral density of the mandible. However, these effects vary across different mandibular regions—such as the angulus, condyle, corpus, and interdental areas. These regional variations should be taken into account when planning orthodontic, prosthetic, or surgical interventions. Keywords: Panoramic Radiography, Fractal Dimension Analysis, Radiomorphometric Indices, Vitamin D, Obesity.