Investigation of the effect of periodontal treatments on the trabecular structure of the jaw bone using fractal analysis method

Periodontal diseases are chronic inflammatory conditions that begin with a soft tissue inflammatory response and, if left untreated, progress to involve deeper periodontal tissues, leading to alveolar bone destruction. Depending on the severity and extent of the disease, resorptive changes may occur in the jawbone, resulting in structural irregularities within the trabecular bone architecture. Various treatment approaches, such as dental scaling, subgingival curettage, and periodontal flap surgery, are employed according to the degree of bone involvement. These therapeutic modalities aim to halt disease progression and preserve the trabecular integrity of the alveolar bone. The present study aimed to evaluate the potential changes induced by different periodontal treatment modalities on the trabecular structure of the jawbone using the fractal analysis (FA) method applied to panoramic radiographs (PRs). In this retrospective study, panoramic radiographs of 150 systemically healthy patients who presented to Gaziantep University, Faculty of Dentistry, Department of Periodontology, at different periods were analyzed. Participants were divided into three groups based on the type of periodontal treatment received: Group I – Scaling (50 PRs), Group II – Subgingival Curettage (50 PRs), and Group III – Periodontal Flap Surgery (50 PRs). Each patient had two radiographs—pre-treatment (PT) and post-treatment (PoT)—resulting in a total of 300 PRs (150 PT + 150 PoT) evaluated through FA. In intra-group comparisons, no significant differences were observed among the ROIs in Group I. In Groups II and III, the FA values of ROI 2, 3, 4, and the mean ROI 2–3–4–5 showed statistically significant increases after treatment (p<0.05). Inter-group comparisons revealed that the increase in ROI 3 and mean ROI 2–3–4–5 values was significantly higher in Groups II and III (p<0.05). This study represents one of the first comparative evaluations of the effects of different periodontal treatment methods on alveolar trabecular bone using a non-invasive FA approach. Further studies with larger sample sizes and a broader range of ROI regions are warranted to validate and expand upon these findings.