Evaluation of Trabecular Bone Structure in Periodontal Disease Using Fractal Dimension and Lacunarity Analysis in Cone-Beam Computed Tomography: A Cross-Sectional Retrospective Study

The aim of this study was to evaluate trabecular bone structure in periodontal disease using fractal dimension (FD) and lacunarity analysis (LA) in cone-beam computed tomography (CBCT). A total of 120 CBCT images from the archives of our college were collected after applying inclusion and exclusion criteria. Regions of interest were preprocessed and subjected to fractal analysis and LA using the ImageJ software and statistical comparisons were performed between healthy individuals and periodontitis patients. Lacunarity values were significantly greater (p < 0.001) and FD values were significantly lower in patients with periodontitis than in healthy controls. Differences by gender were noted, with larger lacunarity values seen in females in the periodontitis group. In cases of periodontitis, FD and lacunarity were found to be inversely correlated by Kendall's tau correlation. Increased heterogeneity and decreased trabecular bone complexity are linked to periodontitis. Even before severe bone loss is radiographically apparent, FD and LA on CBCT images can identify modest trabecular alterations. In the context of periodontal care, these measures can be sensitive supplementary instruments for early diagnosis, disease surveillance, and treatment planning.