Fractal analysis of mandibular bone in children with delayed formation or agenesis of the mandibular second premolar germ

Background: The presence of dental developmental anomalies, such as hypodontia or delayed tooth germ formation, is a common etiological factor contributing to malocclusion. Understanding whether these anomalies affect mandibular trabecular bone structure is crucial for risk assessment and interceptive orthodontic planning. This study aimed to evaluate whether delayed formation or congenital absence of the mandibular second premolar germ alters the trabecular architecture of the mandible in children and adolescents. Methods: Two groups were studied (n = 48): delayed formation group (n = 24) and agenesis group (n = 24), age- and sex-matched at fractal dimension (FD) analysis. Standardized panoramic radiographs were processed using ImageJ software to calculate FD values for two regions of interest: the furcation area and the mandibular angulus. Results: There were no significant differences in age or gender between the groups at the time of FD analysis (mean age = 5.75 years in both groups). No significant differences in FD values were found between the two groups (p > 0.05). However, both groups exhibited significantly higher FD values in the mandibular angulus region compared with the furcation area (p < 0.05). Conclusions: These results suggest that the distinction between delayed formation and agenesis of the mandibular second premolar germ was not associated with major differences. Larger longitudinal studies are needed to further explore the relationship between trabecular architecture and dental developmental anomalies.