Exploring regional structural differences of maxilla and mandible via fractal dimension

Background. The maxilla and mandible are two distinct anatomical structures that differ significantly in terms of functional loading, embryological development, and cortical-cancellous bone ratios In clinical practice, infiltrative anesthesia is often sufficient for the maxilla and anterior mandible, but regional anesthesia is frequently required for the posterior mandible. Study aims to provide objective and reproducible data to support the indirect clinical observations of bone structural differences in local anesthesia applications and surgical planning via fractal analysis.

Methods. In panoramic radiographs, a total of 8 regions of interest were selected from the right and left apical regions, including 2 anterior maxillae, 2 posterior maxillae, 2 anterior mandibles, and 2 posterior mandibles. These were evaluated for fractal dimension using the box counting method with ImageJ software.

Results. When evaluated according to these four regions, the fractal dimension ranking was highest in the mandibular posterior region and lowest in the maxillary anterior region. Notably, the maxillary posterior region has a lower mean value for trabecular organization compared to the mandibular anterior region. According to the Tukey post hoc test, there is no statistically significant difference between the maxillary anterior and posterior regions. However, the differences between all other regions are statistically significant. In all regions of interest fractal values of male individuals were higher than females.

Conclusion. This study demonstrated that differences in sex related and regional trabecular organization between the maxilla and mandible, as well as within the same jaw, can be revealed quantitatively using fractal analysis applied to apical regions of interest obtained from panoramic radiographs, in a low radiation imaging technique and open access software in terms of maximum accessability.