Mandibular trabecular fractal dimension in individuals with type 2 diabetes and hypertension: a retrospective cross-sectional panoramic radiography study.
Type 2 diabetes was significantly associated with higher microarchitectural complexity in mandibular trabecular bone as measured by fractal dimension analysis on panoramic radiographs, whereas the increase observed in the hypertension group did not reach statistical significance.
Key Findings
Results
Age-adjusted fractal dimension values were higher in both the diabetes and hypertension groups compared to healthy controls.
Age-adjusted fractal dimension averages: diabetes group = 1.409, hypertension group = 1.407, control group = 1.386
Study included 156 individuals: Control (n=43), Hypertension (n=63), Diabetes (n=50)
Age-related confounding effects were adjusted for using Analysis of Covariance (ANCOVA)
Gender distribution was similar across groups, but controls were younger, necessitating age adjustment
Results
Type 2 diabetes was significantly associated with higher mandibular trabecular bone microarchitectural complexity as measured by fractal dimension.
The diabetes group showed a mean age-adjusted fractal dimension of 1.409 compared to 1.386 in controls
The association between Type 2 diabetes and elevated fractal dimension reached statistical significance
Fractal dimension was measured on mandibular molar regions using the box-counting algorithm applied to panoramic radiographs
This finding suggests systemic disease impacts mandibular trabecular bone microarchitecture
Results
The increase in fractal dimension observed in the hypertension group did not reach statistical significance compared to controls.
The hypertension group had an age-adjusted fractal dimension of 1.407, compared to 1.386 in controls
Despite a numerically higher value than controls, the difference for the hypertension group was not statistically significant
The hypertension group was the largest subgroup with n=63 participants
After age adjustment via ANCOVA, systemic diseases overall impacted fractal dimension values
Methods
Intra-observer reliability for fractal dimension measurements was excellent.
Reliability was assessed using the Intra-Class Correlation Coefficient (ICC)
The study characterized the ICC result as 'excellent'
This was a retrospective cross-sectional study design using existing panoramic radiographs
The box-counting algorithm was used to calculate fractal dimension in mandibular molar regions
Conclusions
Fractal analysis on routine panoramic radiographs was proposed as a potentially adjunctive non-invasive clinical tool for assessing systemic effects on bone microarchitecture.
The authors noted these are 'preliminary findings' that 'require validation with established reference methods'
Panoramic radiographs are a routine clinical imaging modality, making this approach potentially accessible
The study was retrospective and cross-sectional in design with n=156 total participants
Authors described the method as 'non-invasive' and 'adjunctive' rather than a standalone diagnostic tool
What This Means
This research suggests that common systemic diseases like type 2 diabetes and high blood pressure may leave detectable changes in the microscopic structure of jawbone tissue, and that these changes can potentially be identified using standard dental X-rays (panoramic radiographs). The study analyzed the complexity of the spongy (trabecular) bone in the jaw of 156 people — some healthy, some with type 2 diabetes, and some with hypertension — using a mathematical measurement called fractal dimension, which quantifies how intricate or complex a bone's internal pattern appears on an X-ray. After accounting for age differences between groups, people with type 2 diabetes had statistically significantly more complex bone patterns than healthy controls, while people with hypertension showed a similar but non-statistically-significant trend.
The practical implication is that routine dental X-rays, which patients already receive for dental care, might one day provide additional information about a person's bone health in relation to systemic conditions like diabetes. This could be valuable because it would require no extra radiation or invasive procedures. However, the authors are careful to note that these findings are preliminary and based on a relatively small, retrospective study, meaning the results need to be confirmed using more rigorous methods and larger populations before clinical use could be considered.
This research matters because type 2 diabetes and hypertension are extremely common worldwide and are known to affect bone quality, potentially increasing fracture risk. Having a simple, non-invasive way to monitor these skeletal effects through dental imaging could have broad public health applications, but more research is needed to validate whether fractal dimension analysis can reliably serve this purpose.
İncebeyaz B. (2026). Mandibular trabecular fractal dimension in individuals with type 2 diabetes and hypertension: a retrospective cross-sectional panoramic radiography study.. BMC oral health. https://doi.org/10.1186/s12903-026-09785-3