Friday, July 25, 2025
The aim of this study is to examine changes in the trabecular structure of jaw bones in acute leukemia (AL), which can cause extensive osteopenia using Fractal Analysis (FA). Panoramic images of 45 patients with AL, who had no additional disease affecting the bone, were used as the case group. Control images of 45 patients without bone disease were used for analysis. For each image, 4 regions of interest (ROI) were identified in two anterior and two posterior areas of the mandible. FA was applied to these ROIs, and results were analyzed statistically. The case group showed significantly lower FA values compared to the control group. Gender had no effect on FA values, and there was no correlation between age, blood values, or FA values. The changes in bone structure from AL can be detected with FA, and gender and age had no impact on FA values. There is no correlation between blood values and FA values. AL causes osteopenia, leading to reduced trabecular complexity, as trabecular jawbone has a high bone turnover rate. Diseases affecting internal organs may show signs in dental structures. Dentists may first suspect systemic diseases based on early signs in oral cavity. Oral structures such as teeth, jaws, oral mucosa, and temporomandibular joints can be affected by metabolic, endocrine, or vascular disorders. Leukemia, a significant blood disease, involves malignant anomalies in hematopoiesis. When normal hematopoiesis is disrupted, mutations occur in early precursors, leading to uncontrolled proliferation. These malignant cells spread throughout the body [1, 2]. Although leukemia classification is complex, it is clinically divided into acute and chronic forms. Acute leukemia (AL) is particularly significant as it is the most common malignancy in childhood. The disease progresses rapidly without treatment, often with a poor prognosis. Radiographically, extensive osteopenia of bones can be seen in AL. Jaw involvement is more common in developing teeth and manifests as rarefied osteitis in periapical regions. Radiographic features include poorly defined radiolucent areas and, in some cases, onion-skin-like periosteal new bone formation. Destruction of the cortical border of lamina dura and follicular structures may occur, and erupting teeth may change position [1, 2]. Panoramic imaging (PI) is a two-dimensional diagnostic tool used to evaluate large areas of the jaws. PI is simple, practical, and cost-effective. Beyond assessing dental structures, bone morphology can be analyzed, and various methods are used for analysis. Fractal analysis (FA) is a statistical texture analysis technique based on fractal mathematics, measuring self-similarity and complexity. It measures shapes—curves, points, and surfaces—that cannot be represented by conventional geometry but exhibit fractal features. FA has been used to describe shapes in biological images. It is non-invasive, accessible, and cost-effective. As a result, its use in medicine and dentistry continues to grow. The validity and reliability of FA in dental studies have been reported, especially in evaluating bone structure. Many studies have explored FA's use to detect osteoporotic changes in the jaw bones associated with metabolic diseases. The image of internal alveolar bone resembles a lattice formed by thin spicules, trabeculae, and lamellae. Trabecular bone features a branching structure with fractal characteristics, such as self-similarity and scale invariance. Measuring fractal dimensions using fractal geometry allows information on subtle changes in three-dimensional trabecular bone to be obtained from two-dimensional images using FA values [14]. This enables detection of changes in bone structure from two-dimensional images using fractal parameters. Various pathological conditions may alter anatomical structures, and these changes can be detected with fractal parameters [12, 16]. The aim of our study was to examine changes in the trabecular structure of jaw bones affected by AL using FA.
Reference: Retrospective panoramic radiographic evaluation of acute leukemia patients with fractal analysisLabels: BMC Oral Health
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