Fractal dimension and lacunarity analysis of mandibular bone on digital panoramic radiographs of tobacco users

Background. This study aimed to evaluate and compare changes in the mandibular trabecular bone pattern using the fractal dimension (FD) and lacunarity analysis in tobacco users with healthy controls.

Methods. This study was carried out on digital panoramic radiographs of 225 subjects divided into three groups: smokeless tobacco users (SLTs), smokers, and control (n=75). ImageJ program with FracLac plugin was used to assess the FD and lacunarity of mandibular trabecular bone on the digital panoramic radiographs.

Results. The differences in the mean FD values of the study and control groups were statistically significant (P<0.001). Mean FD was lower in the case groups than the control group, with SLTs having the least FD value. A significant difference in lacunarity was noted between SLTs and controls (P<0.001). On the contrary, there was no significant difference in lacunarity between smokers and controls.

Conclusions. FD values were lower in tobacco users, suggesting that tobacco users have a less complex trabecular bone pattern than healthy controls. Higher lacunarity values in SLTs indicated a more heterogeneous bone pattern. These findings signify that FD and lacunarity analysis on digital panoramic radiographs can serve as promising predictive tools to assess bone quality for osteoporotic changes in tobacco users, thereby facilitating prompt referral for further management.