This study aimed to investigate the effects of malocclusion and tooth loss on the trabecular bone microarchitecture of the temporomandibular joint (TMJ) condylar head using fractal dimension (FD) analysis on panoramic radiographs. A total of 1,061 individuals (684 females, 377 males) were included. Malocclusion and tooth loss were determined through clinical examination. Fractal analysis was performed on 50 × 50 pixel regions of interest from both TMJ condyles using ImageJ software. Statistical analyses included independent t-tests, chi-square tests, and two-way ANOVA to assess the main and interaction effects of malocclusion, tooth loss, and TMJ side on FD values. Malocclusion showed no significant effect on FD values (p > 0.05). However, tooth loss significantly affected the trabecular bone structure (p < 0.001), with a notable interaction between the TMJ side and the side of tooth loss. Individuals with unilateral tooth loss exhibited significantly reduced FD values in the contralateral condylar head compared to those without tooth loss (p < 0.001). This contralateral FD reduction may be associated with asymmetric functional loading following unilateral tooth loss; however, chewing side preference was not specifically evaluated in this study. While malocclusion did not significantly influence TMJ trabecular architecture, tooth loss—particularly unilateral—was associated with distinct microstructural alterations detectable through fractal analysis. Early prosthetic rehabilitation following tooth loss is therefore essential to prevent long-term structural changes in the TMJ. Fractal analysis of panoramic radiographs provides a valuable, non-invasive method for evaluating TMJ bone integrity in clinical and research applications. Not applicable.
Yunus Balel (Sat,) studied this question.