Assessment of Mandibular Trabecular Bone by Fractal Analysis on Digital Panoramic Radiograph in Patients with Inherited Bleeding Disorder.

The aim of this study was to assess mandibular trabecular bone health in patients with inherited bleeding disorders using fractal analysis (FA) on digital panoramic radiographs (DPR). Thirty-five patients with hereditary bleeding disorders (hemophilia A or B, and von Willebrand disease (VWD)) and 35 healthy controls were included. Data were collected on factor levels, inhibitor status, bleeding history, factor replacement therapy, vitamin D use, and calcium supplementation. Using ImageJ software, FA was performed from the determined regions in the mandible via DPR: ROI-1 (condylar region), ROI-2 (mandibular angle) and ROI-3 (molar region). Each region was independently evaluated by a radiologist and a maxillofacial surgeon trained in FA. Of the patients, 23 (65%) had severe hemophilia, 3 (8%) had type III VWD, 5 (15%) had moderate hemophilia, and 4 (12%) had type I VWD. Interobserver agreement for FA measurements in the condyle, angle, and molar areas was almost perfect (Kw = 0.992-0.993). In these three regions, no statistically significant differences in mean FA values were found between patients and controls, regardless of age or gender (p > 0.05). However, four high-risk patients-one with severe hemophilia B with inhibitors, two with type III VWD, and one with severe hemophilia A on an on-demand regimen-displayed significantly lower mean FA values in the condylar region compared to controls (p < 0.05). These findings suggest that while most patients with inherited bleeding disorders may not show marked alterations in mandibular trabecular bone structure, some high-risk individuals could have compromised bone health detectable via FA. This preliminary study indicates that FA may be a valuable tool for identifying at-risk patients with inherited bleeding disorders. Larger studies are needed to confirm these preliminary findings.