Application of Fractal Analysis in Digital Orthopantomographs of Bruxers: A Systematic Review

Background: Traditional diagnostic methods for bruxism often rely on subjective assessments. Recently, fractal analysis (FA)—a mathematical method used to quantify complex structures—has gained attention as a noninvasive radiographic tool to evaluate trabecular bone changes. Objective: This systematic review aims to assess the application of FA in differentiating digital orthopantomographs (OPGs) of individuals with bruxism from those without. Materials and Methods: In accordance with PRISMA guidelines, a comprehensive search was conducted across five databases to identify studies evaluating fractal dimension on OPGs of bruxers. The JBI Critical Appraisal Checklist and the QUADAS-2 tool were employed to evaluate the risk of bias. Results: Out of 18 studies identified, 10 met the eligibility criteria, encompassing a total of 1666 participants. Four studies reported higher fractal dimensions in bruxers, three reported lower fractal dimensions, and three found no significant difference. Sex-related differences were inconsistently reported across studies. The QUADAS-2 assessment indicated moderate overall quality, with concerns regarding patient selection, reference standards, and variations in study design. Conclusion: FA offers insights into mandibular structural changes in bruxers; however, inconsistencies in methodology and results underscore the necessity for standardized FA protocols.