Fractal Analysis of Periodontal Tissues in Geriatric Patients With Different Periodontal Conditions: A Retrospective Study

OBJECTIVE: This study evaluated the relationship between fractal dimension (FD) values and periodontal status in geriatric patients using digital panoramic radiographs. METHODOLOGY: In this retrospective observational study, 147 elderly individuals were classified as periodontally healthy (n = 30), gingivitis (n = 32), Stage I periodontitis (n = 26), Stage II periodontitis (n = 14), Stage III periodontitis (n = 20), and Stage IV periodontitis (n = 25) according to the 2017 World Workshop Classification. FD values were calculated using the box-counting method in ImageJ from standardized mandibular posterior trabecular bone regions (#35-36 and #45-46). Clinical periodontal parameters were recorded, and statistical analyses were performed using ANOVA and independent samples t-test (α = 0.05). RESULTS: No significant differences were observed among groups regarding age or gender distribution (p > 0.05), whereas clinical periodontal parameters and FD values differed significantly (p < 0.001). The highest FD values were observed in the healthy and gingivitis groups, with progressive decreases corresponding to periodontal disease severity. Gender-related differences were detected in gingivitis and periodontitis groups (p < 0.05). CONCLUSION: FD values vary with periodontal disease progression in geriatric patients, suggesting that fractal analysis may support radiographic assessment of trabecular bone changes when interpreted alongside clinical findings.