Association between bruxism and mandibular trabecular bone microarchitecture: A fractal dimension analysis using panoramic radiographs

Objective To evaluate the association between bruxism and mandibular trabecular bone microarchitecture using fractal dimension (FD) analysis and determine whether this association persists after adjustment for demographic confoundersMethods This retrospective study included 200 systemically healthy individuals (100 with bruxism, 100 controls). Bilateral FD measurements were obtained from condylar, gonial, and mandibular corpus regions on panoramic radiographs using ImageJ. Independent t-tests and age-adjusted ANCOVA were performed.Results Bruxism was associated with lower FD in the right gonial region in unadjusted analysis (p = .007), while males showed higher FD than females (p < .001). After adjustment for age and sex, bruxism was not significantly associated with FD in any region (all p > .05). A sex effect persisted in the right gonial region (p = .002, partial η2 = 0.047). Conclusion Demographic confounding may partly explain previously reported FD differences attributed to bruxism.