Radiographic fractal analysis of mandibular trabecular bone in children with down syndrome: a matched case-control study

Down syndrome (DS) is associated with systemic skeletal abnormalities; however, to the best of our knowledge, mandibular trabecular bone microarchitecture has not previously been evaluated in pediatric patients using fractal analysis (FA). This study assessed mandibular trabecular radiographic architecture in children with DS on panoramic radiographs and compared fractal dimension (FD) values with healthy age- and sex-matched controls. Thirty-six children with DS and 36 matched controls were retrospectively included. FA was performed on bilateral condylar, gonial, and dentate regions using ImageJ. Between-group comparisons used the Mann–Whitney U test, with Holm adjustment for six regional comparisons. Exploratory receiver operating characteristic (ROC) analysis was restricted to regions remaining significant after correction. After Holm adjustment, FD values were significantly lower in the right condylar (adjusted p = 0.035) and right dentate (adjusted p = 0.003) regions in children with DS. The right dentate region showed the highest exploratory discrimination (AUC = 0.738, 95% CI: 0.624–0.851), followed by the right condylar region (AUC = 0.684, 95% CI: 0.557–0.810). These findings suggest region-specific differences in mandibular trabecular radiographic texture in children with DS. The observed discriminatory performance was moderate and requires independent validation in larger prospective studies.