Akademik Veri Yönetim Sistemi
JOURNAL OF IMAGING INFORMATICS IN MEDICINE, cilt.39, ss.1-9, 2026 (SCI-Expanded)
This retrospective study aimed to evaluate the effects of diabetes mellitus and periodontitis on alveolar bone density and
trabecular bone quality using cone-beam computed tomography (CBCT) and to compare fractal analysis with Hounsfield
unit (HU) measurements. CBCT images of 217 individuals aged 20–80 years were retrospectively analyzed and divided into
four groups. A standardized square region of interest was defined in the trabecular bone between the apex of the mandibular
first molar and the superior border of the mandibular canal. HU values were obtained using CBCT software, while fractal
dimension (FD) values were calculated using an automated single-click fractal analysis method. Significant differences in
FD values were observed among groups in axial and coronal sections (p < 0.05), but sagittal sections showed no significant
differences. HU values differed significantly among all groups in most sections (p < 0.05). Systemically and periodontally
healthy individuals demonstrated higher HU values and lower FD values compared with those affected by diabetes mellitus or
periodontitis. A weak positive correlation was observed between FD axial and HU sagittal values. Age was weakly negatively
correlated with HU axial values, while no significant association with gender was found. Age had a significant negative effect
on HU values in the axial and sagittal models, but no significant effect on any FD sections. CBCT-based analysis revealed
section-dependent sensitivity of FD, with significant differences in axial and coronal sections but not sagittal. HU values
partially reflected alveolar bone density differences between healthy and diseased individuals. FD and HU measurements
provide complementary, not interchangeable, information on alveolar bone quality.