Evaluation of Peri-Implant Bone Changes with Fractal Analysis

<b>Background/Objectives:</b> Accurate scientific methods are essential for monitoring the osseointegration of dental implants postoperatively. This study aims to evaluate peri-implant bone changes using the fractal analysis (FA) method during follow-up. <b>Methods:</b> Periapical radiographs were obtained from 77 patients with dental implants, and 33 permanent teeth serving as a control group, retrieved from the radiology archive. Radiographs were taken using the parallel technique at 3, 6, and 12 months post-surgery. All images were digitized and saved in TIFF. Each image was aligned using the TurboReg plugin in ImageJ software. Regions of interest (ROIs) were selected from the mesial and distal aspects of the implants, then prepared for fractal analysis. FA was performed to assess changes in bone structure over time. <b>Results:</b> In the study group, radiographs of 24 patients for 0, 3 and 6 month, radiographs of 34 patients for 0, 6 and 12 month, radiographs of 8 patients for 0 and 12 month, radiographs of 5 patients for 0 and 3 month, radiographs of 5 patients for 0 and 6 month, and 1 patient of 0, 3, 6 and 12 month of radiographs were used in the study. There were no statistically significant differences in FA values over time when analyzed by gender and age in both the study and control groups. However, a statistically significant difference was observed in FA value changes over time and jaws. <b>Conclusions:</b> The study indicates a positive correlation between bone remodeling over time and FA results, likely due to the restoration of masticatory forces in the implant area. Image analysis on two-dimensional dental radiographs can be a useful tool for detecting changes in bone density. Fractal analysis is a cost-effective and practical diagnostic method for monitoring bone changes over time.