The Role of Fractal Analysis in Evaluating Bone Structure in Pediatric Dentistry

Fractal analysis (FA) is an emerging quantitative method used to assess mandibular trabecular architecture in pediatric dentistry. While bone mineral density (BMD) measurements such as DEXA provide limited information about bone quality, fractal dimension (FD) analysis offers additional insight into microstructural complexity using routine dental radiographs.Current evidence shows that FD values reflect developmental, metabolic, and functional changes in children. Studies report preserved mandibular FD in Familial Mediterranean Fever and MIH, age-related increases in FD during normal growth, reduced FD in newly diagnosed celiac disease with improvement after a gluten-free diet, altered trabecular patterns in amelogenesis imperfecta, and region-specific FD increases in pediatric bruxism due to mechanical loading. Children with previous chemotherapy generally exhibit stable FD values.Overall, FA represents a non-invasive, accessible, and cost-effective adjunct for evaluating pediatric mandibular bone microarchitecture. Despite methodological limitations, standardized protocols and longitudinal research are needed to optimize its clinical utility.