Comparative Fractal Analysis on Orthopantomography Images of Bone Remodeling Changes at 3 Months Between Natural Socket Healing and Immediate Implant Placement

<b>Background:</b> Osseointegration is the main factor that ensures the long-term success of implant-prosthetic therapy, but besides this, there are other important factors, such as the quality of the alveolar bone and the time of placement of dental implants. The study aimed to analyze changes in the alveolar bone following tooth extraction, comparing natural healing with immediate implant placement, using fractal analysis on OPG images. <b>Methods:</b> This retrospective study included OPG images obtained before tooth extraction and 3 months after surgery in 91 patients who underwent maxillary and mandibular molar extractions and opted for either natural healing or immediate dental implant placement. Fractal analysis of OPG images was performed using Image J software, and the resulting measurements were subsequently statistically analyzed. <b>Results:</b> Most extractions were performed in the maxilla, and most were at the level of the first molar. The study group showed a faster healing process following immediate placement of dental implants, regardless of location, and a similar distribution of bone resorption and healing, with clear differences in location: the mandible had a faster healing process than the maxilla. <b>Conclusions:</b> Fractal analysis showed a better and quicker bone healing of the alveolar bone in immediate implant placement in molar areas compared with post-extraction natural healing, especially in the lower jaw.