Individuals diagnosed with epilepsy: a fractal analysis and radiomorphometric evaluation

Epilepsy and the long-term administration of antiepileptic drugs (AEDs) are increasingly recognized as significant risk factors for metabolic bone disorders, including osteopenia and osteoporosis. While the systemic reduction in bone mineral density (BMD) is well-documented, the specific alterations in mandibular trabecular microarchitecture and cortical integrity remain less understood. Digital panoramic radiography provides a non-invasive modality to assess these osseous changes through quantitative image analysis. This study aimed to evaluate the effects of epilepsy and long-term AED therapy on mandibular bone microarchitecture and cortical morphology using quantitative fractal and radiomorphometric analyses performed on panoramic radiographs. A total of 150 digital panoramic radiographs were retrospectively examined, including 50 epilepsy patients under AED therapy, 50 non-medicated epilepsy patients, and 50 healthy controls. Standardized regions of interest (ROIs) were selected bilaterally from the mandibular notch, angulus, and interradicular areas between teeth 35–36 and 45–46. Fractal dimension (FD) values were calculated using the box-counting algorithm in ImageJ software. Radiomorphometric indices including mandibular cortical width (MCW), mental length (ML), and panoramic mandibular index (PMI) were also measured. Statistical analyses were performed using ANOVA with LSD post-hoc tests (p < 0.05). The mean FD values were significantly lower in both epilepsy groups compared with the control group (p < 0.001). The lowest FD values were observed among AED users across all ROIs, indicating reduced trabecular complexity and connectivity. Radiomorphometric analyses revealed significantly lower MCW values in epilepsy and AED groups than in controls (p < 0.001), while PMI did not differ significantly (p > 0.05). These findings suggest that chronic AED therapy and epilepsy itself contribute to cortical thinning and trabecular simplification in the mandible. Epilepsy and long-term AED use are associated with measurable deterioration of mandibular bone microarchitecture. These results highlight the clinical importance of monitoring oral bone health in epileptic patients to prevent potential complications such as tooth loss or implant failure. Integrating fractal analysis into routine dental screenings offers a practical, non-invasive approach for the early detection of systemic bone quality alterations.