Investigation of the effect of obesity on trabecular and cortical bone structure in the peri-implant region using fractal analysis and radiomorphometric indices

This study aimed to evaluate the effects of obesity on trabecular and cortical bone architecture in the peri-implant region by using fractal dimension (FD) analysis, together with panoramic morphometric indices. In this retrospective cross-sectional radiographic study, panoramic radiographs of 42 patients aged 40–70 years were evaluated. Two groups were formed: obese (n = 21) and non-obese (n = 21), each having dental implants placed in both the right (Ri) and left (Le) mandibular regions. A total of eight regions of interest (ROIs) were identified on the panoramic images, corresponding to peri-implant regions of interest (ROIol) located anterior and posterior to the mental foramen. FD and radiomorphometric index measurements were obtained for all designated regions. Measurements of the supracervical area above the Ri mandibular angle and the trabecular region distal to the mental foramen were significantly higher in the obese group compared with the non-obese group (p = 0.020 and p = 0.001, respectively). In addition, a strong negative correlation was observed between age and trabecular measurements in the left posterior peri-implant region of interest (LePoROIol) the obese group (r = -0.711, p = 0.004). In both groups, radiomorphometric indices (sPMI, iPMI, and MCW) demonstrated strong positive correlations with cortical measurements obtained from the symphysis, anterior, molar, and posterior regions. The absence of significant findings in the FD analysis of the peri-implant region suggests that obesity may not have a direct association with the trabecular and cortical bone structure immediately surrounding dental implants. However, the observed decrease in trabecular density in the Le mandibular region of the obese group with increasing age indicates that obesity, when combined with advancing age, may weaken trabecular architecture. Accordingly, these findings imply that obesity affects different bone regions in distinct ways, potentially influenced by local biomechanical loading patterns and the inherent characteristics of regional bone structure.