Analysis of the effects of metabolic syndrome and periodontitis on cortical-trabecular bone structure of the mandible and periodontal inflammation

To evaluate the effects of metabolic syndrome (MetS) and periodontitis on mandibular cortical and trabecular bone structure and their association with periodontal inflammatory burden, 80 individuals were allocated to four groups: systemically and periodontally healthy (MetS - P-, n = 20), periodontitis only (MetS - P+, n = 20), MetS only (MetS + P-, n = 20), and both conditions (MetS + P+, n = 20). Trabecular bone was assessed by fractal dimension (FD) analysis in three regions, while cortical morphology was evaluated on panoramic radiographs using radiomorphometric indices: symphysis index (SI), anterior index (AI), molar index (MI), panoramic mandibular index (PMI), and Klemetti index (KI). Periodontal inflamed surface area (PISA) and periodontal epithelial surface area (PESA) were calculated to quantify inflammatory load. Condyle and angulus FD values were higher in MetS groups (p < 0.05). AI and SI were highest in MetS + P+ and lowest in MetS - P- (p < 0.05). MI and PMI showed no intergroup differences (p > 0.05). KI distribution differed significantly, with more C1 in controls and more C2 in MetS + P+ (p < 0.05). PISA was greatest in MetS + P+ (p < 0.05). Positive correlations were observed between PESA and AI, and between PISA and both AI and SI (p < 0.05). Coexistence of MetS and periodontitis is associated with regional mandibular trabecular and cortical bone alterations and increases periodontal inflammatory burden, suggesting a combined effect of metabolic stress and periodontal inflammation on bone microarchitecture.