Impact of Type 2 Diabetes Mellitus on Periodontitis-Related Trabecular Bone Changes Assessed by Fractal Analysis: A Comparative Study

Background Conventional radiographic imaging often struggles to detect early bone issues, as in early periodontitis, since radiographically detectable changes usually don't appear until a significant amount of bone mineral has been lost. Periodontitis and type 2 diabetes mMellitus (T2DM) have a well-established bidirectional association. This study aimed to assess and compare the trabecular bone structure among healthy individuals, patients with periodontitis, and those with T2DM and concomitant periodontitis using fractal analysis (FA) of digital periapical radiographs. Materials and methods The study comprised a total of 120 participants, divided into three equal groups: 40 periodontally healthy individuals, 40 individuals diagnosed with Stage II/III periodontitis, and 40 individuals with T2DM and concurrent Stage II/III periodontitis. The fractal dimension (FD) of the trabecular bone was assessed in both the interdental space and apical region of the mandibular first molar using the box-counting method via ImageJ software. Results Statistical analysis revealed a significant difference in FD values of the interdental bone region of interest (ROI) across all three groups (P < 0.05). In contrast, the FD values of the apical ROI did not differ significantly among the groups (P > 0.05). Conclusion FD values showed a reduction in the proximal/interdental alveolar bone, with no significant changes in the apical region. Notable differences in FD values among healthy individuals, patients with periodontitis, and those with T2DM and periodontitis suggest an effect of glycemic status on variations in trabecular bone quality.