Oral Radiology

, Volume 35, Issue 1, pp 23–28 | Cite as

Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study

  • Kemal Özgür Demiralp
  • Emine Şebnem Kurşun-Çakmak
  • Seval BayrakEmail author
  • Nihat Akbulut
  • Cemal Atakan
  • Kaan Orhan
Original Article



This study was performed to evaluate the trabecular pattern of patients with cancer taking bisphosphonates on panoramic images using fractal dimension (FD) analysis by comparison with healthy subjects and to assess whether any difference exists between regions.


FD analysis was conducted using ImageJ 1.3 software (National Institutes of Health, Bethesda, MD, USA) with the box-counting method on panoramic radiographs of 33 patients taking bisphosphonates (13 males and 20 females) and 33 healthy sex- and age-matched individuals.


FD values were higher (1.39 ± 0.14) in the study group than control group (1.38 ± 0.07) (p ≤ 0.05). No difference was detected in the FD values among the tested regions. The mean FD values in the control and study groups were as follows: region 1, 1.49 and 1.41 (p = 0.54); region 2, 1.36 and 1.37 (p = 0.84); region 3, 1.35 and 1.42 (p = 0.11); and region 4, 1.39 and 1.39 (p = 0.90), respectively. Female patients showed significantly lower values above the mandibular canal on the distal side of the second premolar and anterior to the mental foramen than did male patients (p ≤ 0.05). Age was unrelated to the FD in the study group (p ≥ 0.05).


The FD values of the patients with cancer taking bisphosphonates were higher than those of the controls. FD analysis showed the potential for examining bone structure in panoramic radiographs. Studies with a larger sample size are necessary to confirm these results.


Bisphosphonates Fractals Panoramic radiography 


Compliance with ethical standards

Conflict of interest

Kemal Özgür Demiralp, Emine Şebnem Kurşun-Çakmak, Seval Bayrak, Nihat Akbulut, Cemal Atakan, and Kaan Orhan declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was not needed in this study.


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Copyright information

© Japanese Society for Oral and Maxillofacial Radiology 2018

Authors and Affiliations

  • Kemal Özgür Demiralp
    • 1
  • Emine Şebnem Kurşun-Çakmak
    • 1
  • Seval Bayrak
    • 2
    Email author
  • Nihat Akbulut
    • 3
  • Cemal Atakan
    • 4
  • Kaan Orhan
    • 5
  1. 1.Türkiye Public Hospitals AgencyMinistry of HealthAnkaraTurkey
  2. 2.Dentomaxillofacial Radiology Department, Dentistry FacultyAbant İzzet Baysal UniversityBolu MerkezTurkey
  3. 3.Dentomaxillofacial Surgery Department, Dentistry Faculty, Gaziosmanpasa UniversityTasliciftlik yerleskesiTokat MerkezTurkey
  4. 4.Statistics Department, Faculty of SciencesAnkara UniversityYenimahalleTurkey
  5. 5.Dentomaxillofacial Radiology Department, Faculty of DentistryAnkara UniversityBesevlerTurkey

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