Objectives This controlled study aimed to evaluate the effects of Herbst therapy on the trabecular structure of the condyle and angulus mandible using fractal dimension analysis (FD-A) accompanied by skeletal cephalometric changes. Material and method The panoramic and cephalometric radiographs of 30 patients with skeletal Class II malocclusion treated with the Herbst appliance (C II-H group, mean age: 15.23 ± 1.08), 30 patients with skeletal Class II malocclusion that received fixed orthodontic treatment (C II-C group, mean age: 15.73 ± 1.38), and 30 patients with skeletal Class I malocclusion (C I-C group, mean age: 15.90 ± 1.30) were selected. FD-A was performed on the superoposterior region (C-SP) and centre of the condyles (C-C) and the mandibular angulus (Ang) on the panoramic radiographs taken at the pretreatment (T0), intermediate stage of treatment (T1), and posttreatment (T2) timepoints just like cephalometric analysis. Results Herbst therapy provided a statistically significant increase in SNB, ANS-Me, Na-Me, S-Go, Co-Gn and a decrease in ANB and overjet (P < 0.05). All skeletal changes remained stable during the fixed appliance treatment after Herbst. The FD values in C-C increased (P < 0.05), and C-SP values decreased (P < 0.05) during Herbst therapy, while after removal of the Herbst appliance, no significant change was observed despite an increase in C-SP. The Ang value did not change during Herbst treatment, but then increased significantly (P < 0.05). There was no significant change in the FD values of the C I-C and C II-C groups at any stage of treatment. The C-C and C-SP changes at T1–T0 period, C-SP and Ang changes at T2–T1 period, and C-C, C-SP, and Ang values at T2–T0 period were found higher in C II-H group compared with the C II-C group significantly (P < 0.05). Conclusion Herbst therapy changed the trabecular structure of the condyles in different directions at the superoposterior and central regions of the condyles, while the structural complexity of the angulus mandible, which did not change during the Herbst treatment, increased during the fixed orthodontic treatment after Herbst.

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Purpose: The aim of this study was to assess the impact of exposure parameters and image formats on fractal dimension (FD) values in periapical, panoramic, and CBCT images. Materials and methods: Seven dry male mandibles were selected, and a Gutta-Percha was used to identify identical regions of interest. A periapical radiograph was taken with 60 kVp/7 mA and exported in DICOM, JPEG, TIFF, and PNG formats. Nine periapical radiographs (60, 65, 70 kVp; 4, 5, 6 mA) were taken from seven dry human mandibles. Additionally, 12 panoramic radiographs (60, 70, 81, 90 kVp; 5, 8, 13 mA) and 10 CBCT images (with different scanning options and FOVs) were taken from each mandible. FDs were measured from a standard area. Results: The intra-class correlation coefficient demonstrated a high degree of agreement between observers. No significant difference was found between TIFF and PNG formats (p > 0.05). The highest FD mean was found in TIFF format, while the lowest FD mean was found in JPEG format (p<0.001). There was no significant difference between kVp and mA settings in periapical images. In panoramic images, a significant difference was found at 90 kVp (p = 0.001) and 13 mA (p<0.001), with lower FD values observed at these settings. There was no significant difference between FOV and resolution in CBCT images (p > 0.05). Conclusion: The format of the image can influence FD. For periapical and panoramic radiographs, kVp and mA settings do not have a significant impact on FD. However, fractal analysis may not be an ideal method for evaluating three-dimensional images, such as those obtained with CBCT.

Objective This study aimed to compare the trabecular internal structure of different regions of the mandible according to the grades of appositional classification in the mandible angle region in probable bruxist individuals and non‐bruxist G0(Convex course of the basal cortex, no directional change, no bone apposition) individuals by measuring fractal dimension (FD) on panoramic radiographs. Methods 200 sample jaws, bilaterally, of 80 probable bruxists and 20 non‐bruxist G0 individuals were included in the study. According to the classification in the literature, each mandible angle apposition severity was classified as G0‐G1‐G2‐G3. FD was calculated by selecting the region of interest (ROI) area of 7 regions from each sample. Gender differences in changes between ROIs in radiographs and independent samples t‐test were evaluated. Relation between categorical variables was determined by chi‐square test (p < .05). Results In the comparison of the probable bruxist and non‐bruxist G0 groups, FD was found to be statistically significantly higher in the mandible angle (p = 0.013) and cortical bone (p = 0.000) regions in the probable bruxist group than in the non‐bruxist G0 group. There is a statistically significant difference between probable bruxist G0 and non‐bruxist G0 grades in terms of FD averages in cortical bone (p < 0.001). A statistically significant difference was found in the relationship of ROIs with gender in canine apex (p = 0.021) and canine distal (p = 0.041) regions. Conclusion FD was found to be higher in the mandibular angle region and cortical bone in probable bruxist individuals than in non‐bruxist G0 individuals. Morphological changes seen in the mandible angulus region may be a finding that may raise suspicion for bruxism for clinicians.

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