Assessment of Mandibular Trabecular Bone by Fractal Analysis on Digital Panoramic Radiograph in Patients with Inherited Bleeding Disorder

Abstract

Objective: The aim of this study was to assess mandibular trabecular bone health in patients with inherited bleeding disorders using fractal analysis (FA) on digital panoramic radiographs (DPR).

Methods: Thirty-five patients with hereditary bleeding disorders (hemophilia A or B, and von Willebrand disease (VWD)) and 35 healthy controls were included. Data were collected on factor levels, inhibitor status, bleeding history, factor replacement therapy, vitamin D use, and calcium supplementation. Using ImageJ software, FA was performed from the determined regions in the mandible via DPR: ROI-1 (condylar region), ROI-2 (mandibular angle) and ROI-3 (molar region). Each region was independently evaluated by a radiologist and a maxillofacial surgeon trained in FA.

Results: Of the patients, 23 (65%) had severe hemophilia, 3 (8%) had type III VWD, 5 (15%) had moderate hemophilia, and 4 (12%) had type I VWD. Interobserver agreement for FA measurements in the condyle, angle, and molar areas was almost perfect (Kw = 0.992-0.993). In these three regions, no statistically significant differences in mean FA values were found between patients and controls, regardless of age or gender (p > 0.05). However, four high-risk patients-one with severe hemophilia B with inhibitors, two with type III VWD, and one with severe hemophilia A on an on-demand regimen-displayed significantly lower mean FA values in the condylar region compared to controls (p < 0.05). These findings suggest that while most patients with inherited bleeding disorders may not show marked alterations in mandibular trabecular bone structure, some high-risk individuals could have compromised bone health detectable via FA.

Conclusion: This preliminary study indicates that FA may be a valuable tool for identifying at-risk patients with inherited bleeding disorders. Larger studies are needed to confirm these preliminary findings.

Keywords: fractal analysis; hemophilia; panoramic radiography; von Willebrand disease.